Postprofessional Cartography in Physical Therapy: Charting a Pathway for Residency and Fellowship Training

Abstract

Remarkably little is known about what constitutes a good residency or fellowship training program. In contrast to entry-level programs, the job of residency and fellowship educators is sometimes more subtle and difficult to articulate. Developing advanced clinical reasoning, communication skills, use of evidence, and patient-management approaches beyond entry-level competencies for students of various levels of education and backgrounds creates unique and diverse teaching challenges. There is no gold standard and precious little evidence to guide us on how best to sequence and pace residency/fellowship curricula, integrate mentoring into didactic and clinical coursework, conduct examinations, and measure the impact of training on patient care. To this end, we'd like to congratulate Drs Rodeghero, Wang, Flynn, Cleland, Wainner, and Whitman on their paper, “The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients With Musculoskeletal Conditions.” This is a significant first step in the effort to explore that most important challenge of any health profession's educational initiatives: did training result in improved patient outcomes?

Perceptions of the professional and personal impact of hybrid fellowship training: a qualitative study

“…This study aimed to expand and provide a deeper picture of the impact of fellowship training at a personal and professional level using qualitative methods, a need identified by Robertson and Tichenor [3,5]. The results above support the previously noted programmatic evaluation survey findings that graduates of the hybrid model are impacted by training with strong personal and professional benefits [9].…”

“…Regardless of design, fellowship is a rigorous process and noteworthy educational achievement, with many anecdotes of professional enhancement and reward upon completion of the process, but also associated with anecdotal reports of high levels of stress. Along with the relatively recent history of advanced fellowship program development [5], the intensity and time commitments are possible reasons for the low proportion of physical therapists completing fellowship training. In the United States, there are approximately 225,420 physical therapists, with nearly 53% self-described as an outpatient practitioner [6].…”

Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

“…Clinical reasoning, the ability to weigh evidence with the specifics of a patient case and clinical experiences, is a critical skill at all levels of professional and postprofessional education. [5][6][7] However, as an athletic trainer progresses from being a competent clinician, the goal of professional education, to a clinical specialist, clinical reasoning skills should advance and residency graduates should demonstrate higher levels of clinical reasoning associated with a provider ready for advanced practice. 4 Literature describes a combination of 2 primary models, analytical and nonanalytical reasoning, as the most effective means of reasoning during clinical evaluation.…”

“…4 Even though neither the AT Milestones Project nor the Commission on Accreditation of Athletic Training Education (CAATE) has identified clinical reasoning specifically as a measurable component of clinical education, the skill of clinical reasoning is a foundational competency for the implementation of evidence-based care and is highlighted as such in a multitude of postprofessional health care residency programs and fellowships. [5][6][7] Unfortunately, the current literature regarding the development and assessment of clinical reasoning in athletic training education is scarce, particularly pertaining to advanced clinical reasoning developed through residency programs.…”

Attributes, Attitudes, and Motivations of Personnel Involved with Sports Physical Therapy Residency Training

“…The content of the specialty expertise is captured by the description of residency practice and governed by the American Board of Residency and Fellowship Education. [1][2][3][4][5][6][7] As of January of 2021 there were 58 accredited sports physical therapy residency programs with an additional 14 programs in a developmental or candidacy status. 8 Additionally, there are nine fellowship training programs relevant to the practice of sports physical therapy (performing arts, upper extremity athlete, and D1 athlete) and three more fellowship programs in the development stage.…”