Transforming Physical Therapy Residencies: An Integrated Model Innovative Partnerships
To describe a unique residency model that blends traditional residency didactic curricula with a distance model incorporating multiple clinical sites across five states in order to reach clinicians who would otherwise be unable to participate in residency training.
Methods and/or Description of Project
A preliminary marketing analysis indicated that the southeastern United States was greatly in need of additional neurologic residency locations to accommodate the growing needs for post-professional specialty education in physical therapy. In a survey of 152 current PTs and DPT students, 61% of current PTs and 79% of students were either interested or very interested in pursuing residency education, with 1/3 of responders specifically interested in neurologic residencies. At the time of this survey, there were only four neurologic clinical specialists (NCS) in the state of SC, so the need was clearly identified. However, 94% of responders were fearful of residency costs, and over half were apprehensive of relocating for a one-year residency experience (without the guarantee of resulting employment). Our goal was developed to provide residency education and develop neurologic clinical specialists specifically from those who might not otherwise pursue residency education.
MUSC does not currently have inpatient rehabilitation as part of the spectrum of services provided on campus, so the original model sought to develop multiple clinical partners throughout a 7-state area in the Southeast. However, most physical therapy departments within rehabilitation centers could not manage the residency tuition estimates ($8000-$10,000) as part of their internal continuing education budget. These conversations ultimately led to marketing the program to HealthSouth, a national rehabilitation provider with more than 110 individual facilities, as a partnership opportunity rather than an individual continuing education opportunity. As a result, HealthSouth promoted the residency program within its east coast regions, and the first applicants were accepted from 4 facilities to start in January, 2014. HealthSouth agreed to cover all tuition and NCS examination costs for participating residents, and an integrated curriculum was developed minimizing the necessary resident travel to the directing institution (addressing the 2 largest reported fears).
The curriculum model was developed to maximize face to face opportunities with residency faculty by taking advantage of distance learning technology. The resultant model requires residents to come to Charleston four times during the program for focused, diagnostic specific weekends in which didactic content is mixed with live patient interactions. Residency faculty in turn go to each facility 3 times per year to observe patient care, mentor-resident interactions, and evaluate for benchmarks and competencies. The remainder of the didactic material is covered through a series of virtual classroom experiences, conducted through several software programs, including Adobe Connect, Tegrity, and Moodle. While there are several software options, these programs were chosen because of the ability to share documents and videos behind a user id and password protected firewall. These online sessions cover a variety of topics and include assignment discussions, journal clubs, and patient case presentations/discussions with videos of current patients. Live lectures are limited as much as possible, and content in lecture format is pre-recorded and made available via electronic media. The curriculum is continually amended based on quarterly assessments and year-end evaluations competed by the residents and mentors.
While much time and energy has gone into optimizing the curriculum and resident-faculty interactions, the largest challenge with a decentralized model has involved the translation of didactic knowledge into relevant clinical experiences. As often as possible, assignments are designed to build on clinical practice and force the residents to apply newly developed information. In addition, the residency has developed a more structured mentor training program, complete with a detailed orientation workshop, monthly online meetings, and a formal “lead mentor”. In addition, all mentors are required to complete the APTA online course “Successful Mentoring for Residency and Fellowship Education”. As with all residencies, mentors spend at least 150 hours in one-on-one mentoring with the residents, focusing on improving clinical decision making and applying frameworks developed through the residency.
The learning process is always ongoing; for residents, mentors, and faculty alike. This aspect of continual self-assessment and refinement may be the most essential aspect of the residency development, particularly in a de-centralized model with multiple clinical partners. In addition, up-front communication of expectations of the resident, mentor, and clinical site is critical. For example, the evaluation process now does not only include the prospective resident’s application, but also an application for the mentor as well as the facility. It is not enough for a facility to desire residency partnership, but it must also demonstrate the ability to work with the resident and mentor to establish necessary time, patient coverage, and patient assignment to maximize the benefits of this model and the partnership.
The residency is now in its third year with 13 therapists either graduated or currently enrolled, and 8 facility partnerships have been developed within 5 different states. In the first year of the neuro residency, 2014, four residents were enrolled and completed the program. In addition, one of the resident’s mentors completed all residency requirements. All five individuals sat for the NCS, with a pass rate of 80%. In 2015, four residents were enrolled and graduated, and, again, one of the mentors completed all residency requirements. All five individuals sat for the NCS exam and are awaiting results in June. Currently, 5 residents are enrolled, and three of the five mentoring clinicians are graduates of the program.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Physical Therapy residency programs strive to meet the need for more specialized and systematic clinicians, providing a platform to expedite clinical skills progression. Many therapists interested in pursuing the residency learning experience are excluded from participation due to a number of factors including location of programs, availability, economic factors, etc. Current accessibility to the 33 accredited neurological residency programs is extremely limited, and in most cases restricted by the parameters of the institution directing the residency program. We have developed a unique residency model that blends traditional didactic curricula with an innovative distance learning model, incorporating multiple clinical sites across five states in order to reach clinicians who would otherwise be unable to participate in residency training. Although DPT programs strive to offer clinical based learning opportunities, less than 36 weeks of the average curriculum is spent in the direct patient care environment, where the quality of mentorship is highly variable. As insurance provider reimbursement increasingly limits patients’ access to care, the efficiency of delineating disease specific impairments and systematically deriving patient focused intervention is paramount. This level of expertise has become the expectation within the physical therapy profession, recognized as leaders in optimizing human movement, and is especially important in the treatment of patients with neurological injury. In an ever evolving healthcare system, highly specialized patient care has become more important than ever before.
Furze JA, Tichenor CJ, Fisher BE, Jensen GM, Rapport MJ. Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future. Phys Ther. 2015 Dec 17. [Epub ahead of print]
At the end of the course learners will:
1. Use strategies provided to help design class activities using a webinar platform that integrates the classroom to the clinical residency.
2. Be able to differentiate between material that can be delivered through an online format and material that is better delivered face to face
3. Critique the pros and cons of the integrated residency model discussed
4. Create an educational outline to imbed curriculum into residency that directly translates the evidence from the classroom to the clinic.
1. Interactive lecture
2. Break out work sessions
3. Audience presentations
20 min - Present the Medical University of South Carolina (MUSC) Physical Therapy Residency model
20 min - Discuss curricular design focused on translating the classroom to the clinical residency
15 min - break-out sessions to brain storm ideas
15 min - Audience presentations
20 min - Wrap up and questions