A Physical Therapy Residency isn’t the Same as PT School

By Dave Cavagnino, PT, DPT

Geriatric Clinical Resident

Late nights cramming. High-stakes testing. Carefully navigating practicals with built-in pass/fail landmines. It’s the only way to learn how to be a great physical therapist, right?

If your higher education experiences were like mine, then that’s where your mind might go when considering whether a residency would be a good choice for you. Thankfully, the reality can be very different. My experience six months into the FOX Geriatric Physical Therapy Residency has shown me the value of merging the business and academic sides of PT, which are so often held apart. From the Residency’s emphasis on leadership and advocacy to its focus on quality assurance, giving presentations to professional audiences, and even dabbling in teaching physical therapy students, I’ve been exposed to sides of the profession that I hadn’t previously.

Becoming a Specialist is a Different Process than Passing Your Clinicals

The biggest difference between PT school and the Residency has been in the mentorship. Instead of one clinical instructor (CI), with whom I spent all of my time, I have two official mentors, plus site visits with members of the Residency leadership team. We spend two or three days a month together and follow up on the phone afterward to discuss how our sessions have resulted in specific improvements to patient care. Instead of focusing on becoming competent, as we did in school, we’re focusing on becoming more efficient and more effective.

Don’t get me wrong, I had great clinical experiences in PT school. I had supportive CIs who helped me achieve that coveted “Entry Level” status that opened the doors for graduation and beyond. However, having worked for FOX for more than a year before joining the Residency, I brought more to the table than back when my name tag ended with “SPT.” So, during my first Residency mentoring sessions, I wasn’t sure what to expect. Would I be asked to demonstrate certain skills? Would I be corrected in front of my patients? Would I be pulled aside and asked for my resignation? Okay, that last one was a little extreme, but sometimes fresh PT imposter syndrome got the best of me.

It’s About Refining Your Style, not Adopting Someone Else’s

The reality was both refreshing and intimidating: I was treated like a peer. Of course, my mentors are both Geriatric Clinical Specialists (GCS) with their own areas of expertise with their own styles of interacting with patients and structuring treatment sessions, so there is plenty to learn. However, it quickly became apparent that they weren’t trying to mold me into their image. Instead, I was questioned. A lot. “Why did you use that test?” “Why did you set that goal?” “Do you think that’s a realistic outcome?” “Was that education session really adequate for the patient?” “What’s your discharge plan?” And the list goes on.

Gone are the days of memorizing and regurgitating facts. And the days of getting patted on the back for tying treatment to an outcome measure. The objective is no longer “entry-level,” it’s proficiency and leadership. I’ve had to adjust to being able to explain my rationale for each decision made during an evaluation or session. I’ve been challenged to arrive at conclusions more quickly. I’ve also been challenged to integrate my evaluation and treatment skills, to create a fluid experience for the patient while gathering more information with fewer questions and measurements. It isn’t always easy, but my practice has grown beyond where I would have been able to reach by myself in such a short time.

The experience of having my thought processes and decision making laid bare was uncomfortable at first, and while my explanations weren’t always perfect, I was never asked to hand in my resignation. Since these mentoring sessions have a week or two in-between, I have been able to reflect, recalibrate, and strengthen my approach each time.

The Residency Teaches the Power of Specificity in Evaluation, Goals, and Treatment

The entry-level clinician may approach treatment of an older adult like this: “The patient was referred after a fall. I’m going to document their fall risk, use a functional outcome measure to back up my assertion, and implement a general set of balance exercises that research says reduces fall risk.” Of course, with time, this approach becomes more refined and skilled.

However, it wasn’t until the Residency that I have been able to say “Okay, you’re falling? Let’s find a pattern to these falls and make corrections. Let’s distinguish whether you may have an underlying vestibular, vision, or sensory issue contributing to the problem. Let’s really hone in on whether you have issues with static, dynamic, or ambulatory balance, and let’s tie that to the functional task you want to accomplish safely. Let’s trust your subjective interview and my movement observations more, and do (gasp) fewer, better functional outcome measures. Let’s write fewer, better goals.”

Are you a Good Fit for the FOX Geriatric PT Residency?

What I’ve accomplished to date has not been to learn the secrets of the universe, or cram new fact after the new fact into my already-full brain. I’ve been asked to change my mindset. And that is what I’ve found the most surprising.

The FOX Geriatric Residency is designed to take residents from the procedural and mechanical “novice” phase to an expert who can be responsive, listen actively, and build treatment around the patient in front of them. With an added emphasis on teamwork and peer leadership. This can be a frustrating experience for someone who is used to being given the material and regurgitating. But just like we tell our patients, we have to push ourselves and feel uncomfortable to stimulate improvement. Seeing the results has been extremely satisfying. Halfway through the Residency, I’m glad that I didn’t let myself become too intimidated to apply. I’ve already grown as a clinician and a clinical leader, and I’m looking forward to seeing what the final half of the Residency brings.

So I’ll say this: if you are willing and able to put in the extra work, you’ll come out more flexible, pragmatic, and focused. You’ll be more confident and able to finally say goodbye to that pesky imposter syndrome. You’ll even start to see that your peers are coming to you for advice more often. You’ll put your clinical growth into overdrive, and most importantly, your patients will get the highest quality care.