good let me just put this
little fancy thing and we
can start the show all
right welcome to
orthostatic a product uh a
service provided by the
academy of orthopedic
physical therapy I'll be
your host today my name is
jimmy mckay and with me uh
paul neal how do you
introduce yourself you say
orientation people are
always wanting more like george costanza
Because I usually just I'm
happy to say Paul Milchuk,
I'm a physical therapist
and I kind of just leave it at that.
And then, you know,
they always want to know
all these other things and
everything like that.
And I'm kind of like,
you can go to the website,
go to our faculty page.
You can kind of read all about that stuff,
you know, if you're interested in it.
So not not a big self promoter.
We got to promote a little bit.
We got to give context.
So you said you said faculty.
Where are you on faculty?
What do you get to do there?
I am on faculty at Stony Brook University.
I graduated from PT school
in 1995 from Stony Brook.
I started teaching in 2004.
I joined the faculty in 2010
and I actually did clinic
for a couple of years.
And now I basically teach in
the orthopedic track.
So that's kind of why I
think I'm here today.
Yes.
Orthopedic, you know, kinesiology,
orthopedics.
That's that's kind of my my
my area of interest.
Whenever someone asks, you know,
what's your area of expertize?
The only thing I'm
comfortable with saying I'm
an expert in is the Simpsons.
So when it comes to PT,
my area of specialty,
my area of interest is
orthopedics and sports medicine.
So- We'll do the Simpsons on
another episode today where
we'll talk about
orthopedics and
specifically something that
popped up and I didn't
really know a lot about
when I was going through PT
school until probably maybe
my second or third year,
people started sort of
whispering and murmuring
about this thing.
And it was this thing called
specialty exams and
specifically one had popped
up in conversation,
which was the orthopedic
clinical specialist exam.
Other people might call it the OCS exam.
So, you know, Paul,
how do you describe it when
students or clinicians
started talking about it?
What is the exam and maybe
who should consider taking it?
OK, so I was like you.
I really never heard about
specialization when I was in school.
I started to kind of hear about it.
And then I graduated and.
heard about it a little more,
and then I kind of looked into it,
and then I kind of went after it.
So in terms of the specialties,
kind of a more broader overview,
the American Board of
Physical Therapy
Specialties kind of runs
all these specialties,
and there are 10 of them,
and you can go to the
website and kind of see any
of the other ones.
But for the purposes of our discussion,
obviously,
we're talking about the orthopedic one.
So what it is, is
It's a way to kind of
recognize that you have a
deeper knowledge in a
specific area of physical therapy,
in this instance, orthopedics.
So basically, if you're interested in it,
you're interested in pursuing, again,
this specialization that
just demonstrates that you
have deeper knowledge and
that you have a deeper
skill set and that you
focus in this one area of
physical therapy.
Perfect.
So if someone's nodding along or saying,
yeah, you know,
going through school or
going through clinical practice,
orthopedics is really what
gets me excited.
And this might be a path I
want to take before I before I leap.
I do want to look right.
How do I determine if I'm
ready to sit for the OCS exam?
What are the things,
what are the prerequisites, you know,
officially or unofficially
that I might need to
consider before deciding to
take the OCS exam?
So, um,
first thing you need is you need
2000 hours of direct patient care hours,
um, in the specialty area.
So the way this is done,
if you go to the website,
they give you kind of a
nice Excel sheet that says, um,
basically a year is 50 weeks.
And if you're working full time,
that's 40 hours a week.
So if you do the math,
you're going to work 2000
hours in a year.
If you take two weeks vacation and then,
and then you break it up on, on, um,
after that.
So you'll say, all right,
this year I worked 2000 hours.
I spent 75% of those hours
in direct patient care
because we all have
paperwork and other things,
administrative issues that
we have to deal with.
So then you'll say, all right,
for that year,
whatever 75% of 2000 is
that's how many hours I
spent in direct patient care.
And then you'll say, all right,
out of those hours in direct patient care,
yeah,
a hundred percent of those were in
orthopedics.
So that's how many hours
that you would claim for that year.
So you just kind of go
through that little spreadsheet.
And once you get to 2000,
that's the first
requirement that you need
to sit for the exam and
then you need to provide
evidence that you have expert,
not expertise,
but that you have
experience in different
areas of orthopedic PT.
And this is something that's new, Jimmy,
as of 2026, as for the new exam,
we changed our,
some of our requirements
and these can be seen on the website.
But basically what we did
was we just went into body regions.
So we said, if you look at,
We broke them up like spine,
lower extremity, upper extremity.
And again,
there's a nice chart on the website.
So I'd encourage everyone to look at that.
But basically what we did was we said,
if you look at the spine,
we talk about obviously like TMJ,
we talk about cervical, thoracic, lumbar,
SI, you need 750 hours in that area.
And same thing.
If you look at upper quarter,
you need 500 hours, lower quarter,
you need 500 hours.
And the way it's broken up
is I just told you about
those five areas in the spine.
um you need to have a
minimum of 100 hours in
three of those five areas
so I know this is this is
kind of getting in the
weeds a little bit but um
again on the website
there's a nice chart that
breaks this up and
basically if you're someone
that's working in a general
orthopedic clinic and
you're just treating
general orthopedic patients
with back pain and neck
pain and shoulder pain and
knee pain and ankle pain
you're you're going to knock
off all these hours fairly
easily it's basically for
someone who may be a little
more specialized in in
clinics where maybe they
don't get to see a lot of
spine or extremities or
something like that and
there are ways that you can
attain those hours so you
can observe a certified
hand therapist and if you
observe them for 100 hours
treating the clinic they
sign off and then you've
you you've had hours in in
that subset so um that's
basically kind of the
second piece so it's the 2000 hours
And then it's kind of how
those 2000 hours are broken up.
And that's basically it.
That's basically the two
qualifications or the
requirements that I should say you need.
And in terms of if someone
is thinking like,
why should I do this or am
I ready for it?
Kind of two different questions.
I think why you should do it,
that's inherent up to you.
you know,
if you feel like you've been
working in this area,
you've been working in orthopedics,
it's your true love,
and you feel like that, you know,
you're going to courses and
you're reading articles and
you know more than just your average bear,
this is a way to identify that.
And this is a way to show the public that,
you know, I'm above average,
that I've attained this,
I possess this knowledge,
and I've proven that I have
this knowledge in this specialty area.
Yeah.
Any suggestion for what
someone who's considering this,
talking to someone who's
gone through the OCS might pop up?
Yeah, I think that's a very good idea.
There are resources that you
can use to study for it, obviously,
if you're interested in it.
The section puts out the current concepts,
which is an awesome, awesome, awesome.
I think even if you're not
thinking about it,
it's absolutely awesome for a clinic to
for clinic practices as well
so that's an excellent
resource for for gaining
knowledge um in terms of
when we look at these
specialty exams when you
look at the licensing exam
when we when we write
questions for the licensing
exam those are referenced
from textbooks because we
want to make sure students
have entry-level knowledge
this is beyond that so I
would encourage people if
you're if you're reviewing
for this exam you want to
get into the literature you
want to be looking at
journal articles to make
sure that you're up to date
on current practice
And we use articles that
people should have access to, JOSPT,
American Journal of Sports Medicine,
British Journal of Sports Medicine,
kind of the real kind of
common ones that are very
referenced in our literature.
So, again,
I think if you're thinking about it,
it's more inherent.
If you're kind of thinking
and if you're in the clinic
and you're thinking, you know,
I really I feel like I'm
good at what I do.
I feel like I strive to learn more.
And, you know,
I kind of want to be identified for that.
Then the OCS is for you.
Yeah,
and that's typically what the
profession of physical
therapy from where I've seen.
That's the type of person it
typically draws.
So if you're in orthopedics,
it feels like the next step.
So you mentioned body
regions in terms of
acquiring the hours to be
able to sit for the exam.
Let's go beyond that.
Now you're sitting and
you're preparing for the exam.
What are the key topic areas
and areas of focus that you
should be paying attention
to as you go through that study process?
Okay, so...
The exam breaks it down a
couple of different ways.
So when it comes to kind of
just knowledge areas,
we talk about anatomy, movement science,
pathology or that pathophysiology piece,
pain science,
and that's kind of a newer
one that we just added and
are adding items to the exam,
medical and surgical considerations,
and obviously orthopedic
physical therapy practice.
and critical inquiry,
so evidence-based practice.
So that's kind of the research piece.
So those are kind of the
areas that you want to think about.
And then when it comes to
the tasks that are involved
in those areas, it's kind of, I think,
what people would expect.
Examination, evaluation, diagnosis,
prognosis, interventions, and outcomes.
So you're kind of using
those tasks over those knowledge areas,
and then you're applying
those to the body regions.
Sure.
okay good uh now let's get
really specific for anybody
who is preparing for this
they want to make sure
whatever whatever time
they're investing for all
the the the blood sweat and
tears hopefully not as many
uh tears but all the effort
you're putting into it is
going in a good direction
in terms of study materials
I know when I was preparing
for the npte I didn't
decide which which resource
was better I bought a
couple of those yeah
But you mentioned one.
So in terms of study
materials and resources
that are most effective for
preparing for the OCS exam,
what are a couple you might suggest?
So, again,
I think Current Concepts is an
excellent product.
People that might be unfamiliar with it,
it's a series of monographs
published by the Academy of Orthopedics,
and it covers every body region.
So shoulder, elbow, wrist, hand.
lumbar spine, cervical spine,
thoracic spine, ribs,
everything in the lower extremity.
So it covers everything.
So maybe if you don't have
great experience in one of those areas,
this can really help you.
It's published every five
years and it's up to date.
So if you purchase it and
you use that as a resource,
you know that you're going
to be up to date on current
information in all those areas.
So that I think is an excellent,
excellent resource.
The clinical practice
guidelines are another one.
Those are, in my opinion, very well done.
And they reflect current
clinical practice.
Again,
the folks that put those together
review all the literature,
and then they make the best
evidence-based
recommendations about what
you should be doing with a
certain condition in terms
of these are the best
outcome measures you should be using.
These are the best interventions.
These are the best examination techniques.
So I think those two resources,
all the current concepts
and the clinical practice guidelines,
and the clinical practice
guidelines are free.
You can go to the JOSPT's website.
You don't have to be a
member and you have access to all,
I think there's 21 of them now.
And if you put those two
resources together,
that puts you in really,
really good shape.
in addition to your clinical practice.
And then, like I said,
as things come out in JOSPT
and these newer journals,
if you're keeping your eye on that,
you'll be in pretty good
shape for this exam.
Perfect.
And yeah,
Current Concepts in its fifth
edition right now,
they're already preparing
for the sixth edition.
That's available at orthopt.org,
as well as those CPGs,
all those different CPGs
available for free right now,
if you're a member or not.
All right,
so now let's get into even more
of the nitty gritty.
We're getting more and more specific.
How do I balance exam preparation?
Because I'm also, as you mentioned,
a lot of people currently
working in the clinic.
So how do I balance exam prep
with my current professional
and work responsibilities?
What's the suggestion or two?
So it's kind of similar to
what I tell students when
they're reviewing for the NPTE.
Pay attention to the content outline.
The content outline is the
blueprint for the exam.
So what I tell students, look at the NPTE.
If there are going to be
three to five research
questions on a 200 plus question exam,
you probably don't need to
spend two weeks studying
that area because that's
not going to be time well spent.
If there's going to be close
to 50 musculoskeletal
questions on that exam,
you probably want to spend
a decent amount of time on that.
I think this is no different.
When you look at the body regions,
we don't have the same
amount of items per body region.
So lumbar spine is about 20% of this exam.
Shoulders about 15% of this exam.
So I think you want to pay
attention to that.
And if you have limited time,
which we all do,
You want to make sure that
you're going to spend a
decent chunk of that time
on the lumbar spine,
because that's going to be
a good 40 questions or so on this exam.
TMJ is about 3%.
So you're talking six questions.
So, you know,
maybe you don't spend three
weeks on that.
So I think that helps you
balance it out because you say, all right,
I have work, I have family,
I have some other things.
So this is how much time I
have to study for this exam.
And then once you get into that,
you want to look at the
areas that are going to be
most represented on the
exam and make sure that you
kind of dedicate time to that.
Yeah.
That's a that's a good
suggestion to mimic your
study patterns to the actual exam.
And a lot of these exams, you know,
I was surprised.
But when you look into them,
they are very transparent
in terms of percentages and
proportions of different
regions and different types
of questions on there.
So use those use those those
given resources.
And I can tell you that.
I mean,
we those are not suggestions and
it's the same for NPT and
for this exam as well.
When we say 20% of lumbar spine,
we're not gonna have a
hundred questions on the lumbar spine.
We're not gonna have two
questions on the lumbar spine.
When PSI,
the company that puts the exam together,
they stick to this blueprint really,
really close.
So those numbers are really,
really accurate.
So I can't emphasize enough
that you kind of wanna have
that handy when you're studying,
because it does help you, I think,
apportion your time correctly.
Yeah,
prepare for the test that you're
taking and understand that
that is the test that
you're actually taking.
Absolutely.
Perfect.
All right, so some common challenges.
There are some things that
come up frequently.
What do people run into in
terms of pitfalls in the
exam preparation or while
they're taking it?
And then the million-dollar question,
what are some suggestions
to avoid those things?
All right, so some pitfalls.
You mentioned it before.
I think you need multiple
resources to study for this exam.
How many is up to you?
So if you're someone that
can really assimilate and absorb stuff,
maybe you're going to get
current practice.
You're going to get all the CPGs.
Maybe you're going to take
an online course.
There are online courses
that are available.
I know a couple of
colleagues that have taken
them and spoke very highly of them.
It's not my job to advertise
for them or anything like that,
but they're very well known.
And I've looked at some of
that material and I think
it does a nice job.
So you might be someone that
can have like four or five
different resources and you
can get through all of them.
And that's wonderful.
You might be someone that
can't quite do that.
So maybe, you know, you mentioned too,
maybe you're just going to say,
you know what,
let me get through current concepts.
Let me get through the CPGs.
and maybe let me see where I
am after that it kind of
you have to be very
reflective and say how much
how much time does it take
me to get through x amount
of material and that's
different for all of us and
then like I said how much
can you assimilate um there
are some people that when
they take continuing
education courses you know
they may say I'm going to
take mckenzie courses and
they just need to stick to
the mckenzie piece because
if they start taking some
other theories they get
confused and there's
nothing wrong with that we
all learn differently so
I think a common pitfall is
trying to have too many
resources and then trying
to get through all of them
and then not getting through any of them.
And then you're kind of not prepared.
And that probably also we
spent a lot of money.
So I think that's number one.
I think another common
pitfall is don't just rely
on your clinical experience.
There are conditions out
there that can be asked on
this exam that maybe you haven't seen.
And it's not because they're super,
super rare,
but maybe it's just the clinic
you're working at.
Those patients go to another
facility or whatever the case might be.
So don't just say,
I'm just going to base it
on the patients I'm treating.
I think that's a very common
mistake as well.
No different than when a
student's studying for the
licensing exam and they
just think about the
patient who had Parkinson's
disease in the clinic
versus what the global
presentation of it is.
make sure you're not doing
that your clinical
experience is wonderful
it's why you're sitting for
this exam but it's not the
be-all end-all you know
every everyone that's
taking the exam those of us
that write the exam aren't
in the clinic with you and
we don't get to see your
patients so so make sure
you don't just pigeonhole
yourself to that so I think
it's it's those are
probably the the two main
pitfalls um that people
kind of tend to fall into
Yeah.
So know thyself,
understand what's great for you,
and don't fall into this pitfall,
which I did when I was
studying for the MPTE,
which was watching what
everybody else was doing and saying, well,
if they're doing it,
I must be doing that.
And that's, of course, not true.
That's the worst thing you can do,
I think.
One of the worst things you can do.
Right.
And then also, you know,
to summarize your last suggestion,
which is understand that
what your clinical experience is,
it might be vast, but it's not the entire,
it's not necessarily the
entire big picture.
So make sure you understand that as well,
because that's what's being tested.
Correct.
Perfect.
We're going to share all the
resources that you had mentioned.
We'll put the links in the
show notes and the
description of the video so
people can check off.
The last thing we do on the show,
Paul Neal, we call it Words of Wisdom.
Wow.
You work with students.
If someone was about to
embark upon the OCS,
what's something you might
share with them in terms of
Words of Wisdom?
Time management.
You know, again,
and I would say what you said,
you need to be self-reflective.
If you know it takes you a
long time to get through material,
there's nothing wrong with that.
But this process starts in
May when the application process opens,
and then you'll find out
sometime in the fall when you take it.
So you probably have a good
five to six months to study
for this exam.
And some people need to use
every second of that time.
So you have to know yourself
and know how much
how much time it takes you
to get through material and
then plan accordingly.
Because if you don't, you may say,
I'm going to get through
the lumbar spine in a week.
And then all of a sudden a
week happens and you only
got through half of it.
Now you start freaking out.
I'm like, oh my goodness,
how am I going to get
through everything else?
I'm never going to be able
to study for this.
And we just start kind of
catastrophizing and going
down that slippery slope.
So you need to know yourself.
And again,
if it takes you a little longer
to get through material, that's fine.
You just plan for it accordingly.
And like with anything in life,
time management.
And if you know that about yourself,
you know, you studied for exams before,
you know,
kind of how you get through things.
Just plan your time accordingly.
And, you know,
I think you'll I think
you'll be in good shape.
And another piece, something you said,
just because everyone else
is doing it doesn't make it right.
If you if you're good with group study,
you know,
maybe there's a couple of other
people in your area that are that or that,
you know,
maybe across the country and you
want to zoom with that are
that are also going to take the exam.
Yeah,
maybe you can study with two or three
people and that that works for you.
For some people that doesn't work.
So again, you need to kind of know that.
It's not helpful if you're
sitting in a group and just
listening to people say
things and you're kind of
agreeing with them and saying,
I knew that, I knew that,
I knew that because they're
not gonna be sitting with
you when you take the exam.
So you just have to be
careful about that group
study piece because that
can give you a full sense of security.
Good wisdom.
Paul Neal,
all the way from Stony Brook
University on Long Island.
Thanks for a little insight
into mastering that OCS exam.
Thanks so much.
Thank you so much, Jimmy.
My pleasure.