beginner.
Here's the intro graphic.
Check this thing out.
Michael Gross here with the
Academy of Orthopedic Physical Therapy.
Michael,
thanks very much for coming on
Orthostatic and recording this with us.
My pleasure.
uh people often nervous
before we hit record we
talked about knowledge
being power and people in
that uh that inquisitive
points before deciding to
do a residency should I do
it where should I do it why
am I doing it in the first
place they get a lot of
these questions from
colleagues from friends and
family so the goal really
is you've got these seven
things you need to check
before we apply for that PT residency,
or a checklist, I should say.
We see these lists in
supermarket checkout counters.
The seven things you should
do to get that beach body, right?
So we're gonna throw the beach body out.
We're gonna look at the
things that you need to
check before applying for
that PT residency program, all right?
So why don't I, we'll kick it off.
The first thing that you
think on the list is,
You got to do your due diligence,
accreditation and credentials.
That's got to be off the
that's off the bat.
That's the very first thing
you've got to do, according to you.
Why is that?
I mean, it seems obvious, but.
Well, you know, so it's a big decision,
number one,
because they if they're a new graduate.
They could go out and get a
great job with a full salary.
So they're thinking of,
they're possibly thinking
of doing a residency where
they're not gonna get a full salary.
They've had to go through an
undergraduate program, right?
And they may have taken out
loans for that.
They've gone to physical therapy school.
If they've taken out loans for that,
they may have a huge
financial debt on their hands.
So to be prepared
academically at this point
as a new graduate to go out
and make a full salary,
and now they're thinking of
not getting a full salary
because they want some further education.
Now that's a big decision.
So really a self-assessment
sounds like it's first, which is,
do you understand the
physics of this game and what,
what you're doing,
what it's going to entail,
what it's going to cost in terms of money,
time, effort, things like that.
So really it sounds like it
starts with the person, the self.
Yeah.
They may not realize that
they're not going to make a
full salary when they do a residency.
You know,
a lot of times it's like two
thirds salary or, or something like that.
You don't want sticker shock that way.
No, no.
So then, you know,
if they're going to go if
they're going to make that sacrifice,
that financial sacrifice, and they're,
you know, they're, they haven't,
they haven't just felt like, okay,
I cannot go to school anymore.
Right?
They're gonna,
they're gonna punish
themselves with some more education.
They want to know that the
program is accredited
because for most of them,
the end goal is to sit for
the orthopedic
certification specialty exam.
And they need to go through a, well,
one of the routes to enable that,
it's not the only route,
is to have completed an
accredited orthopedic residency program.
They want to know that it's accredited.
Sure.
And how can they do that?
I know they can ask, right?
They can ask the program,
but a lot of times they'll have that.
That's one of the things
that a program will have on
its website in the materials, correct?
They'll have it.
And then if they want to
know there's truth in advertising,
they can go to the APTA
website and see who are the
accredited orthopedic residency programs.
All right.
So that's off the bat.
Number one,
accreditation and credentials
of the program.
You want to understand it's
fully accredited.
Recognize so that you don't
get to the end and realize that...
you hitched your wagon to
the wrong program because
it wasn't accredited.
So understanding what you're
getting into and
understanding who you're
getting into it with is number one.
Next on your list is faculty
and mentor profiles.
Why is that important?
Okay.
Well,
some of the orthopedic residencies
have a relatively small faculty.
It might be a clinic-based program,
and you may have...
one, two, three mentors through that?
What are their qualifications?
What are their experience?
What are you going to gain
out of interacting with
those individuals?
Or is it a relative?
Are the the cadre of mentors?
Is it relatively large?
And to those?
How much experience do those people have?
Are they nationally
recognized internationally
recognized as having
expertise in their areas?
So what you know who are
going to be your mentors?
Are you looking?
Perhaps you feel strong as as an entering
Perhaps you feel strong as
in certain areas,
but you're really looking
for advanced expertise in certain areas.
Are you going to get that?
Are the mentors there that
are going to provide that for you?
This makes me think of
Sesame Street in that song, which says,
who are the people in your neighborhood?
Make sure you understand who
are the people in your neighborhood.
These also feel like just really,
I feel like if a potential
applicant were asking these
questions during an
interview or even before that,
it sort of makes you stand
out a little bit because
you're asking the right questions.
What makes them stand out?
Because we interview
applicants for the residency program.
And so if that's part of the process,
what makes them stand out
is have they done their homework?
Have they gone to the website?
Have they investigated?
Who are the mentors going to be?
And what expertise, what experience,
what kind of reputation do
these folks have?
Have they published in their
areas of expertise?
Go ahead and look at some of
their publications.
Yeah,
that always impressed me when we've
interviewed folks who want
to enter our residency program.
Have they done their homework about,
you know,
what their goals are and do
their goals match our goals
for who we want our
residents to be when they
finish the program?
So we've talked about the self-assessment,
understanding this.
We talk about the program as
a whole and their credentials,
the people involved, the mentors,
the people that will
actually be instructing.
Next up on the list is a
natural fit in terms of time progression.
Alumni and the network who
has gone through this
program is a good thing to look into too.
I don't know if I would have
thought of that,
but that's a good thing on your list.
Yeah.
We try to have the
applicants have available
to them conversations with current,
not just the alumni,
but current residents and
what is the experience like,
and also have access to alumni
of the residency program.
What did you like about it?
What didn't you like?
I'm looking for this in the program.
Do you think I'm going to
get that from being in the program?
Yeah.
Good questions to ask and a
good audience to ask
because a lot of times
you're going to get a real honest answer.
You're going to get a
different answer than if you ask,
I'm imagining,
than if you ask someone from the program.
You're going to get
different perspectives.
And that's what you're looking for.
You're going to kick the tires on this.
Sure.
We'd like to say to the applicant,
don't trust us.
You know,
maybe we think we're better than
we actually are.
Talk to people.
who have gone, who are in the program,
talk to people who've gone
through the program.
What do they see as the strengths?
What do they see as the weaknesses?
So if you're thinking of
being a resident and access
to those individuals is not
offered to you upfront,
then you should ask, you should say,
is there any way that I
could talk to current
residents and some of the
residents who have
graduated from the program?
And if in response to that request,
No, no.
It's a red flag.
You don't want to go there.
What are you hiding?
What are you not showing?
Well,
we are really in an age of upfront
social proof, right?
I mean, as we record today,
it is Amazon Prime Day.
While we buy things online
or we decide what restaurant to eat at,
we are, whether we like it or not,
looking at what our fellow
humans are thinking or
saying about these things
before we make that
commitment to buy or go somewhere.
And I think this is...
It's a pretty large commitment, time,
effort, energy, as well as money.
So asking those things is a good thing.
Yeah.
All right.
After alumni success in the network,
now we get on something a
little bit more specific,
but not to be overlooked.
Again,
you don't want to get into a program
and realize that, well,
this isn't actually what
they're focused on.
So your next on your list is
ask about or look into the
program focus and specializations.
Okay, so, you know,
an orthopedic residency program should,
should entail the
acquisition of advanced
knowledge across the
spectrum of orthopedic physical therapy.
It shouldn't be, hey,
we're specializing in dry
needling or whatever, right?
It should cover the gamut of
orthopedic physical therapy.
So having said that, again,
the applicant may be
interested in some really specific thing.
Oh, I want to get good at this.
So they might be interested
in addition to being
prepared as an advanced
generalist in physical therapy.
I'm going to have as one of my mentors,
somebody who's really good
in whatever it is that I'm interested in.
So there's that,
but then there are
additional things that
might be involved in the
orthopedic residency.
Is there an opportunity to
get involved in a little bit of research?
Okay, is that something that's there?
It can't be a great amount
because you just don't have
the time for that, but a little bit,
yeah.
Is there an opportunity to
be a clinical instructor
be a clinical mentor now we
offer that at our program
we have physical therapy
students in our doctor
physical therapy program
who come and spend time in
our clinics and we mentor
them for like sixty hours
so our residents get to
function in the role of a
clinical instructor and a
lot of them are looking for
they haven't had that
opportunity and they're looking for
Is the applicant looking for
the opportunity to do some
classroom teaching in an
academic program?
Well,
if you're going to a residency
program that's clinically based,
you're not gonna get that.
But if you're gonna engage
in a orthopedic residency
program that is either
fully academically based or
partially academically clinically based,
then those opportunities may
exist to go in and do some
face-to-face classroom
teaching with your clinical
mentors and your academic
mentors in the room,
giving you feedback on how
well you are engaging the
students in clinical instruction.
And a lot of
A lot of people who are
looking at orthopedic
residency programs have in
mind that in the end,
as part of their professional development,
they would like to be
involved in face-to-face
teaching in an academic program.
And most all of our students
take advantage of that opportunity.
Most all of our residents
take advantage of that opportunity.
It sounds like it just comes
back to that self-assessment.
What are you looking for?
There are a lot of differences,
but there's a lot of
similarities and crossover,
but it sounds like there's
a lot of differences.
And if you're looking for
something and it's not available there,
that's a missed opportunity.
If you didn't know that that
wasn't available in a particular program.
I would say, you know,
one more thing that we
offer to our residencies is
we have a pro bono clinic
where we provide free services to,
to folks who don't have insurance.
Um,
And our faculty,
our mentors for our
physical therapy students
who are engaged in that,
we have the oldest
student-run pro bono clinic
in the United States at the
University of North Carolina.
And we have physical therapy
offered at that clinic, medicine,
so medical students are there,
pharmacy is there,
and a few other disciplines.
And the students run the clinic,
and our faculty are there
to provide mentorship.
So that's another thing that
has attracted some of our
applicants to our residency program.
Again,
what you've said about what are you
looking for?
And maybe they're not looking for that,
but when they hear that's available,
they go, oh,
I'd like to become involved in that.
I've heard that there are
three L's in real estate.
It's location, location, location.
But Michael,
you say the next thing on your
list is two L's.
It's location and lifestyle.
So it's where you are, but really,
what is that place in the country?
Because you're going to be
spending a significant
amount of time there,
depending on the program.
You should understand not
only what you're getting into,
but where you're getting into.
Location and lifestyle.
Sure.
Just to be clear and to be
straightforward here,
I had two lists of seven
questions that were sent to me.
Oh.
And it was a forced choice.
I had to pick, well,
which list would you like
to address in this opportunity?
All right.
So the next item on the list
that I selected, right,
was location and lifestyle.
So, so yeah, it's like,
I've always wanted to live in that area.
Okay, there's a residency available there.
I have family there.
I'd like to be there to have
a like a support system or
to be able to engage more
easily with my family.
And then what's lifestyle?
What's my quality?
It's gonna be at least a
year long experience,
maybe a little bit longer.
I'm not sure about how long
some of the other programs are.
What's my life gonna be like
outside of the clinic?
Can I get, do I like the beach?
Do I like the mountains?
Do I want cultural opportunities?
So that could enter into the equation.
It went into the calculations,
but I did get into PT school somewhere.
I won't say where,
but it did have a
significant amount of snow.
And I had done that in undergrad.
So when I got into another
program that was a little
bit south of the Mason-Dixon line,
I went that way because I said,
I've experienced this.
If I'm gonna do a program
for a couple of years,
I'd like it to be a little warmer.
But hey, if you want to ski,
you've got to go where the snow is.
And if you want to be in the warm,
you've got to go where the warm is.
You're going to have at least one winter.
That's correct.
What is winter like and how
do you like winter?
That's a good question.
Um, next, uh, on the list,
it sounds like we talked about it earlier,
but feedback and reviews,
this is like insights from
past residents.
We sort of touched on that already.
So, you know, I think that's on the list.
We sort of mentioned it
under asking alumni networks, but that's,
it's good.
It's saying, um,
asking smart questions to
people who've already
experienced that particular, uh,
program and what did they maybe like or,
or,
or get out of that and see if that
matches your expectations.
Yeah.
Yeah, and you might also ask,
as you're talking to those folks,
current residents and
alumni of the program, you might ask,
how responsive is the program,
the mentors and the program in general,
how responsive are they to feedback?
that they receive,
do they request feedback?
Do they even request feedback?
We do,
we always do X in interviews and we
gather feedback and we try
to make changes if we think
the changes are appropriate
based on that feedback.
So did you have, ask those folks,
did you have an opportunity
to provide feedback about the experience?
Did you get the impression
that the program in general
and the mentors were
receptive to that feedback
and made changes based on
the feedback that they received.
Yeah, that's a great thing to ask.
And again,
I think asking these questions
as an applicant is going to set you apart,
shows that you did your homework.
Yes,
who knew watching a video or listening
to a podcast can actually
be considered doing a
little bit of homework and
checking into programs.
Last thing we have on this list,
this list,
Yes.
This also touched on
location and lifestyle a little bit,
but that's compatibility
with personal commitments.
I had a friend of mine who
did a residency while his
wife was pregnant,
and she brings that up
often as he was traveling a
lot to a faraway land to
complete his residency.
But that is one thing to think about.
What kind of other stresses
or other things in your
life commitments do you have going on?
Something to ask yourself.
Yeah,
those are things to ask if there are
any special set of
circumstances that the
applicant thinks would
impact their participation
in the program and need accommodations.
How receptive does the
program seem to that
request or request for accommodations?
If they feel like they need
the experience to be
extended slightly longer
than what things are set,
the lockstep approach of the schedule.
of the residency, you know,
or are those accommodations,
can those accommodations be met?
Certainly a good question to
ask at the time of
investigation and interview.
All right.
What didn't make the list?
Because we had this seven
list set up for you and you
knocked them down for us.
What didn't make the list?
What's on your secret list?
Well,
what I'm going to do first is I'm
going to look at the other list.
There you go.
How long have you been
working with residents at
University of North Carolina?
What's the timeline?
We didn't set that up for the audience.
Oh, I'd have to go back and look at my CV.
I want to say we've been in
existence about twelve years.
And I think Sharon Klinsky, who's the
I think associate editor of, yeah.
She asked me to do this in
the first place because I
have been the lead mentor
for one of the modules of our program,
which requires that our
residents submit for
publication a case report.
Yeah.
And we feel, and so she asked me, you know,
would you be willing to
talk about why you think
that's important?
So that wasn't on the list.
Well, so why is a case report important?
Why do you think that's- Well,
that's a good question.
Thank you for asking me that.
Thank you for telling me what to ask.
I like that.
So we hope that graduates of
our residency program will be leaders in
in the area of
musculoskeletal physical therapy.
And as part of that,
if they're working in the clinic,
which most all of them
wanna continue to do,
whether they're doing some
academic teaching or not,
they wanna be in the clinic,
we want them to be capable
to communicate with the
rest of the musculoskeletal
physical therapy community,
about special cases that
they have seen that maybe
other therapists would would see rarely.
So that so that they are
residents can can educate
the community on, hey,
this is something you may
not see very often.
And and
And I've really dug into the
literature and the literature, you know,
I use the literature to
base my clinical reasoning
on to achieve hopefully a good outcome.
We want them to be leaders in that regard.
We don't want them to just
be leaders in the clinic.
or in the classroom,
but we want them to be able
to demonstrate some
leadership in that regard.
And if you've never gone
through the publication process,
there's a learning curve
there in terms of writing it up,
writing up the report and being able to,
they don't even realize
what's involved in the
process before doing this.
So here's how you write it up.
You need to follow the
instructions to authors.
It's not going to be accepted like that.
Never, never.
How do you respond to
feedback of the reviewers?
Yeah.
And how do you, in the end,
achieve success and get the information,
success being get that
information out to people,
therapists and their
patients who may benefit
from that information.
So, you know, maybe you want to ask,
is there an opportunity for that?
I talked before about, you know,
is there an opportunity to
engage in research?
Maybe you're just, you know,
an extra set of hands in
the lab and you're helping
with data acquisition.
But there's not much more
time for things like that.
But here's an opportunity.
You're going to be a clinician.
We're trying to train you to
be an elite clinician.
And we think part of your
responsibility in that
regard is you see something
special and you figure it out, right,
based on the literature and
you achieve a good outcome.
Help other people learn.
By doing the report.
Can you communicate,
which is a very valuable skill.
Oh, yeah.
Scientific writing is a different animal.
Yes, absolutely.
My mantra, I don't have any tattoos,
Michael, but if I had one, it would say,
science isn't finished
until it's understood.
Meaning just because you saw
something and you
understood it and you got a good outcome,
if you can't communicate it,
that it dies with you.
And I think that's a shame if it does.
It is.
It's almost a professional
obligation to share that information.
Agreed.
When I first came back to
graduate school after
working as a PT for a year and a half,
one of the courses I took
was scientific writing.
It was a humbling experience.
I jumped in in ninth grade
English and I took technical writing.
And the very first
assignment was explain how
to make a peanut butter and
jelly sandwich.
And of course, the teacher,
when you said take the bread,
he took the bread and left
because you said take the bread.
He didn't say where to take the bread.
But his example was make
sure your words matter and
be careful with what words
you're choosing because the
reader might not interpret them that way.
What else wasn't on the original list?
Some of the things we've talked about,
some of the things on the other list,
we've talked about,
what are my long-term career goals?
We always want to see that.
When we interview, we want to hear it.
We're always asking,
five years down the road,
what do you want to be doing?
so is there a good match
between what your goals are
down the road and and what
this what you see this
program offering uh and so
you you can look at the
face of it what does it
seem like they're offering
but the other thing that we
talked about where are the
alumni are those are some
of those alumni where you
would like to be right
five years down the road.
They were able to do it.
Okay.
Maybe I can do it as well.
Let me ask you this.
Is it a red flag if you ask an applicant,
where do you want to be in five years?
And they say,
I'm not a hundred percent sure.
Is that a reason to say that
this isn't right for you?
Or what's your thoughts on that?
Well, I can only speak for myself.
Right.
And that's okay.
I would probably say
I'm not sure you're ready.
Come back when you're
prepared to answer that question.
Because it's a really big
commitment financially, time-wise,
all those time, effort, money.
It's another year.
Now the advantage, a big advantage here,
big.
Some people would argue that
a new graduate one year
down the road is comparable
to a new graduate who's gone
through a one-year residency program.
Now,
I would say if they've gone through a
one-year residency program
that's a really good program,
that's targeted toward
their specific needs, I would say no way.
I'd like to use stronger language,
but this is an open communication here,
so I won't.
I would say no way.
Because if you go through a residency,
a good residency,
then the mentors who are
operating that program,
they have expertise in all these areas.
They have created didactic
modules where you read what
they think are the most
important papers in each area.
And you contrast that with a
new graduate who's on their
own for one year,
who has to struggle to find those papers.
Did they really find the
most important information?
The didactic stuff is like
organized for you.
It's like a gift.
Here you are, here's the, we think.
Now,
let's assume it's a large cadre of
mentors.
who are really experienced.
And you can tell that by
looking at their CVs and all of that.
Okay, these people know their stuff.
They've published some of
the important information
in all these areas.
They should know what's
important and they're gonna
prepare it all for me and
give it to me and I don't
have to go looking for it.
That is a huge plus.
And you need, that's why,
know we talked earlier that
was one of the seven things
that you know you you you
pushed my way you know so
are the are those the
people who are are the
mentors in this program or
is it like two or three
clinicians some of whom are
you know two three years
out from from uh their just
being a new graduate
Yeah, that's a great opportunity,
and maybe you decide a
two-thirds salary is worth
it to get that opportunity
for all that knowledge.
All right,
I didn't prepare you for this question,
but what's a good question
an applicant has asked you
before that made you say, oh, wow,
that's a really good – I'm
impressed by that question?
Yeah.
A good question is,
what are you looking for in
a new resident?
Ah, there you go.
So it's like, okay, see what they say,
and then ask yourself,
are you that person?
Is that me?
Right, right, right, right, right.
It reverses it.
Describe your perfect candidate,
and you're asking yourself,
am I that candidate?
Yeah.
Another question.
Yeah.
So what are you looking for?
And, you know, or like,
what kind of person has
good success in this program?
Now, it's kind of the same question,
right?
But it's an opportunity for, okay,
do a self-assessment.
Am I that kind of person?
Because maybe you ask that
same question in an
interview at another residency,
and the answer you get is
something different.
We're looking for this kind of person.
And so we're always
interested in the match.
Is there a good match for
how we think this person can learn,
what this person's goals are?
We talked about that.
What we have to offer.
The last thing we want is a
resident to go through the
program and they're
disappointed because they
didn't get what they wanted.
We want a good match.
Everybody, when everybody achieves success,
it's a good match for the program.
It's a good match for the resident.
That's the measure.
Yeah.
All right.
Last thing we do on
orthostatic is called words of wisdom.
Is there a particular piece of advice,
a quote that maybe resonated with you?
Or what's one set of words
of wisdom you'd want to
leave with someone who's
going through these steps and saying,
okay,
these are the things I'm going to
ask these questions.
What would you say to that
person who's deciding,
do I do a residency or not?
It's a lot of what we've
already talked about.
It's like,
What are you looking for?
Does this program have all
things that would help you
get where you want to be?
Otherwise, don't do it.
Can you get where you want
to be on your own with experience?
because you're so
self-motivated that you're
gonna chase down all the
information in the literature?
Or do you feel like you need assistance?
And not just the assistance
of the knowledge,
but the hands-on skills.
A lot of people are looking,
they're new grads,
they didn't have that much
opportunity to learn the
manual skills of intervention,
the manual skills of doing the exam.
And if you're feeling
lacking in just about every,
unless the new graduate is,
just fooling themselves and
doesn't have a realistic
assessment of their own skills,
they all feel like, you know, inadequate.
They go, oh, I'm not good enough yet.
I don't, you know,
I just want to know so much more.
But, you know, for a lot of them,
it's like, okay, you went through four,
you scratched and clawed
four years of undergrad.
You have financial debt.
You went straight into a PT
program for another three
years and you're exhausted,
just exhausted from being a
student and you wanna break in that.
A lot of times,
I think it's a good idea
for a new grad to go out
and practice for a year or two.
gives them an opportunity to
learn what they don't know
and to come up with
clinical questions that are
plaguing them for which
they would like answers.
And then it better prepares
them to do the
self-assessment of what I
feel like I'm strong in,
What am I looking for to
advance my knowledge and
hands-on skills and better
prepares them to
investigate the various
residency programs to see
which programs will meet those needs.
There, that's it.
I'm sorry it took me a while to get there.
It's called words of wisdom.
I didn't say how.
Lots.
Yeah.
All right.
Yeah.
There we go.
Thank you for running
through that checklist.
I know a lot of people, especially,
you know,
the next couple of months will
be thinking about this.
It's that time of year.
I'm glad to have some
insight from somebody like yourself,
Dr. Michael Gross from the
University of North
Carolina School of Medicine,
Department of Health
Sciences and Physical Therapy.
Appreciate you taking that
time and sharing that
knowledge and those words
of wisdom with people about
considering taking that
leap for a residency.
Jimmy, thank you for the opportunity.