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An Exciting New Journey

Making the decision to embark on a residency program should be carefully considered.


After 10 years of practicing physical therapy, I started a residency. I'm not your typical story. Residencies are typically deisgned for therapists to complete within the first five years of practice. My story was different. I had practiced in multiple treatment settings, including inpatient rehabilitation, home-based pediatrics, case management, outpatient orthopedics and outpatient pediatrics.

The majority of my time as a therapist had been invested in pediatrics over the past 10 years, and I loved that field. Once I began working with children, especially under one year of age, I found my niche. I love the challenge of learning new conditions and diagnoses, working with the family unit as a whole, and collaborating with other professionals for family-centered care.

Once I decided to focus my career on pediatrics, I began investigating ways to learn more about pediatrics and to advance my own clinical reasoning process. Although I had taken numerous continuing education courses and attended many conferences, I continued to feel that I wanted more professional development.

What I really wanted was one-on-one mentorship. I discovered that pediatric physical therapy residencies had developed, and the first graduate from an APTA-credentialed program was in 2007 from Oregon Health Sciences University. That was the solitary APTA-credentialed pediatric PT residency program in the country at the time of my application, with another being credentialed by the time I interviewed. I ultimately chose to go to the program at Duke University Medical Center, and ended up being their first graduate after the program was credentialed. The program was credentialed in early 2010. There are now a total of six credentialed pediatric residency programs in the country.

Was It Worth It?

The residency was the right decision for me, but it does have its pros and cons. First and foremost, the process of being mentored by other physical therapists is irreplaceable. Having the opportunity to analyze gait, evaluate and treat alongside another therapist, and then comparing observations was priceless. Having the pediatric experience prior to the beginning of residency allowed me both the time and experience to build a great base from which to learn. I had developed questions over the years that I felt were finally being answered.

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The residency provided me the opportunity to develop, strengthen and refine handling skills, evidence-based practice in pediatrics, and overall clinical reasoning.

Although it is humbling to admit, I learned how much I did not know about pediatric physical therapy during the residency. Thankfully, the residency provided opportunities to acquire that knowledge and experience. It helped me build confidence in my clinical practice with children.

What I Liked Most

I loved the one-one-one mentorship with experienced physical therapists. I loved hearing the thought process that each therapist has in choosing their evaluation or treatment technique.

It was a unique experience to have a front row seat to witness their creativity, intelligence and passion for children. I was also able to get a glimpse into what truly motivated the therapists to excel at what they do.

What I Liked Least

There can be a large variation in how each therapist mentors their resident. Although the process has countless benefits, it can be challenging to adjust to a different mentor in a different treatment setting numerous times through the 12-month program. I equate it to the experience of beginning a new job each time I worked with a new mentor.

As with a new job, there is an adjustment period needed to understand the culture of the position, coworkers' personalities or styles, varying expectations from a different supervisor, and so on. There is also a certain amount of stress associated with those adjustments. Imagine starting more than 10 new jobs in one year. That part of the residency process was my least favorite, yet I learned so much about myself and others through that process.

Should I Do a Residency?

This is a question that's frequently asked. When selecting a residency program, the pros and cons of a residency and the focus of each program should be carefully considered. In my opinion, I needed several years of experience (though maybe not 10!) prior to engaging in such an intense learning process. I needed the first several years of clinical practice to simply figure out how to be a physical therapist.

If the first year after PT school is someone's first full-time job, it can take time to learn how to balance personal and professional life. Some therapists need time to adjust to the physical and emotional demands of working full-time, without semester breaks and with the new responsibility of practicing under their own license.

That said, others have shared that transition and adjustment is a way of life from college to PT school to a residency or first job, so adjustment is a given-whether in a residency, marriage or a first job.

This is an individual decision, and the pros and cons should be weighed. Since some residency programs have minimum experience requirements, review them prior to applying. When newer graduates ask my opinion about what to do if they're not able to participate in a residency, I suggest seeking employers who provide mentoring and diverse learning opportunities. Some therapists have said that their first jobs provided so much on-site development that they felt as if they had a residency.

Whatever form it may be, if you have the desire to learn and grow more in the profession, I say go for it. You never know where it may lead, and as my dad told me when I left for Duke, "Nothing but good can come from this opportunity." He was right.

If a residency isn't for you, maybe you can approach experienced therapists in your area and discuss mentorship in their facility. Possibly a doctor of science (DSc), PhD, or certificate program will better suit your needs. Go forward with your motivation to learn and grow, and enjoy the journey. 

Debra Seal is a pediatric physical therapist III at Cedars Sinai Medical Center.

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CRISTIAN FEDERICO LEDESMA,  physical therapyJanuary 15, 2012


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