Austin Sheldon – Top 5 Residency Lessons

Dr. Bradley Grohovsky, DPT did a guest post on his Top 5 Residency Lessons So Far. If you haven’t read it, then I encourage to do so. Here we have a guest post by Dr. Austin, Sheldon, DPT on the same topic. 

“Austin Sheldon PT, DPT is currently a staff physical therapist working at Box Butte General Hospital in Alliance, Nebraska. While maintaining a busy outpatient orthopedic caseload, he also assists with the Sports Medicine outreach program by providing pro-bono care for high school athletes, provides in-patient coverage, and occasionally helps with skilled nursing facility coverage. Austin is a 2008 graduate of Regis University’s DPT program. In December of 2013, Austin officially graduated from the Andrews University/NAIOMT orthopedic manual physical therapy residency program’s initial cohort. Currently, Austin is enrolled in Andrews University DScPT program and closing in on the dissertation phase of the program and also is a NAIOMT OMPT fellow-in-training. Clinical areas of interest include patient education, the cervical spine, hip/pelvic girdle, conservative management of pars defects, conservative management of avulsion fractures, pain management, and education. He enjoys the rural western Nebraska life and outdoor opportunities with his wife, son, and two Labrador retrievers.”

Enjoy the read!

Perhaps how I arrived at doing a post-graduate physical therapy residency will resonate with some readers: Put yourself in the shoes of a new graduate. You are ready to take on the world, ready to become a vital member of the healthcare force, and let’s be honest, ready to start making some money. You graduated from a great PT program, learned from leaders in the field, and made some great friends along the way. BUT, along the way, while you spent three years working hard to keep your head above water, your other non-PT school friends were already earning money, traveling the world, paying off undergraduate debt.  You, a newly minted DPT, with student loans from undergraduate AND graduate school, are faced with the reality that the grace period for loans is looming like an un-escapable thundercloud, the closer it gets the bigger it appears…

The situation above is what I was faced with and in talking to students and new graduates, the situation above is all too common. Faced with growing debt and diploma, I applied for and accepted the highest paying job I could get: a SNF. I worked in a sub-acute/LTAC/SNF for the next 2.5 years, earning good money. Don’t’ get me wrong, I enjoyed the patients I worked with, each with medical complexities that needed to be acknowledged, respected, and addressed. My heart warmed when the patients succeeded and left the facility for home; however, I felt a deep professional emptiness. I was burnt out with the bureaucracy of RUGS, of constantly being asked to “look for opportunities for more minutes,” of having my clinical opinions and recommendations trounced, lack of professional growth, and absence of any one to talk to about clinical questions.

Long story shortened: I quit feeling sorry for myself and changed jobs. I became proactive rather than reactive. I moved on to an opportunity where I felt I could flourish personally and professionally. After having accepted the position, I looked into residency options that allowed me to keep my current job and ultimately applied to the Andrews University/NAIOMT program. After a series of interviews, I was accepted and began a nearly two-year long residency program that was formative, both personally and professionally. Without further ado, here is my “Top 5 Things I Learned from Residency:”

1) Don’t Forget How to Read

My residency instructor, mentor, and friend told me this the night we first met face-to-face. I was in Seattle, WA for the first class of the NAIOMT component of the residency program. Brett Windsor PT, PhD(c), MPA, OCS, FAAOMPT looked directly at me and said, “If you want to be the best you can be, read. Read everything. And read it for understanding.” It’s through reading pertinent and relevant literature to the clinical questions you are faced with that foundational differential diagnosis skills and clinical patterns are developed. Too many clinicians use the professional journals they receive from their professional associations as coasters for their morning coffee, collecting dust and stain rings. Open those journals if you get them and aim to read at least one article of interest per week that is applicable to a current clinical case you are managing. Don’t forget that, though your library access to journals from graduate school may have lapsed, PubMed is free to everyone!

2) Don’t Stop Listening

This is applicable to both the patients/clients you interact with as well as the instructors in your residency. When interacting with the patient, take the time to listen to the story he or she is telling you. Don’t interrupt. Part of the therapeutic process is allowing the person in front of you to tell you why he or she is seeking physical therapy to began with. Don’t look at the clock or the phone (that shouldn’t be in your pocket anyway, right Dr.?) or talk through the curtain to a colleague about last night’s “Mad Men” episode.

Part of participating in a post-graduate residency program is to better yourself as a clinician. Again, in the words of my mentor Brett Windsor, “to become a better clinician, you have to learn from someone better than you.” Listen to your mentor and consider what he or she is telling you. Be open to constructive criticism and leave the ego at home.

3) Don’t Discount Mentorship and Relationship-Building

You don’t need to complete a residency or fellowship program to find an invaluable mentor or to build positive relationships with colleagues; however, I am of the opinion that mentorship and relationship-building skills are integral parts of a residency program that will only better your professional development and satisfaction. One of the precipitating factors that lead to my dissatisfaction early in my PT career was the lack formal mentorship. I did not have a senior colleague to bounce problems, ideas, successes, and failures off of.  My mentor and residency instructor made himself available to me via phone, text, email, and in person throughout the program. He selflessly gave of himself at the expense of his time and resources to mentor me. Find a mentor that will challenge you rather than stroke your ego and coddle you.

Social and inter-personal skills are important to become a successful clinician and businessperson too. As part of the residency program’s requirement, I interacted with orthopedic surgeons, interventional radiologists, MSK radiologists, physiatrists, physician assistants, and nurse practitioners.  Understanding other healthcare professionals’ perspective and being able to communicate effectively and positively can only lead to improved inter-disciplinary care.

4) Don’t Become a Technician and Don’t Pigeon-Hole Your Learning

Realize that the primary reason to participate in a residency program (in my opinion) is to improve clinical reasoning and critical thinking, first and foremost.  Upon returning from the AAOMPT conference in Cincinnati last year, I was sitting on a bus at Denver International Airport on the way to long-term parking when I noticed the conference program sticking out of a fellow bus rider’s gigantic purse. I then asked the fellow attendee what she thought of the AAOMPT conference. She looked at me aghast and asked me how I knew she was there; I just pointed at the program hanging out of her purse. Turns out this colleague was Kristin Carpenter, a fellow-in-training through EIM. We had a great conversation and compared our experiences with EIM and NAIOMT as well as our experiences and take-aways from the conference.  The biggest take-away from our conversation was the agreement that clinical reasoning and critical thinking are more important than the psychomotor skills of mobilization, manipulation, dry-needling, etc. that may be learned in a residency program. If you critically think and reason through clinical problems, then the psychomotor skills/techniques you arrive at (if you choose to do anything at all) will develop. Don’t carry out a particular technique and then retrospectively ask yourself why said interaction succeeded or failed; think about what you are doing before, during, and after the interaction.

I think the mark of a good residency program is the realization and openness of the faculty that, while the instructors and mentors may have some answers, insights, and techniques for most clinical situations most of the time, NOBODY knows what do all with every situation 100% of the time. So, as a resident, I was encouraged to participate in other learning opportunities with other programs, institutions, and continuing education providers. In this way, I wasn’t pigeon-holed into uni-lateral group think. Be open to other approaches. Use what you like and what seems to work and forget the rest.

5) Add Value (for the patient/client) to Your Clinical Encounters

Quite simply: What do you add to the patient/client’s well-being that they have not already received? Listen, engage, interact, and connect with the patient. Patient education and activity modification, in my opinion, are two of the most valuable interventions a physical therapist can provide. By educating the patient/client about what is going on (and perhaps more importantly, what IS NOT going on), you are providing re-assurance that improvement is most likely going to occur and providing a “green light” to the patient to explore the world in a safe and pain-free manner. Aside from patient education and activity modification, you also may be the first person to touch the patient and provide a comprehensive examination. Providing hands-on care that facilitates pain-free movement that can then be reinforced through active and independent exercise is also key to adding value to the clinical encounter. The patient/client has “bought in” to physical therapy.

So, those are my “Top 5 Things I’ve Learned from My Residency.” I hope that some of the insight, experiences, and opinions I’ve provided resonate with some of the readers. I’d encourage anybody that strives to become a better physical therapist to explore residency options. Structured learning is important to a point; however, the mentorship, clinical reasoning, and critical thinking that residencies provide are priceless and set the stage for life-long fulfillment in the physical therapy profession.

Find Dr. Sheldon on Twitter: @ASheldDPT

I am @Cinema_Air

Brad Grohovsky: Top 5 Lessons from the Residency Trenches

I am a big proponent of doing a Residency program upon graduation from Physical Therapy school. Not only does it contextualize what you learned in PT School, but it also gives you valuable mentorship that fast-tracks you on your journey to become a better clinician (and more!).

Dr. Bradley Grohovsky, DPT serves on the APTA Private Practice Section Government Affairs Committee and is currently a Resident studying with the Institute of Physical Art at Encompass Physical Therapy in Annapolis, MD – specializing in Functional Manual Therapy™. Brad received his Bachelor’s degree from Western Kentucky in his home state prior to moving to Boston, MA for physical therapy school. While attending Simmons College he also served on the APTA Student Assembly Board of Directors prior to graduating with his Doctorate of Physical Therapy in 2011.”

You can read more of his thoughts here. I recently asked him about the top five lessons he learned from his Residency so far. He responded with this generous guest post. Enjoy!

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. The practice of evidence-based medicine is a process of life-long, self-directed learning…” (Sackett)

​Physical Therapy is a rapidly evolving profession that is experiencing some revolutionary transitions both in our position in the healthcare system, but more importantly in our clinical skills and approach to patient care. Our profession currently stands at a great pinnacle with an opportunity to integrate into a vital (and missing) medical role in our society as both movement and lifestyle experts. Residency education is a catapult towards clinical expertise – if our profession is truly going to step into this role then we must step up to the plate as clinicians. If you are a student who is about to graduate (or just passed the NPTE..congrats!), a new professional, or a burnt-out experienced veteran I encourage you to check out a Residency in a specialty that interests you!

Here are the top five most valuable lessons of my Residency:

1. There is nothing more valuable than a mentor you respect and who challenges you to be your best.

-Because if you are not being challenged to be a better clinician everyday, then really what’s the point? Having an experienced mentor that challenges you to be your best improves both your skills as a clinician and your patient’s outcomes.

2. Attempt to prove yourself wrong with EVERY patient.

-Develop a hypothesis and use objective pre/post tests to validate your treatment and direct your plan of care. This allows you to develop and test your hypothesis every visit – if your theory isn’t correct, then change your treatment next visit (don’t wait until the next re-eval)! Every treatment becomes evidence-based and the objective information can provide immediate positive feedback for the patient!

3. Use your eyes, but trust your hands.

-More often than not, we are the first clinician to actually touch a patient’s pain. Learn to trust what your hands are telling you – they are your most valuable tool. In the book Outliers, author Malcolm Gladwell claims that 10,000 hours is the amount of time it takes to master a craft and achieve “greatness”. You can’t be Yoda – a Jedi Grand Master PT without mastering the force – and you can’t understand the force without putting in your time in the Jedi Academy.

4. Make every patient understand that this is a team effort.

-This reinforces compliance and accountability, which will encourage long term success. We are the mechanic who can repair broken parts, provide a tune up and clarify sections in the owner’s manual, but it is up to the patient to maintain the condition of their vehicle to the best of his/her ability.

5. Be an intelligent teacher, but an excellent pupil.

-Evidence continues to mount in support of the neuromatrix components of chronic pain involving neural, psychological and social components in addition to the physical presentation (Butler, Moseley, Wardlaw). Patients often teach us how to best treat them, whether intentionally or unintentionally. During treatments, be an active listener – both treat and educate each patient based on his/her individual learning style!

For further Residency reading please check out my recent post on – To a Residency and Beyond!

Follow me on twitter @DrG_PT


1. Sackett: Evidence Based Medicine: What it is and what it isn’t, BMJ 1996;312:71

2. Butler, D: Explain Pain

3. Wardlaw C: Taming Pain

4. Moseley: A Pain Neuromatrix Approach to Patients with Chronic Pain, Manual Therapy 2003

I am @Cinema_Air