Residency and Fellowship: Is there good value?
An interesting article by Rodeghero et. al. was published in this month's JOSPT (http://www.ncbi.nlm.nih.gov/pubmed/25579690). The piece looked at the effect of Residency and Fellowship training on functional outcome scores. In other words they were comparing the efficiency and effectiveness of therapists with post-graduate Residency and Fellowship training to those without it. For those of you who haven't read it yet, they basically found that Fellowship training resulted in improved outcomes whereas Residency training did not. Many discussions began popping up across social media questioning the value of Residency training, after all if your outcomes don't get better then what is the point? This question really got me thinking. As I near the end of my Fellowship program with Evidence In Motion (if all goes well I graduate in June) I find it interesting to reflect on this question, what was the point? Over the past three years I have seen my FOTO outcomes improve and there is no question in my mind that clinically I am more efficient and achieve success with an ever growing percentage of patients, but are these improved outcomes the most important thing I gained from Fellowship training? Not even close. In fact 'improved outcomes' doesn't even make the top 3. This is what bothered me about the discussion going on in Twitter world and elsewhere questioning the merit of Residency/Fellowship based solely on this recent study. Here are the top 3 reasons that pursuing Fellowship training was the best professional decision I have ever made:
- I witnessed greatness. Through Fellowship training I have been exposed to individuals operating with a clinical proficiency that is mind-boggling. This exposure has left me deeply humbled and intensely motivated. Watching these master clinicians showed me first hand what life-long learning can do, and it has made me promise myself that I will never deviate from the path.
- I got connected. Fellowship (def.): "friendly association, especially with people who share one's interests". Couldn't have said it better myself. Fellowship training has brought me alongside some truly incredible folks. These are colleagues who share the purity of vision I have in my finer moments, the one that is always at risk of being snuffed out by long hours and declining reimbursement. I have far greater confidence in my ability to be the person and therapist I want to be for the entirety of my career having made these professional friendships.
- I learned my strengths and weaknesses. I know I know, you are thinking by now you are well aware of your strong points and limitations. I thought I was to. However many of us have never had a truly incredible teacher give it to us straight, a teacher who cares more about your development and about our profession than about feelings. Rare is the opportunity to have a mentor who is exceptional at their craft and deeply invested in bringing you to their level. These are the folks who can see things in you that you are blind to, and they are willing to call them to the forefront for the greater good. Through Fellowship I have had the luxury of finding not one but several of these mentors.
What I am trying to highlight here is not that outcomes aren't important, or course they are, and certainly improving patient care is an outstanding reason to pursue post-graduate training. Instead I am offering the opinion that this is one reason among many, and that some of the others may have value far greater to you as a professional and as an individual than percentage of functional change. Cheers.