Residencies: Preparation and Finding the Right Fit

There are a lot of different opinions out there about the value of residency and fellowship training. Is it something everyone should do? Should everyone enter residency training immediately upon graduating? What residency model is best? The answer to these and many other questions is . . . it depends. I will be beginning at a sports residency program later this year, and I have some strong feelings about residencies and fellowships.

The Case for Pursuing Residency

The closer I have gotten to graduating from physical therapy school (19 days as I write this, but who’s counting?), the more apparent it has become how little I know about physical therapy. My view of our preparation to be entry-level clinicians is that we are trained to be adequate in most areas of practice and we will not kill anyone. Hopefully, we’re all capable of getting most patients better, but certainly not as efficiently as is possible. I think students are given a solid base in school upon which they can build as they gain more experience.

To be very good at what we do, we absolutely should be specialized in a more narrow area of clinical practice. I believe residency training is the most efficient route towards specialization. Not only does it accelerate one’s development through concentrated didactic work and mentorship, but also it can help in challenging and further developing critical thinking. One year (give or take a few months depending on the program) is not enough time to become an expert, but it certainly can equip a young clinician with the necessary skills to continue working towards being an expert in a specialty area.

Preparing for a Residency

If a residency is something that you think you would like to pursue, be intentional about preparing yourself to stand out to residency programs while you are in physical therapy school. I am not a residency director, and each residency director surely has differing opinions as to what he or she looks for in a candidate. However, as a student who worked towards entering a residency, I think there are things you can do to demonstrate your dedication to a specialty area and to be a stellar candidate.  

First and foremost, get involved with your desired specialty as much as you can.

This is a no-brainer – if you want to attend a residency, gain as much exposure as possible to that area. This is not only important for being a competitive applicant, but also to further refine what you may be looking for in a residency based on each program’s focus.

While it is vital to show that you are passionate about about particular practice area, always look for opportunities to diversify yourself within different specialty areas. A residency program may look favorably upon a you as candidate who has a well-rounded background of exposure in addition to immersing yourself in one area. This means take advantage of your internships and get involved around different practice areas (orthopedics, sports, pediatrics, acute, inpatient, etc.) beyond one in which you want to complete a residency.

In addition to being involved in your desired specialty, which every other competitive candidate is likely also doing, demonstrate a consistent passion for something that can make you a valuable contributor as a member of a team of clinicians. Now, that does not mean everyone who wants to do a residency has to go make his or her own blog, website, or Youtube channel (though this may look unique on a resume). There are numerous ways you can show a residency program your desire to go above and beyond what is required.

  • Get involved in the APTA at the national and state level
  • Contribute to a faculty research project
  • Get involved in community volunteer events
  • Take on a leadership position within your program

Those are just a few examples, and the possibilities are endless. Be creative and innovative, and find something about which you are excited.

Finding the Right Fit

When it comes time for you to begin the application process, do your research and find the programs that best fit what you want to get from a residency. Residences range in size, focus, and structure. There are on-site residency programs and long-distance residency programs. There are university-based programs, and there are private clinic-based programs. Even within the same specialty, residency programs vary widely in their focus. Take sports residencies, for example. Some sports residencies provide a great deal of exposure to treating athletes at a Division 1 college program, others provide exposure to treating runners and endurance athletes, while still other programs provide the opportunity to treat mostly high school athletes. How residencies structure their mentorship is extremely important.  Look at how much time you will get working directly with a mentor and ensure that mentorship is a priority for a program.

The time spent with a mentor being challenged in your clinical reasoning is an invaluable component of a residency. 

Additionally, some sites place a larger emphasis on research than others. If research is something that is important to you, find a program that shares that value. Faculty is another component to take into consideration. 

  • How experienced are they?
  • How long have they held a speciality?
  • How long have they been mentors towards other residency students?
  • What contributions could they provide towards your individual interests?
  • Do they match your personality?

There are just a few questions to consider when doing your research.  

When you have narrowed down a list of potential residency sites, be sure to be proactive in reaching out to them. Now that you have done all of that homework to determine which residencies you really want to attend, contact them and let them know how interested you are in their program. Ask them any additional questions you may have about their programs. While not always feasible, see if you can coordinate a time to come observe so you can get a chance to see how they work and whether it is an environment in which you can see yourself. Understanding which programs you want to attend is vital when it comes to writing application essays. Knowing more about them and how they fit your own goals for a residency will allow you to shape your responses to their questions in a manner that indicates that you took the time to learn about them and that both your and their priorities are consistent.  This will also benefit you in the face-to-face interview session where they will be able to tell how honest you were with your responses and your reasoning for attending their program.   

I strongly believe that residency (and fellowship) training is a huge investment in your career. I understand it means taking significantly less pay and staying in a student mindset for a year longer, but it can set you up to develop into a clinician who really excels in a particular area and achieves outstanding patient outcomes. It may also indirectly benefit you in the future by opening doors to mentorship opportunities, referral sources, partnerships, and generally increasing your credibility as a board-certified specialist Doctor of Physical Therapy. A residency is so much more than a quicker way to get some extra letters behind your name, so make sure you find one that challenges you and meets your specific needs. I think you will find it to be a rewarding experience if you truly invest in it and try to get as much out of the time as you can.  As always, share your thoughts below about what a residency/fellowship program means to you and how it may (or already did) shape your future.