Starting a Residency or Fellowship Program

Requirements for Starting a Program

The goal of all postprofessional residency and fellowship programs ("programs") is to produce physical therapists who demonstrate superior postprofessional skills and advanced knowledge in all areas of physical therapy including educational techniques, research methodology, clinical skills, and administrative practices.

Mission, Goals, and Objectives
The program has a mission statement, goals, and objectives that reflect the area of emphasis of the specific residency/fellowship program that are also compatible with the umbrella organization's mission statement. The mission statement addresses the performance outcomes of the program, and the scope of practice for the area of clinical practice.

Patient/Client Population
The program has a patient/client population that is sufficient in number and variety to meet the educational purposes, goals, and objectives of the program.

Residency and fellowship programs must provide sufficient mentored clinical practice experiences for the most common diagnoses or impairments identified in the Description of Specialty Practice (DSP), the Description of Advanced Specialty Practice (DASP), or practice analysis. Other learning experiences (observation, patient rounds, surgical observation, etc.) may supply sufficient exposure to less commonly encountered practice elements.

Clinical Residencies: If the curriculum of the residency program is in an area or portion of an area where American Board of Physical Therapy Specialties (ABPTS) specialist certification exists, the patient/client population must reflect the current ABPTS DSP. If the curriculum of the residency program is not in an area where ABPTS specialist certification exists, the patient/client population must be consistent with the findings of a reliable and valid practice analysis.

Clinical Fellowships: Because the curriculum of a fellowship is designed to advance the physical therapist's clinical skills beyond that of the residency, the patient/client population must be consistent with the findings of a reliable and valid practice analysis for the subspecialty area.

Faculty
The program has a sufficient number of faculty with demonstrated expertise in the needed areas of academic and clinical practice, including the appropriate credentials, to achieve the mission and goals of the education program.

The faculty has the collective qualifications necessary to conduct the activities of the program. Those qualifications include the following: advanced clinical skills, academic and experiential qualifications, diversity of backgrounds appropriate to meet program goals, expertise in residency or fellowship development and design, and expertise in program and resident/fellow-in-training evaluation. The faculty as a unit, including the program director or coordinator, have the qualifications and experience necessary to achieve the program goals through effective processes of program development, design, and evaluation of outcomes.

Faculty members must have expertise in their area of clinical practice and teaching responsibility, effective teaching and evaluative skills, and a record of involvement in scholarly and professional activities. Judgment about faculty competence in a curricular area for which a faculty member is responsible is based on: 1) appropriate past and current involvement in specialist certification and/or advanced-degree courses; 2) experience as a clinician; 3) research experience; and 4) previous teaching experience (e.g., classroom, clinical, in-service and/or continuing education, and presentations to, and attendance at, in-service or continuing education courses). When determining teaching effectiveness, multiple sources of data are collected, including evaluations by residents or fellows-in-training.

The program has an adequate number of didactic and clinical faculty to allow for: 1) teaching, clinical mentoring, administration, continuing individual counseling, mentoring of residents or fellows-in-training by faculty, and supervision and conduct of clinical research throughout the period of study; 2) faculty involvement in residency or fellowship committee responsibilities; and 3) faculty activities that contribute to individual professional growth and development.

The program has a sufficient number of clinical faculty to ensure that the residents' or fellows'-in-training service delivery tasks and duties are primarily learning-oriented. Educational considerations should take precedence over service delivery and revenue generation.

Where the focus of the program is within an ABPTS specialty area, the program will have at least one ABPTS-certified faculty member in that area. For multisite programs there must be a clinical specialist on site unless the resident/fellow-in-training will be rotating to other sites where there is a clinical specialist. For orthopedic manual physical therapy programs, the program will have at least one FAAOMPT on faculty. The ABPTS-certified faculty member and FAAOMPT faculty member must be providing some of the mentoring within the clinical practice setting.

Clinical Residencies: At least one ABPTS-certified (current) clinician will serve on the faculty of the clinical residency program and be involved in all major areas of the clinical residency program including development of the curriculum, the supervision of clinical experiences, mentoring, and advising of students. At least one full-time faculty member will be ABPTS-certified (current) in the clinical residency program where full-time faculty exist. A sufficient number of ABPTS-certified (current) clinicians must serve on the faculty of clinical residency programs that are composed of part-time faculty.

Clinical Fellowships: The same standards apply for the faculty of a clinical fellowship. The faculty must include at least one individual with substantial experience in the subspecialty area, which can be clearly documented. For orthopedic manual physical therapy fellowships, the faculty must include one fellow of AAOMPT.

Curriculum
Both the residency and fellowship experiences combine opportunities for ongoing mentoring and formal and informal feedback to the physical therapist resident or fellow-in-training, including required written and live patient practical examinations, with a foundation in scientific inquiry, evidence-based practice, and course work designed to provide a theoretical basis for advanced practice. Each program is based on a well-defined, systematic process for establishing content validity of the curriculum that describes practice in a defined area. Residencies are created in a specialty area; fellowships should have a curriculum based in one or more subspecialty areas. In specialty areas where validated competencies have been identified, the curriculum should be based on those competencies. In addition, the curriculum should be consistent with the most current version of APTA's Guide to Physical Therapist Practice.

Specialized and sub specialized programs must include postprofessional education and training in the scientific principles underlying practice applications. The curriculum sets forth the knowledge, skills, attitudes, and values needed to achieve the educational goals and objectives of the program.

The program has the responsibility to include activities that promote the physical therapist resident's or fellow's-in-training continued integration of practice, research, and scholarly inquiry, consistent with the program's mission and philosophy. An evaluation component helps to ensure that the stated goals are being met by the physical therapist resident or fellow-in-training through the curriculum plan.

The program has a comprehensive curriculum that has been developed from, and is reflective of a validated analysis of practice, or comprehensive needs assessment (non-clinical programs only) and that incorporates concepts of professional behavior and ethics.

The program's curriculum must cover the entire corresponding DSP, DASP, valid analysis of practice, or comprehensive needs assessment for that specialty/subspecialty. When updates are made to the document, programs have 1 year to modify their curriculum to meet the updated document.

The program provides a systematic set of learning experiences that addresses the content (knowledge, skills, and behaviors) needed to attain the performance outcomes for the clinical residents or fellows-in-training.

• All residents must have a minimum of 150 hours of 1:1 mentoring and 75 hours of didactic instruction over the course of the program. 
• All fellows-in-training must have a minimum of 100 hours of 1:1 mentoring and 50 hours of advanced didactic instruction within an area of subspecialty over the course of the program. 

The didactic instruction may include a variety of educational opportunities, including but not limited to, case review, didactic classroom instruction, chat room, problem-solving sessions, clinical rounds, and other planned educational experiences.

Clinical Residency: If the curriculum of the residency program is in an area or a portion of an area where American Board of Physical Therapy Specialties (ABPTS) specialist certification exists, the curriculum must reflect the entire spectrum of the current ABPTS Description of Specialty Practice (DSP). If the curriculum of the residency or fellowship program is not in an area where ABPTS specialist certification exists, the curriculum must reflect the use of an analysis of practice using validated process. The validated analysis of practice must be approved by ABPTRFE prior to establishing the program curriculum. See the definition for "Analysis of Practice" in ABPTRFE Credentialing Handbook for requirements related to conducting an analysis of practice for the purpose of developing a new residency or fellowship practice area. Please note that ABPTRFE approval of an analysis of practice and residency program is not formal recognition of a specialty area as defined by APTA. In addition, ABPTRFE recognition does not guarantee recognition by ABPTS and ABPTS retains its authority to require additional work and documentation should a petition to establish a specialty area be filed with ABPTS.

Clinical Fellowship: If the curriculum of the fellowship program is in a portion of an area where ABPTS specialist certification exists, the curriculum must reflect the current ABPTS DSP and also extend beyond the DSP in its scope. That is, the program may establish the fellowship curriculum, including didactic content, competency expectations, and description of patients seen through one of the following two methods: 1) A valid and reliable analysis of practice in the subspecialty area; or 2) Expansion of applicable portions of a DSP providing a detailed description of the knowledge, competency expectations, and types of patients seen, including references where appropriate. Orthopedic manual physical therapy fellowships must follow the most recent version of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT's) Orthopaedic Manual Physical Therapy Description of Advanced Specialist Practice (DASP).

Orthopedic Manual Physical Therapy programs must meet the following additional requirements:

• A minimum total of 1,000 hours with at least 90% orthopedic case load that includes:
  • A minimum of 200 hours of theoretical/cognitive and scientific study in OMPT knowledge areas.
  • A minimum of 160 hours, including 100 hours spinal and 60 hours extremity, practical (lab) instruction in OMPT examination and treatment techniques.
  • A minimum of 440 hours of clinical practice with an orthopedic manual physical therapist instructor available.
    • A minimum of 130 hours (of the 440 hours) of clinical practice must be under the direct 1:1 clinical mentoring of the instructor in which the fellow-in-training must serve as the primary clinician responsible for the patient/client's care for 110 of these 130 hours. The remaining 20 hours of the 130 hours may be devoted to observation, discussion, and interaction with the mentor on patient/client management.
    • A minimum of 40 hours (within the 440 hours) of interaction with the clinical instructors in non-patient care situations must be included in the curriculum. The focus of these hours should be related to clinical problem solving. Various methods may be employed including small group tutorials and “chat room” discussions between peers and clinical faculty, onsite or phone/web-based technology interaction.
     
   

Sport Physical Therapy Residency programs must meet the following additional requirements:

• A minimum of 1,500 hours of clinical practice in a variety of settings that allow for at least 40% sports physical therapy caseload.
• A minimum of 200 hours of sports physical therapy coverage at athletic venues.

Evaluation
The program conducts ongoing evaluation of the program goals, faculty, curriculum, and participants. The evaluation process is planned, organized, scheduled, and documented to assure ongoing quality of postprofessional specialty and subspecialty education.

The performance of the program participant is evaluated initially, on an ongoing basis, and at the conclusion of the program. Data collected on the evaluation of a program participant is used to further focus the resident's or fellow-in-training's learning and instruction, as well as to confirm achievement of the residency or fellowship performance outcomes. Data are also collected on the postgraduation performance of the residents or fellow as a whole, in order to evaluate the program and revise the curriculum.

At a minimum, residents and fellows-in-training must have one (1) written examination and two (2) live patient/client practical examinations over the course of the curriculum. Nonclinical programs must include a minimum of one (1) written examination and two (2) assessments over the course of the curriculum.

Orthopedic Manual Physical Therapy Programs  

Additional requirements include a minimum of:

• Four technique examinations on models and/or patients/clients with a minimum of one technique demonstrated during each exam.
• One patient exam with a spinal/axial focus. (ideally one evaluation and two follow-ups) The fellow-in-training is required to demonstrate skill in application of low velocity and high velocity manipulative (thrust) techniques. Practicum and oral discussion are part of this exam.
• One patient exam with a peripheral/appendicular focus (ideally one evaluation and two follow-ups). The fellow-in-training is required to demonstrate skill in application of low velocity and high velocity manipulative (thrust) techniques. Practicum and oral discussion are part of this exam.
• Oral defense: The fellow-in-training should be able to orally defend the examination and treatment decisions following each patient examination.
• Ongoing informal assessments of clinical competence.

Sport Physical Therapy Residency Programs  

Additional requirements include a minimum of:

• Four technique examinations on such topics as rehabilitation techniques, advanced evaluation techniques, manual therapy techniques.
• One patient examination in the clinic for each: Knee, ankle, spinal/axial, and upper extremity.
• Direct observation of a patient examination on the field for both contact and noncontact sports (the observation of the examination may be administered by a physical therapist, an athletic trainer, or team physician, however the final determination of pass/fail will be made by the physical therapist overseeing the resident's athletic venue experience).
• One patient examination for preparticipation screen.
• One patient examination for wellness evaluation.
• One patient examination for functional testing for return to sports for each: knee, ankle, spinal/axial, and upper extremity.

Multisite Programs
Please refer to the definition of a multisite program versus a multifacility program in the Glossary of Terms in the Credentialing Handbook. At a minimum, multisite programs must demonstrate that:

• The faculty meet to discuss methods of assuring consistency in the quantity and quality of didactic instruction and mentoring.
• The curriculum is applied consistently at each clinical site.
• For residency programs, there must be at least one board-certified specialist in the area of clinical specialty for the program at each clinical site.

Mentoring

A learning experience is a planned educational event, designed to facilitate learning and build upon a resident's or fellow-in-training's knowledge, skills and/or behaviors. A set of learning experiences is a purposeful grouping of individual learning experiences that is organized in a systematic way to attain the performance outcomes for the clinical resident or fellow-in-training. In the aggregate, these learning experiences are sequenced and progressed to facilitate the resident's or fellow-in-training's mastery of the curriculum. The rationale for the organization of learning experiences, including the sequencing, integration, and continuity of the content, is derived from educational theory, literature, and/or experience.

The required clinical mentoring hours (150 hours for residency; 100 hours for fellowship) includes the time that the resident or fellow-in-training spends with the physical therapist mentor in patient/client management, including examination, evaluation, diagnosis, prognosis, intervention, and assessment of outcome; and discussion specific to patient/client management. Mentoring is provided at a postlicensure level of specialty practice (for residents) or subspecialty practice (for fellows-in-training) with emphasis on the development of advanced clinical reasoning skills.

The resident/fellow-in-training will be the primary patient/client care provider for a minimum of 100 hours of the 150 required mentoring hours for a residency and for a minimum of 50 of the 100 required mentoring hours for a fellowship. For 12 month residency programs, this averages out to 3 hours of mentoring per week and 2 hours per week in fellowship programs. In addition to the minimum hours of mentoring in patient/client management, mentoring should be also provided in areas identified by the program's goals and many include practice management, clinical instruction, professional behaviors, ethics, etc.

Examples of mentoring that is acceptable for the minimum hour requirements include:

• Examination, evaluation, diagnosis, prognosis, intervention and outcome measurement when the mentor is the primary provider.
• Examination, evaluation, diagnosis, prognosis, intervention and outcome measurement when the residency/fellow-in-training is the primary provider.
• Discussion about individual patient/client management – with or without the patient present.

Examples of learning opportunities that are not included in the minimum required hours of mentoring include:

• loosely or unsupervised patient/client management,
• physician or other health care provider observation,
• grand rounds,
• observation of other physical therapists during patient/client management, and
• clinical shadowing.

Mentoring is not the same as providing clinical instruction to the entry-level physical therapist student. Mentoring is preplanned to meet specific educational objectives and requires the advanced knowledge, skills, and clinical judgments of a clinical specialist. In addition to teaching advanced clinical skills and decision making, the mentor also facilitates the development of advanced professional behaviors, proficiency in communications, and consultation skills. Please refer to the resource manual for additional information and resources regarding mentoring.

Recredentialing

The recredentialing process will evaluate the program's continuing ability to meet all requirements for credentialing. The first recredentialing period is five (5) years from the date of initial credentialing. If a recredentialing application and fee is not received by the end of the credential period, the credential will be withdrawn. The process for recredentialing is the same as that for the initial credentialing process, including a site visit with the program being responsible for the costs incurred. A program has one (1) year from the date of their current credential expiration date to obtain recredentialed status. Any program that extends beyond one (1) year will have their credentials withdrawn. When ABPTRFE grants the program recredentialed status, the credential will begin on the last day of the month in which ABPTRFE approves the program, and is granted for a period of ten (10) years provided the program continues to demonstrate compliance with credentialing criteria on their annual report submissions.

Fees

Application Fee: A nonrefundable application fee must accompany each application (initial or recredential). The fee schedule for credentialing of residency and fellowship programs is determined by the number of residents/fellows enrolled. The written application is not distributed to the reviewers until the application fee has been paid. programs that exceed the one year application time frame will be required topay an additional application fee equal to one half of the original application fee.

Site Visit Fees: The program agrees to reimburse APTA for the direct expenses of travel, lodging, and meals for a team of two onsite visitors for a one-day visit for a single site (approximately $1000 to $2500). programs with multiple clinical and/or educational sites may require two day visits, depending upon the number of sites and the distance between them. The Board and site visitors will make every effort to minimize the expenses associated with travel.

Annual Fee: Each credentialed program will submit an annual fee postmarked on or before March 1. The annual fee is based on the number of graduates reported in the program's previous year’s annual report, or credentialing application, whichever is applicable. If no graduates are reported on the program's previous year's annual report or credentialing application, the program will pay the 1 to 5 resident/fellow-in-training fee schedule. Annual fees not postmarked by March 1 will receive a written notice of delinquency through certified mail notifying that their program's credentials have been suspended and they will be assessed an additional 10% of the annual fee.  If both the annual fee and the assessed penalty fee have not been received by May 1, the program's credentials will be withdrawn and will have to reapply for credentialing. A program does not pay an annual fee in the year that they recredential.

Recredentialing Fee: The recredentialing fee will be due with the recredentialing application on or before the expiration date of the program's credentials. The fee is based on the number of graduated residents or fellows reported by the program in the previous year's annual report. If a recredentialing application and fee is not received by the end of the credential period, the credential will be withdrawn. A program does not pay an annual fee in the year that they recredential.

Grant Funding: The following APTA sections offer grant funding for residency credentialing fees (Geriatrics, Neurology, Orthopaedic, Pediatrics, Sports, Women's Health). Please visit the section's website for information regarding the amount of grant funding and application requirements.

Get Started

Download the most current application and application resource manual.

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Additional Resources

Role of Residency Training in Contemporary Practice (.pdf)
As the physical therapy profession continues to mature and evolve, postgraduate training and education of therapists is becoming even more important. Direct access can be achieved only if we are able to demonstrate that our training and expertise enable us to be a "point of entry" into the health care system. Hence, we can expect to become practitioners of choice only if we are prepared educationally for this challenge.

Contact APTA

For additional information, questions, or to obtain consultation through the Program Services Council, please contact APTA's Department of Residency/Fellowship & Specialist Certification at 800/999-APTA, ext. 3152.

• Last Updated: 2/12/2013
• Contact: resfel@apta.org
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