APTA Residency/Fellowship 2012Annual Report

*The data collected in the Annual Report is confidential

I. Program Information
NAME OF PROGRAM
TYPE OF PROGRAM: RESIDENCY FELLOWSHIP
SPONSORING UMBRELLA ORGANIZATION
PROGRAM ADDRESS / LINE 1
LINE 2
CITY / STATE / ZIP CODE
TELEPHONE / FAX / WEBSITE (if available)
PROGRAM DIRECTOR/COORDINATOR
NAME (last) / (first) / (middle initial)
CREDENTIALS (i.e. PT, DPT, OCS, etc.) / TELEPHONE / FAX / E-MAIL
PRIMARY CONTACT (if different from Program Director/Coordinator)
NAME (last) / (first) / (middle initial)
CREDENTIALS (i.e. PT, DPT, OCS, etc.) / TELEPHONE / FAX / E-MAIL
PROGRAM INFORMATION
TYPE OF PROGRAM
RESIDENCY
FELLOWSHIP / YEAR PROGRAM
STARTED / LENGTH OF PROGRAM
months
hours / CURRENT # RESIDENTS/FELLOWS-IN-TRAINING / RESIDENT/FELLOW TUITION/FEE?
NO YES AMOUNT$
*please include fees associated with books, coursework, insurance, etc. (if applicable)
MAXIMUM NUMBER OF RESIDENTS/FELLOWS-IN-TRAINING PROGRAM WILL ENROLL
FULL-TIME PART-TIME
IS THIS PROGRAM CONSIDERED A MULTI-SITE PROGRAM PER THE DEFINITION IN THE ABPTRFE CREDENTIALING HANDBOOK? No Yes
IF YES AND THIS PROGRAM IS A RESIDENCY PROGRAM, IS THERE AT LEAST ONE ABPTS CERTIFIED SPECIALIST AT EACH FACILITY? No Yes
TYPE OF RESIDENCY/FELLOWSHIP CONCENTRATION / COMPENSATION TO RESIDENT/FELLOW?
NO YES AMOUNT$ per year/hour
Please indicate what the percent of this salary is compared to a regular employee at your facility (ex: 100%, 75%, 60% of a regular employee’s salary):
How many hours per week does the resident/fellow spend in clinical practice?
BENEFITS PROVIDED TO RESIDENT/FELLOW
DOES PROGRAM RECEIVE NON-TUITION INCOME?
No Yes
Sponsor: Amount: $ / FELLOW SCHOLARSHIP FUNDED BY OUTSIDE AGENCIES?
No Yes
Sponsor: Amount: $ / IS YOUR PROGRAM ASSOCIATED WITH EARNING A DEGREE?
No Yes Degree earned:
PROGRAM DATES FIXED ROLLING
STARTING (month/year) ENDING (month/year) / APPLICATION DEADLINE FIXED ROLLING DATES:
APPLICANT INTERVIEW: Not required Required of each applicant

II.2012 Resident/Fellow Status

List each resident/fellow who was enrolled in the Program between January 1, 2012 to December 31, 2012. You must include the resident/fellow’s contact information and status as of December 31, 2012. Please add additional rows as needed.

RESIDENT/FELLOW NAME
(Include all credentials; eg, PT, DPT, OCS, FAAOMPT, etc) / EMAIL ADDRESS
(personal email; not employer/program email) / START DATE(mm/dd/yy) / CURRENT STATUS
(please check one)
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed
Active Full Time
Active Part-Time
Inactive
Graduated
Date of Graduation:
Dropped Out
Failed

For those resident(s)/fellow(s) listed as DROPPED OUT, please provide the reason below.

RESIDENT/FELLOW NAME / REASON FOR DROP OUT
(ex: medical, work related, not successful in Program, etc)

For those resident(s)/fellow(s) listed as FAILED, please provide the reason for failure as well as what remediation, if any, the Program provided prior to failure.

RESIDENT/FELLOW NAME / REASON FOR FAILING

III. Summary of Patients/Clients by Diagnostic Categories per Resident/Fellow

For EVERY resident/fellow listed as GRADUATED in Section II, please provide their completed diagnostic category chart.Please summarize the number of patients/clients (not number of visits) by diagnostic categories evaluated, treated, and/or managedby the residents/fellows during the entire course of the residency or fellowship program. Do not provide data on patient/clients seen by all staff in the clinic.Copy this form as needed. [Requirement 2.1.1]

DIAGNOSTIC GROUP OR CATEGORY
/ NUMBER OF PATIENTS/CLIENTS TREATED BY RESIDENT OR FELLOW AS PART OF THE PROGRAM / % OF TOTAL PATIENTS/
CLIENTS TREATED BY RESIDENT OR FELLOW
Sports residency and fellowship programs, please delete this form and use the substitute form below (Dx Categories for Sports) that already has the diagnostic categories listed.
Orthopaedic residency, please delete this form and use the substitute form below (Dx Categories for Ortho) that already has the diagnostic categories listed.
Orthopaedic manual physical therapy fellowships, please delete this form and use the substitute form below (Dx Categories for OMPT) that already has the diagnostic categories listed.
Total: / 100%

Diagnostic Categories for Sports Residency and Fellowship Programs

DIAGNOSTIC GROUP OR CATEGORY
/ NUMBER OF PATIENTS/CLIENTS TREATED BY RESIDENT OR FELLOW AS PART OF THE PROGRAM / % OF TOTAL PATIENTS/
CLIENTS TREATED BY RESIDENT OR FELLOW
Lumbar Spine
Thoracic Spine
Cervical Spine
Hip/Pelvic Region
Knee/Lower Leg Region
Ankle
Foot
Shoulder
Elbow
Wrist
Hand/Thumb
TMJ
Total / 100%
% of total clients that are sports physical therapy cases(should be at least 40%):
If the % of total clients that are sports physical therapy cases is less than 40%, please describe the Program’s plan to increase this percentage to ensure compliance.

Diagnostic Categories for Orthopaedic Residency Programs

DIAGNOSTIC GROUP OR CATEGORY / NUMBER OF PATIENTS/CLIENTS TREATED BY THE RESIDENT AS PART OF THE PROGRAM / % OF TOTAL PATIENTS/
CLIENTS TREATED BY THE RESIDENT / THE % INDICATED BELOW ARE PER THE DSP GUIDELINES THAT PROGRAMS SHOULD BE TARGETING
Cranial/Mandibular / 5%
Cervical Spine / 15%
Thoracic Spine/Ribs / 5%
Lumbar Spine / 20%
Pelvic Girdle/Sacroiliac/Coccyx/Abdomen / 5%
Shoulder/Shoulder Girdle / 15%
Arm/Elbow / 5%
Wrist/Hand / 5%
Hip / 5%
Thigh/Knee / 10%
Leg/Ankle/Foot / 10%
Total / 100%

Diagnostic Categories for Orthopaedic Manual Physical Therapy Fellowship Programs

DIAGNOSTIC GROUP OR CATEGORY / NUMBER OF PATIENTS/CLIENTS TREATED BY THE FELLOW AS PART OF THE PROGRAM / % OF TOTAL PATIENTS/
CLIENTS TREATED BY THEFELLOW
Cranial/Mandibular
Cervical Spine
Thoracic Spine/Ribs
Lumbar Spine
Pelvic Girdle/Sacroiliac/Coccyx/Abdomen
Shoulder/Shoulder Girdle
Arm/Elbow
Wrist/Hand
Hip
Thigh/Knee
Leg/Ankle/Foot
Total / 100%

IV. Program Assessment and Updates

  1. Please describe the Program’s plan for providing learning opportunities for all diagnostic category groups/impairments should there be limited patient exposure for any diagnostic category.

  1. Has there been a change in the umbrella organization’s mission or goals that affects the Program? YES NO
If yes, please describe the change and the effect of the change on the Program.
  1. Has there been a change in the Program’s mission, goals, or objectives? YES NO
If yes, please provide these changes and indicate the effect of the change on the Program.
  1. Is the Program meeting its mission, goals, and objectives? YES NO
If no, explain what component(s) of the mission, goals, or objectives are not being met AND describe the Program’s response to not meeting its mission, goals, or objectives.
  1. Are the residents/fellows meeting these goals and objectives? YES NO
If no, explain what component(s) of the resident/fellow goals or objectives are not being met AND describe the Program’s response to its residents/fellows not meeting these goals and objectives.
  1. Have there been any changes in the Program’s policies and procedures and/or the umbrella organization’s policies and procedures that affects the Program? YES NO
If yes, please provide a summary of these changes and indicate the effect of the changes on the Program.
  1. Has your Program been providing the APTA Grievance Policy to its residents/fellows upon starting the Program? YES NO

  1. Has there been a change in the program director? YES NO
If yes, please complete the chart below highlighting the new program director’s resume and explain why.
Faculty Name:
Academic/Teaching Appointments:
Education:
Scholarly Activity/Publications:
Educational Presentations:
Recent Continuing Education Attended:
  1. Have you added any Program faculty? YES NO
If yes, please complete the form below. Complete one form for each new faculty member.
NAME (with credentials) / ABPTS CERTIFICATION/RECERTIFICATON
Designate year certified/Year of latest recertification)
TITLE / % FTE (based on 40 hrs) % / Cardiopulmonary (Cert) (Recert)
Clinical Electrophysiology (Cert) (Recert)
Geriatric (Cert) (Recert)
Neurologic (Cert) (Recert)
Orthopaedic (Cert) (Recert)
Pediatric (Cert) (Recert)
Sports (Cert) (Recert)
Women’s Health (Cert) (Recert)
OTHER CERTIFICATIONS/ASSOCIATION STATUS
Certified Hand Therapist (Cert) (Recert)
FAAOMPT
Certified Wound Specialist (Cert) (Recert)
PLACE OF EMPLOYMENT
SITE WHERE FACULTY PROVIDES INSTRUCTION/MENTORING
AREAS OF RESPONSIBILITY IN PROGRAM
RECENT PROFESSIONAL DEVELOPMENT ACTIVITIES (i.e., continuing education, publications, research, etc.)
  1. Have any faculty left the Program? YES NO
If yes, please list those former faculty members and any impact this has had on the Program.
  1. Please list the namesand credentials of all ABPTS-certified and/or FAAOMPT faculty for the Program:

  1. Has there been a change in the professional development opportunities or resources that allow faculty to maintain and improve their effectiveness as clinicians and educators? YES NO
If yes, describe the change, the reason for the change and the effect of the change. If the impact is adverse, describe the Program’s response to the change.
  1. Have you added any facilities (didactic and/or clinical) utilized for resident/fellow education? YES NO
If yes, please complete the form below. Complete one form for each new facility.
Name of facility:
Address:
City: / State: / Zip code:
Web address (if applicable):
Contact Person: / Phone:
Type of training provided at facility (i.e., classroom, clinical practice, lecturing/presentations):
Names and credentials of didactic and clinical faculty located at this facility:
Describe the impact that adding this facility has had on the program curriculum and provide the affiliation agreement:
If this facility is used for didactic education, please describe how the Program assures that the resident/fellow in this facility receives the same quality of didactic instruction and content as residents/fellows in the primary location:
If this facility is used for clinical education, please describe how the Program assures that the resident/fellow in this facility receives the same quality of mentoring instruction as residents/fellows in the primary clinical location:
If this facility is used for clinical education, please describe how the Program assures that the resident/fellow in this facility receives the same exposure to the patient population as residents/fellows in the primary clinic location:
  1. Is your program a multi-facility program per ABPTRFE: YES NO
“A program that has more than one affiliated facility for residents/fellows-in-training AND each resident/fellow-in-training rotates to EVERY facility over the course of the program.”
  1. Is your program a multi-site program per ABPTRFE definition: YES NO
“A program that has more than one affiliated facility for residents/fellows-in-training and each resident/fellow-in-training completes their training at a particular facility(ies) rather than rotating to every facility during the course of the program”
If yes, please complete the form below (add additional rows as needed):
Name of All Clinics Associated with Program / Name and credentials of Faculty at this Facility
  1. Have you discontinued using any facilities in your Program? YES NO
If yes, please describe the impact of this change on your Program.
  1. Are your residents/fellows placed in clinics with referral for profit situations? YES NO

  1. Has there been a decrease in the Program’s current sources of funding? YES NO
If yes, describe the decrease, the reason for the decrease, the effect of the decrease, and the Program’s response to the change.
  1. Has there been a decrease in the educational resources available to faculty or residents/fellows?
YES NO
If yes, describe the decrease, the reason for the decrease, the effect of the decrease, and the Program’s response to the change.
  1. Has there been a decrease in the availability of support staff and services allocated to the Program?
YES NO
If yes, describe the decrease, the reason for the decrease, the effect of the decrease, and the Program’s response to the change.
  1. Has there been a decrease in the allocation or quality of accessible space for the Program?
YES NO
If yes, describe the decrease, the reason for the decrease, the effect of the decrease, and the Program’s response to the change.
  1. Has there been a decrease in the availability and accessibility to equipment or materials?
YES NO
If yes, describe the decrease, the reason for the decrease, the effect of the decrease, and the Program’s response to the change.
  1. Has there been any change in the didactic component of the curriculum? YES NO
If yes, describe the change, the reason for the change and the effect of the change.
Also, provide the course syllabi, including course description, educational objectives, requirements for successful completion, and teaching methods for all new courses.
  1. *Residency Programs: (Fellowship Programs skip to question 25; OMPT Fellowship Programs skip to question 26)
  1. Does your Program curriculum include a minimum of 150 hours of 1:1 mentoring by a physical therapist for every resident? YES NO
  1. Does your Program include a minimum of 100 hours (of the 150 hours) of mentoring in which the resident serves as the primary patient/client care provider? YES NO
  1. Does your Program curriculum include a minimum of 75 hours of didactic instruction for every resident? YES NO
If you answered “NO” to any of the above questions, explain.
*skip to question 27
  1. *Fellowship Programs: (OMPT Fellowship Programs skip to question 26)
  1. Does your Program curriculum include a minimum of 100 hours of 1:1 mentoring by a physical therapist for every fellow? YES NO
  1. Does your Program include a minimum of 50 hours (of the 100 hours) of mentoring in which the fellow serves as the primary patient/client care provider? YES NO
  1. Does your Program curriculum include a minimum of 50 hours of didactic instruction for every fellow? YES NO
If you answered “NO” to any of the above questions, explain.
*skip to question 28
  1. *OMPT Fellowship Programs:
  1. Does your Program curriculum include a minimum of 200 hours of theoretical/cognitive and scientific study in OMPT knowledge areas? YES NO
  2. Does your Program curriculum include a minimum of 160 hours, including 100 hours of spinal and 60 hours extremity, pre-clinical practical (lab) instruction in OMPT examination and treatment techniques? YES NO
  3. Does your Program curriculum include a minimum of 440 hours of clinical practice with an orthopaedic manual physical therapist instructor available? YES NO
  1. Does your Program curriculum include a minimum of 130 hours (of the 440 hours) of clinical practice under the direct clinical mentoring of the instructor in which the fellow serves as the primary clinician responsible for the patient/client’s care? YES NO
  2. Does your Program curriculum include a minimum of 40 hours (of the 440 hours) of interaction with the clinical instructors included in the curriculum with the focus of these hours related to clinical problem solving? YES NO
  1. Does your Program include a minimum of:
  1. One written examination? YES NO
  2. Four technique examinations on models and/or patients/clients with a minimum of one technique demonstrated during each exam? YES NO
  3. One patient exam with spinal/axial focus with the fellowship student being required to demonstrate skill in application of low velocity and high velocity manipulative (thrust) techniques? YES NO
  4. One patient exam with a peripheral/appendicular focus where the fellowship student is required to demonstrate skill in application of low velocity and high velocity manipulative (thrust) techniques? YES NO
  5. Oral defense: the fellowship student should be able to orally defend the examination and treatment decisions following each patient examination? YES NO
  6. Ongoing informal assessments of clinical competence? YES NO
If you answered “NO” to any of the above questions, explain.
*skip to question 28
  1. *Sports Residency Programs:(All other programs skip to question 28)
  1. Does your Program provide at least four technique examinations on such topics as rehabilitation techniques, advanced evaluation techniques, manual therapy techniques?
YES NO
  1. Does your Program provide at least one patient examination in the clinic for each: knee, ankle, spinal/axial, and upper extremity? YES NO
  2. Does your Program provide at least one patient examination on the field for both contact and non-contact sport? YES NO
  3. Does your Program provide at least one patient examination for pre-participation screen? YES NO
  4. Does your Program provide at least one patient examination for wellness evaluation?
YES NO
  1. Does your Program provide at least one patient examination for functional testing for return to sport for each: knee, ankle, spinal/axial, and upper extremity? YES NO
If you answered “NO” to any of the above questions, explain.
  1. Is your Program providing at least one written examination and two live patient/client examinations that are utilized for ongoing resident/fellow assessment? YES NO
If no, please explain.
  1. Has there been any change in the Program’s assessment process of its goals? YES NO
If yes, describe the change.
  1. Has there been any change in the Program’s assessment process of its faculty (didactic and clinical)? YES NO
If yes, describe the change.
  1. Has there been any change in the Program’s assessment process of its curriculum? YES NO
If yes, describe the change.
  1. Briefly describe changes made to the Program in 2012 as a result of ongoing program assessment of goals, faculty, and curriculum.

  1. Has there been any change in the Program’s assessment of resident/fellow initial competence and safety within the clinical setting upon entry into the Program? YES NO
If yes, describe the change.
  1. Has there been any change in the Program’s assessment process of resident/fellow advancing level of competence and safety? YES NO
If yes, describe the change.
  1. Briefly describe changes made to the Program in 2012 as a result of ongoing program assessment of the resident/fellow from entry into the Program through graduation.

  1. Has there been any change in the Program’s assessment of its graduates? YES NO
If yes, describe the change.
  1. Briefly describe changes made to the Program in 2012 as a result of ongoing program assessment of post-graduation performance of program graduates.

  1. Please comment about other changes, if any, that have affected the Program’s continued compliance with the evaluative criteria:

  1. How many applications did your Program receive in 2012?

  1. How many residents/fellows did your Program admit in 2012?
  1. Of those applicants not admitted to your Program, please indicate the reason:
Not an appropriate candidate (how many)
Good candidate, but no position available at Program (how many)