Choosing the Right O&P Residency Takes Self-awareness, Persistence, and Patience

Earning a master’s degree is a critical step in the journey to becoming a certified orthotist or prosthetist. Once a graduate achieves that milestone, the focus shifts to finding and completing a residency program. Because the residency experience will shape their entire career, it’s imperative to find the right fit—but what makes that fit is as unique as the individuals themselves. Despite their individuality, graduates share the common sentiment that choosing a residency is among the most stressful parts of pursuing a career in O&P. We spoke with residents, residency directors, and educators about factors that influence the experience, and any advice they have to ease the stress of this process. Determining which type of program to choose is the first of many decisions for residents. There are three options for residencies accredited by the National Commission on Orthotic and Prosthetic Education (NCOPE). Graduates can focus on a single discipline of orthotics or prosthetics for a minimum of 12 months, or they may choose to combine O&P residencies for a minimum of 18 months. Each format is delivered in combination with either a clinical track or a research and development track. The chosen track defines the activities and patient care required for a specific program type. “I encourage residents to make sure the site they select can really support their chosen track,” says Meg Sions, PT, PhD, DPT, assistant professor and certified orthopedic specialist at the University of Delaware. “If you want a research residency, then pick a site that is invested in the research process and how important it is.” Building a Career Path Through Residency Many residents have a good idea of what they want to get out of their residencies and what they want their focus to be in their future careers. Still, it’s not uncommon for that focus to shift along the way to an area they hadn’t previously considered. “We get applications from all over, mostly through NCOPE OPRESCAS,” says Anne DuBois, CPO, residency director for the Orthotic & Prosthetic Centers in Florida and the Carolinas. “About 75 percent are sure they know what they want and then there are others who are open to what works best for the clinic.” DuBois encourages graduates to visit as many clinics as possible and to be open to options beyond their initial top choices, which might better align with their goals. “I advise them to go and spend time at these places, because they’re going to be with these people a lot, and they want it to be a good experience,” she adds. Incoming resident Carolyn Ornato agrees. Ornato earned her undergraduate degree in biotechnology from Plymouth State University and her master’s degree at the International Institute of Orthotics and Prosthetics (IIOP). “Shadow at the clinic you’re applying to if possible,” she says. “Not every clinic is built for everyone—you will be spending a lot of time with these people, and it will determine your experience there.” Ornato took that approach when choosing her residency at Hanger Clinic, Wheat Ridge, Colorado. Location was a big factor in Ornato’s decision, and she chose a place she could see herself being for at least two years, or longer if she were to be offered a position. “It’s a job and a residency, but it isn’t just about them choosing you,” she says. “It’s also really important that it’s a dynamic that works for you. At the end of it we all have to pass the same test, so it’s your education and your future that you’re advocating for.” “My advice to other residents is to be patient,” Ornato says. “It’s going to happen so try not to stress yourself out too much about it.” As one of the largest residency providers in the United States, Hanger Clinic places 70 graduates each year in clinic locations across the country, according to Doug Reber, CO, director of education and the national residency program. He says there are as many as 150 residents rotating through the program at any given time between first- and second-year residents. “We interview students while they’re still in school,” Reber says. “And I remind them that this is an extension of their education because I think that can be forgotten sometimes.” Hanger Clinic offers single and dual residencies, and its program comes with the benefit of access to a very large network of clinicians and leading experts in the field. Reber advises all candidates to spend a day or two at the specific clinic they’re targeting. “It’s about the whole team and these people become your family so it’s important that personalities mesh,” he says. “I tell people that they don’t have to take the first offer they get. If your values don’t match and it doesn’t feel like a good fit, keep looking.” Hanger Clinic aims to keep residents on at one of its many clinics after they finish the program. “With a number of clinicians retiring, residents are the future of Hanger Clinic, and our goal is to retain them and help them thrive.” Besides large clinic systems, graduates have no shortage of options when it comes to choosing their O&P residency path. Institutions and clinics do their due diligence to spread awareness about their programs through NCOPE’s OPRESCAS and other outlets. Heidi Truman, CPO, residency director at University of California, San Francisco (UCSF), takes a hands-on approach in her role to fill residency spots. She manages all applications and oversees the interview team, which consists of residency mentors and clinical staff that will be working directly with residents. “I do outreach to all O&P educational programs and provide an overview of our residency so it’s on people’s radars,” she says. UCSF currently has a 12-month, single-discipline residency with three orthotics residents and one prosthetics resident. Residents have monthly check-ins and use the NCOPE Tracker to ensure they meet their goals and completion date. Truman’s approach is to help residents achieve the right balance of experience and exposure. “You can get a lot of targeted experience but only minimal exposure to other things,” she says. “Because we are part of the UCSF medical institution, there is a broad patient population here, so our residents are exposed to a wide spectrum of care.” When it comes to choosing a location, Truman advises residents to rank their list of priorities. “Decide what you can compromise on and what is non-negotiable,” she says. “If geographic location to your family is your number one priority, for example, that will help you zone in on your options, and then perhaps you compromise on the exact type of residency.” Defining how the resident views the experience is also important, according to Truman. “Do you see this as an extension of your education or as your first job? Because those are different mindsets,” she says. “If you see it as part of your education process, that opens you up to take it all in versus seeing it as an 8 a.m. to 5 p.m. commitment.” For Truman, the most rewarding part of her role is watching residents grow and being able to provide the tools and resources to help them achieve their goals. “They come in with a lot of knowledge, but not a lot of context, so it’s great to see it all connect when they’re working with patients and growing to become more independent with care.” Different Residencies, Different Paces The importance of selecting a program that complements learning style was a recurrent theme among the people we spoke with. Wright & Filippis, which has 19 locations throughout Michigan, offers single, one-year residences in O&P, with a fast-paced rotation schedule for each. Orthotics residents complete six rotations over a maximum of ten weeks. Prosthetics residents complete five rotations over a maximum of four weeks. “If rotating through different sites fairly quickly isn’t going to fit with your personality then this won’t be a good match,” says Seth Cochrill, CO, residency director. “We know some people will do better with a single rotation site, so we want to paint an accurate picture upfront.” Wright & Filippis promotes two-way feedback and Cochrill believes this results in the best experience for residents. “There has to be a level of comfort and the ability for people to speak up about what they need and what they’re not getting. They aren’t as afraid to make a wrong decision because they know they’re going to get the communication from a mentor to help them figure it out.” As residency director, Cochrill gives all candidates the opportunity to have a private conversation with a current or outgoing resident. “Often when you’re shadowing, you only hear the good things,” he says. “Challenges or frustrations are not something you’re typically going to tell your shadower on the first day, so we provide this opportunity for a more candid conversation.” Baylor College of Medicine’s Master of Science in Orthotics and Prosthetics program is also a fast-moving program, with 122 rotations and 48 residents moving through its dual residency program each academic year. Rotations happen at any of its nearly 200 partner clinic sites across the US. “Our residents are technically dual status, but they all complete their [Commission on Accreditation of Allied Health Education Programs] requirements in the first 12 months of the program prior to beginning their 18-month residency,” explains Lisa Abernethy, MSPO, CPO/L, the school’s associate director of clinical education. “In this model they are moving around a lot and must build trust quickly. They have to show their skills and demonstrate that they know what they’re doing in a short amount of time.” Abernethy says advocating for residents is one of the most fulfilling parts of her career. “If something happens, I can help them move to a different site, and I get to ensure they have a great experience.” Brad Martin, CPO/L, is associate program director at IIOP and a former orthotics resident at Wright & Filippis. In his role at IIOP, he works to connect students with residency programs. And from his own residency experience, he knows very well the importance of finding the right fit. Martin completed his orthotics residency at Wright & Filippis—a move he says was a game changer on his professional path. While there, he studied under 21 different preceptors. “I didn’t have much clinical experience, and all of my preceptors pushed me to think critically and ask the right questions when creating treatment plans,” he says. That cognitive process translates well to the competency-based approach needed in O&P education, he says, including residency. It wasn’t until beginning his prosthetics residency that Martin fully realized the positive impact of his orthotics residency experience. “I received little guidance in my prosthetics residency and was expected to carry a large caseload immediately,” he recalls. “Without the solid clinical foundation and critical thinking skills acquired in my first residency, I don’t know how successful I’d have been or how differently my career may have turned out.” Martin participates in IIOP’s curriculum development and community outreach. This includes following up with residency sites and preceptors to see which areas students are doing well in and which areas they could improve upon. “Our main objective is maintaining academic standards and creating competent, ethical practitioners. However, making sure that our graduates are ready for real-world practice requires input from the preceptors working with them on a daily basis.” Many students Martin works with have an idea what they want to focus on, but he advises them to get experience in other areas as well. “I tell people to consider shadowing in that area they don’t think they want to specialize in versus only shadowing in their main passion,” he says. His advice to future residents is to use all resources available to them and not to limit themselves. “We had one student go to China for their externship, so don’t rule anything out—if you want something, go for it,” he says. Martin says students must always be networking and self-advocating. He also recommends bookmarking the NCOPE and the American Board for Certification in Orthotics, Prosthetics & Pedorthics sites to stay up to date on all information regarding residency and board exams. “No one is going to come and find you to give you the information,” he says. “It’s your residency and the outcome will reflect the effort and energy you put in.” When a student finds an opportunity he or she is interested in, Martin emphasizes the importance of research and attention to detail. “Something as small as knowing a company’s mission statement can set you apart from other applicants,” he says. “You should know the patient population they serve, and you should have questions of your own for interviewers about what they are looking for in a resident—that is a big one.” Michelle Hall, MS, CPO/L, FAAOP(D), O&P residency director at Gillette Children’s Hospital, echoes Martin’s comments on knowing the details of any desired residency site. Furthermore, she encourages applicants to tailor their resumés and correspondence to the specific opportunity. “You can go anywhere, so communicating why you want a specific residency is critical,” she says. “I look for what it is about our program and our patient population that makes a resident want to come here.” Defining Residency Selection Criteria Lauren Bogardus is an IIOP graduate who recently signed on for a dual O&P residency with West Coast Brace and Limb, Tampa, Florida. “It’s been a long process and stressful at times,” she says. “When I went to IIOP for my master’s degree I fell in love with O&P.” During her time at IIOP, Bogardus was a Special Olympics volunteer and also started an adaptive dance program. “All of this solidified what I wanted from a residency and landed me in Tampa—and I am really happy to put down roots here,” she says. Bogardus understands well how a person’s unique experiences shape what they are looking for in a residency. After moving around most of her life, finding a place where she could plant those roots was high on her priority list. “I was looking for a place where I could see longevity in being there,” she says. “I also know that I want to be in a central fabrication lab for residency and am an aspiring clinic manager post-residency. Beyond that, I want to be well rounded in my experience and I am not looking to specialize in anything right now.” Bogardus took a four-part approach to vetting and selecting her residency and says she would advise future residents to consider a similar process. “Number one is to show up,” she says. “Go shadow, go to conferences, volunteer—throw yourself into it.” Flexibility was number two on her list, she says, because residency hiring timelines don’t always align with graduation dates. Third on her list was finding a solid support system, and she recommends finding an unbiased mentor/mentors for advice. “Being able to talk to people with knowledge and experience throughout the process was nice.” Last but not least, she says, trust yourself. “You will get lots of feedback,” she says. “But ultimately, you need to make your own decision and follow your heart.” Samantha Bousman is also an IIOP graduate. She began her residency in January at Hanger Clinic, Annapolis, Maryland, and will complete one year each of O&P. Bousman says her path to residency wasn’t necessarily a straight one, and she encourages other residents to lean on the network they build along the way. “Keeping in touch with the people you shadow and leveraging them as mentors is important,” she says. “I found my residency largely because of those relationships.” Finding a patient-centered experience was key for Bousman and she encourages other residents to do the same. “I got into this field to help people with their right to mobility and to improve their mobility so for me that was key,” she adds. As someone who juggled clinical rotations and coursework while she was trying to secure a residency, Bousman appreciates how frustrating the timing of graduation and residency application deadlines and start dates can be. “It was stressful because it was October, and there weren’t a lot of residencies posted,” she says. “But you just have to put the time in and be patient. Positions will open up.” Reflecting on the journey has provided some necessary perspective when things get stressful, Bousman says. “It takes a lot of school to get to this point between undergraduate studies, grad school, and then residency,” she says. “It’s very rewarding and I am looking forward to starting and excited to gain more confidence to get to where I want to be.” Reagan Handley also completed her master’s degree at IIOP. Her desire to work with patients and undergraduate degree in materials engineering, combined with volunteer work all led her to O&P. “My mom and I volunteered with the Exceptional Foundation of Birmingham, Alabama, which provides resources for families of children with special needs,” she says. “We would do family fun nights and a lot of the kids wore AFOs and prosthetics.” Handley will be completing her residency at Hanger Clinic in Nashville, Tennessee. Her advice to other residents is not to be afraid to reach out. “Pick up the phone and make a call, even if the location you want isn’t offering a residency,” she says. “Whether or not you gain a residency, you’ve gained a great contact.” She advises residents to talk with professors or other mentors before signing a residency contract to ensure they don’t miss anything they should be asking for. Besides helping patients, being able to serve as a mentor and sounding board for others is one of the things Handley is most excited about in her residency and career. “Whether it’s a professor or someone in the field, it’s nice to have a sounding board,” she says. “That really helped me stay focused and on track when looking for my residency, so I look forward to being able to fill that role for someone else.” Todd DeWees, CPO, residency director and manager of O&P at Shriners Portland, understands the stress resident applicants feel. But he says selection criteria is more multifaceted than candidates realize. “One of the big misconceptions is that they’re expected to have some level of skill that makes them stand out,” he says. “But they really are on a level playing field in terms of their qualifications—I look more at their interest in learning, willingness to put in effort, and their excitement.” Like Martin, DeWees says having an understanding of the residency they’re targeting can make a big difference. “It’s good to have an understanding of the specific site they’re looking at, and that they’ve done their research, and they’re not just checking a box,” he says. Shriners Portland offers one residency per year in a multidisciplinary environment and on a traditional schedule. DeWees says that allows the hospital to focus on that one person, help the resident expand his or her strengths, and bolster weaknesses. He tries to be a source of wisdom and counsel to every incoming resident he encounters. “I tell them to be strategic—it’s easy for this to feel separate from their education rather than the completion of it,” he says. “Once you’re certified, you don’t have the opportunity like you do in residency.” Karli Kochman is six months into her residency at Pongratz Orthotics & Prosthetics, Tucson, Arizona. She stresses the importance of relationship building throughout the educational journey. Kochman worked and shadowed at Pongratz as an undergraduate and they later recruited her for residency. She says it’s important for residents to lean on mentors, and to always have a backup plan. “My mentor and I have regular check-ins and he has a good feel for how I learn—he talks to me about my goals and a contingency plan,” she says. “You don’t want to fail, but it’s smart to have a plan in case that happens.” Shared Mission All the residents we spoke with share the same mission, idealism, and desire to make a difference in the lives of patients. And all of them are eager to get started making an impact in their field. Bryce Dahl, CO, is a board-eligible prosthetist who finished his residency at Hanger Clinic in Dayton, Ohio. He will be taking his exams in April and then moving on to Clarksville Brace and Limb in Tennessee. “Like all of us, I want my career to be patient driven, and to practice with integrity,” he says. Dahl says he believes the best way to stay true to the idealism that brings people to this profession is to always continue learning. “I don’t want the end of my residency to stop my education,” he says. The best practitioners will tell you they learn something new from their patients every day. I plan to leverage knowledge not only from my own patients, but also other practitioners to be the best prosthetist I can be.” Tara McMeekin is a writer and editor based in Colorado. Deciding the Details Choosing between single and dual residency comes down to past experience, education, and personal preference, according to Chris Robinson, MS, MBA, CPO, ATC, FAAO, clinical resource director for NCOPE. “Learning both orthotic and prosthetic patient care at the same time isn’t easy,” he says. “But if a resident can multitask effectively, and they are at a residency site with an adequate patient population and the resources to do both at the same time, for many residents, it is an ideal situation.” Regardless of the path and location chosen, Robinson says that both the resident and the residency mentors and directors have responsibilities to ensure success. “When there is good, frequent communication, things generally go quite smoothly,” he adds. Residency standards and minimum expectations are the same regardless of location, Robinson says, so finding a program where residents feel they can succeed, and one that complements their personal learning style is key. Robinson urges taking advantage of available resources provided to residents when they register and throughout the residency, including the reporting functions built into NCOPE Tracker. “Reports can be generated in NCOPE Tracker from day one, so residents should be using that information to their advantage,” he says. “The biggest reason combined orthotic and prosthetic residencies get extended is that residents don’t spend enough time engaged in orthotic care or prosthetic care, so they end up having to extend to meet the residency standards.” Because each residency site is unique, Robinson urges residents to conduct their own inquiries for a comprehensive picture of what their training may look like. “An O&P clinic or institution’s website is only going to tell you so much,” he says. “You need to ask questions of the residency director, mentors, and current/recent residents to better understand whether or not it truly meets your needs.” He recommends asking questions about program outcomes, such as what percentage of residents finish on time, what percent pass their board exams on the first attempt, and what job placement opportunities exist for residents that complete the program. Robinson also encourages taking advantage of NCOPE’s Resident Networking Directory to connect with people that have completed their residencies. “Residency experiences change over time, so talking to people that have recently gone through the program at a location a person is considering will help them a lot.” Amy Funke, MSOP, CPO, Master of Science in O&P (MSOP) Program Director at Concordia University, says a graduate’s educational background plays a significant role in choosing a residency that will be a good fit. “I’m an advocate for finding a residency that complements your schooling,” she says. Students at Concordia have the opportunity to begin working in their field while they are still in school and can align their educational path accordingly. Concordia partners with nearby Century College, and the MSOP program is based on combined coursework between both institutions. The program is typically three years long but can be completed in two years with dual enrollment. “A lot of students are able to start working full time in the field in their second year and many of them get residencies that way,” Funke says. As daunting as the residency experience can feel for students, Funke says seeing everything connect for them is the most rewarding part of her job. “Witnessing that learning moment is wonderful,” she says. “And while making a difference for a single patient is great, I also get to be part of teaching a whole group that will be able to impact countless patients.” Image: andrey_orlov/stock.adobe.com

Choosing the Right O&P Residency Takes Self-awareness, Persistence, and Patience

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Grading, Assessment, and Motivation to Learn

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Editor’s Note–March 2024

Grading, Assessment, and Motivation to Learn

Grading, Assessment, and Motivation to Learn

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Orthotic and Prosthetic Clinics of America—Jacksonville, FL

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