Featured Fellow: Dr. Raine Osborne PT, DPT, OCS, FAAOMPT

Dr. Osborne is the Director of the Brooks Rehabilitation Clinical Research Center. He also serves as a member of the Brooks Institute of Higher Learning Residency and Orthopaedic Manual Physical Therapy Fellowship faculty and is an adjunct professor with the University of North Florida (UNF) Doctor of Physical Therapy Program. His primary research interests are in the area of post-professional education, specifically investigating the factors influencing professional development and interprofessional education. Dr. Osborne completed his physical therapy training at the University of South Florida and his residency and fellowship training in orthopaedic manual physical therapy at Brooks. He is currently completing his doctorate in educational leadership at the UNF under the mentorship of Dr. Daniel Dinsmore. In addition to his research and teaching activities, Dr. Osborne also serves in a variety of roles for several state and national professional associations.

Areas of Interest

Dr. Osborne’s clinical interests include orthopaedic manual physical therapy (OMPT) with particular focus on spine and chronic pain conditions. As an educator, Dr. Osborne is particularly interested in the development of clinical reasoning skills, advanced proficiency in OMPT practice, and interprofessional collaborative practice. Dr. Osborne’s research interests include post-professional education (in particular residency training), interprofessional education, and OMPT clinical outcomes.

What inspired you to pursue fellowship training?

My two goals as a physical therapist have always been to provide the best care I possibly can to my patients and to help advance the physical therapy profession in order to better meet the health care needs of society. Pursuing the highest level of clinical training available was an essential next step for me after completing my residency training. As an orthopaedic clinical specialist, primary interest is spine and chronic pain. I am grateful that a Fellowship pathway exists in my area of interest and hope to see this pathway open for many more subspecialties.

What fellowship program did you attend and why?

I attended the Brooks Institute of Higher Learning (IHL) Orthopaedic Manual Physical Therapy Fellowship. I initially completed my residency training with the Brooks IHL because I thought the organization was well aligned with my professional views and goals and that the mentoring I received would push me to practice at the best of my ability. The residency exceeded my expectations and I knew I still had a lot to learn from my mentors who would also be my mentors in the fellowship.

What did your fellowship program entail (as far as specific training, etc.)?

There was a variety of experiences and learning opportunities built into my fellowship program. There was some classroom learning, but this was mostly in the form of my cohort members and I preparing and presenting lectures on specific topics. These lectures were moderated by our instructor and the best part was the ensuing discussions. We focused on in-depth learning of the anatomy and biomechanics of the musculoskeletal system along with clinical reasoning skills that took into account the entire biopsychosocial model of practice. Through this process we also learned about education theory and were mentored on providing education to others, culminating in a continuing education course the we designed presented as a cohort. We held lab sessions where we learned and refined OMPT techniques we already knew and learned new ones. We also participated in a variety of shadowing opportunities including with radiologist, conservative musculoskeletal care physicians, surgeons, and physical therapists practicing in highly specialized areas of practice. We developed scholarship skills by completing 4 written case studies and presenting these as a platform style presentation to other clinicians within our system and community. At least one of these had to be submitted for presentation at a national conference such as AAOMPT. We also received mentoring on patient care with our own patients which allowed for direct and monitored integration of the knowledge and skills were learning in class into our practice. There are probably a few other experiences I am overlooking at the moment.

Are you trained in any specific areas of manual therapy (e.g., Maitland, McKenzie, etc.)? If so, why did you choose that area?

I prefer not to claim any one philosophical approach to OMPT practice as I believe this unnecessarily places a label on one’s OMPT training and does not adequately reflect the level of clinical reasoning that goes into selecting the best approach for a particular patient at a particular time. I will say that have had formal training in several “approaches” and find many useful concepts and techniques from all. There is a famous quote by the economist George Box – “all models are wrong, some are useful”. The trick is to understand when certain aspects of the various manual therapy approaches are useful and then apply them appropriately, always monitoring the effects to see if your assumptions and biases were accurate or if you need to make a change. I think we as manual therapists tend to get caught up trying to make patients fit our models of what should be helpful as opposed to the other way around. My advice to newly developing manual therapists is to start with learning about the most time-tested and respected approaches. Focus on the why and the how. This means deeply understanding the theoretical basis behind the techniques or approach, what you should expect if applied appropriately, and become highly skilled in the application. Then compare and contrast the techniques with each other, with the literature, and with any new or more fringe approaches or techniques. You can only make a fair comparison and judgement about what is appropriate, with who, and when if you understand the similarities and differences and are able to perform them equally well. This is a professional development activity that extends well beyond fellowship, but fellowship gives you the tools to continue on the journey outside the confines of a formal education program.

What advice would you give to new grads aspiring to pursue residency/fellowship training?

Do it!  If you are unsure about what area of practice you want to specialize in, or if you struggled to just make it through the day on your final rotation then you may want to wait a year, but still do it!

If you are unsure about a specialty area then I recommend doing some reflection to help identify what kind of position you should seek for a year. If you found yourself totally wrapped up in whatever rotation you were on at the time during PT school and are having trouble deciding on a specialty then perhaps seek a position that provides variety, reflect on what it is that stokes your passion about each setting or population, and then learn about which type of residency would provide you with the skill set best aligned to help you be successful with pursuing your passion. If you find a passion within a specific specialty area then wonderful. If you find that your passion is for something more general then remember that completing a residency does not pigeon hole you into one area of practice or setting. The skills and mentoring you receive will be valuable regardless of area of practice.

If you are debating between two areas of practice, and you are that person describe previously, perhaps take a position in the area you feel less sure about. If your interest and passion wains over time then you have your answer. If it is sustained, reflect on what it is about the area that you really love and determine which type of residency would best prepare you to continue developing in that area.

If you know your passion but struggle with the numerous competing demands of daily clinical practice then perhaps take a position in your area of interest, learn more about yourself, your needs, and how to manage the competing demands and then seek a residency program that will best help you develop in the areas you need. In any case, talk to the residency program directors and faculty, be candid about the areas you know you need work on and your longer term goals. A program that is a good match for you will appreciate your self-awareness and clarity about development goals.

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