Joseph Signorino graduated with a Doctorate in Physical Therapy from the MGH Institute of Health Professions in Boston, MA, in 2010. He became a Board Certified Orthopaedic Clinical Specialist in 2014 and completed his fellowship training in orthopaedic manual physical therapy through Evidence in Motion in 2015. Following his entry level training in Boston, he returned to where his family lives and began working at the George Washington University Hospital Outpatient Physical Therapy Department in Washington, DC. During this time at the GWU hospital, he helped establish several programs including Acute Low Back Pain Clinic and the rehabilitation aspect of the Hip Preservation Program. Beginning in 2013 he became adjunct faculty with the George Washington University entry-level physical therapy program and transitioned to an assistant clinical professor in 2017. Among many responsibilities within the entry-level program, he enjoys engaging the most with entry level students in the Advanced Manual Therapy Electives for the Peripheral joints. In addition, Dr. Signorino is faculty with Evidence in Motion following his graduation in 2015 and engages with post-professional learners in a hybrid learning environment. Lastly, he is published in peer reviewed journals along with a textbook chapter on ankylosing spondylitis.
What inspired you to pursue fellowship training?
My drive to pursue fellowship training was established about two years into practice. I exited entry level training with the drive and passion many share – to change the life of each patient (Utopic – I know!). However, after about two years of practice I found myself repeatedly reflectively asking, “What am I doing?” I realized I was making some patients better, but I was often unsure of how I got there. I was showing up for work, believed I was good at what I was doing, and was told I was good at what I was doing. However, I remained uncertain of what I was actually doing! At that moment, I knew I needed further training and a change in clinical thinking.
Additionally, I was privileged to have two fellowship trained clinicians – Cody Weisbach and Paul Glynn – as clinical instructors during my last internship rotation as an entry level student. It was during this experience that I was exposed and guided to appreciate the need for a greater level clinical reasoning in daily practice. I’m grateful for the guidance, time, and impact these two clinicians had on my professional journey. It was this experience that exposed me to what it means to be a fellowship trained clinician and what led me to pursue fellowship training two years into the start of my career.
What fellowship program did you attend and why?
I attended Evidence in Motion’s (EIM) Orthopaedic Manual Physical Therapy Fellowship. The decision to pursue fellowship training came concomitantly when I was getting married and buying a house (these real life events!). With these life events, I knew relocation to pursue fellowship would be challenging. This encouraged my research to include hybrid model fellowship programs. This learning format allowed me to pursue fellowship training without disrupting my current work and home life. My research led me to find EIM, which is an AAOMPT recognized fellowship program with renown faculty. Additionally, I reached out to mentors and colleagues to inquire about different programs. Truly, each fellowship program is different. I wanted to ensure I made the best decision possible to match my needs to what the program had to offer. In the end, the choice I made to attend EIM surpassed all expectations when I entered the program.
What did your fellowship program entail (as far as specific training, etc.)?
The hybrid model program included online training, onsite lab intensive weekends, and onsite clinical mentoring. The program took me about 3 years to complete. The online course work is spread out over time and includes 4 primary management courses for each body region. Discussion board conversations and patient cases were supportive assignments to all the pre-recorded lectures and material. The fellow in training later repeats these same courses as a teaching assistant to ensure command of the material. Following these management courses, the fellow in training enters fellowship specific courses for 12+ months to focus on clinical reasoning – these are the practice changing and hallmark courses of the program! These virtual courses meet weekly and include regular, ample, and honest discussions about clinical performance. These hallmark courses evolve the hypothetico-deductive reasoning process that is most associated with the Maitland based approach, but discussions include all approaches guided by clinical reasoning and evidence.
Onsite training was the time when manual therapy skills were developed and refined with like-minded individuals. Scattered throughout fellowship training are “fellow only weekends” lead by well respected leaders within the field. I would often leave these weekends with a renewed energy and an expanded professional network!
Are you trained in any specific areas of manual therapy (e.g., Maitland, McKenzie, etc.)? If so, why did you choose that area?
Fellowship training guided on problem-based clinical reasoning most often associated with a Maitland approach. With that said, there was exposure to a diversity of management approaches and coaching to best balance the available evidence, our clinical experience, and the patient’s values when making clinical decisions.
What advice would you give to new grads aspiring to pursue residency/fellowship training?
Fellowship and/or residency training is an exciting opportunity to advance your clinical knowledge and skillset. I often encourage anyone thinking or considering pursuit of fellowship training to spend significant time researching, asking questions, and ensure you have an organized, meaningful, and coherent reason WHY you wish to pursue further training. Also, ensure you thoroughly discuss the plan, idea, and your ambitions with your personal support team!
There are a growing number of fellowship programs available. Identify if the program is recognized by APTA and/or AAOMPT. Does this matter to you when making your decision? Does the program allow you to submit for fellowship status with AAOMPT, and again, how does this influence your decision? I also encourage folks to speak to colleagues (fellow AND non-fellow colleagues, critics and non-critics), graduates from specific programs of interest, and program directors. Create a list of meaningful questions that are important to you and seek the answers. Some examples could be “What is the practice approach or model highlighted throughout the program?” “What are the support networks within the program to help the fellow in training succeed?” “How is mentoring aligned with the program’s curriculum?” “What opportunities open up for the graduates after program completion?” “What is the benefit of being a fellowship trained physical therapist?” That last question is often a question I receive and, yes, I do have my 60sec elevator speech that I will spare you. Ensure the drive to pursue fellowship is wholesome and genuine to your professional goals and planned life trajectory. Fellowship training offers the opportunity to join a network of like-minded folks that ambitiously work to improve the life of each patient he or she encounters along with progressing this amazing profession. To me, this is the essence of fellowship training, which then allows me many avenues to achieve this common goal. If you do decide to pursue fellowship training, enjoy the ride and get ready for both professional and personal growth!