Dr. Farrell was a Senior Clinical Fellowship Faculty member of the Kaiser Permanente Northern California Orthopaedic Manual Physical Therapy (OMPT) Fellowship program for 34 years. His influence on the profession as a clinician, teacher and researcher spans over 40 years. He is recognized as one of the pioneers of evidence-based treatment in Orthopaedics and Manual Therapy in the U.S. and played a critical role in the development and promotion of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), where he was a founding fellow and first national president. He co-owned and operated a successful private practice and recently retired from patient care after 41 years in clinical practice. He has been honored by the American Physical Therapy Association (Catherine Worthingham Fellow), Orthopaedic Section (Paris Distinguished Service Award) and the AAOMPT (John McM. Mennell Service Award & Distinguished Lecture Award) for his service and professional contributions.
He remains active serving as a mentor, presenter at national conferences and as a researcher of topics relating to clinical reasoning and employer perceptions of Residency and Fellowship training in the U.S.A. Additionally, he currently serves on the Board of Directors of the PulsePoint Foundation, Sudden Cardiac Arrest Foundation, and Advisory Boards of the Via Heart Project and the HeartSafe Committee of the San Ramon Valley (California) Fire Protection District.
What inspired you to pursue fellowship training?
My first physical therapy job was at Massachusetts General Hospital (MGH) in Boston (1976). I was very fortunate to be mentored by a clinician from Sydney, Australia and an American clinician who were both trained in Orthopaedic Manual Physical Therapy (OMPT) in Australia. I quickly learned that my undergraduate PT training did not really teach me a very good interview or physical examination for orthopaedic patients. Additionally, I was fascinated by their clinicial thinking (clinical reasoning) with every patient who walked in the door and how they presented with excellent problem solving skills. Their mentoring inspired me to think about every clinical decision I made and to “prove” my thinking through treatment/assessment/treatment/assessment concepts that were inherent to the Australian approach of patient management.
The first year at MGH I took a couple of OMPT weekend seminars and become frustrated that I really had just touched on a fraction of what I needed to know to apply what I had been exposed to in those courses. This led to some in-depth discussions with my mentors at MGH who strongly urged me to apply to Post Graduate Diploma in Manipulative Therapy courses in Adelaide and Perth for advanced OMPT training; so that I could obtain training in clinical reasoning, which would be applicable for life-long learning as a clinician.
What fellowship program did you attend and why?
I was accepted in the autumn of 1978 to attend the Post Graduate Diploma in Manipulative Therapy year long program at Curtin University in Perth, Western Australia. In the USA, there were no OMPT residency or fellowship programs which were offered on a long term basis; OMPT course work and clinicial mentoring. My immediate goal was to attend a program in Australia which was well established from an academic and clinical viewpoint.
The two most established Manipulative Therapy courses in Australia were the programs at University of South Australia in Adelaide led by Geoff Maitland, and the Perth program at Curtin University led by Brian Edwards, Bob Elvey and Dr. Lance Twomey. My choice at the time was to attend the Perth program since I was not accepted for admission in South Australia.
What did your fellowship program entail (as far as specific training, etc.)?
The program in Perth included course work in: Gross and Applied Anatomy, Neurophysiology, Biomechanics, Statistics and Research Design, Clinicial Pathology and detailed Manual/Manipulative therapy courses relating to interviewing, physical examination, therapeutic exercise, thrust/non thrust interventions, and clinicial reasoning. I worked in a hospital outpatient clinic at the Royal Perth Hospital 20 hours/week and was mentored 10 of those 20 hours by faculty of the program which included Brian Edwards and Bob Elvey. The main emphasis was on the Maitland/Australian philosophy; however, I was exposed to the Norwegian Approach since Edwards has spent considerable time with Dr. Kaltenborn in Norway. At the time, Robin McKenzie was developing his examination and treatment concepts; thus I was also exposed to his approach while studying in Perth.
Upon completion of the Post Graduate Diploma in Manipulative Therapy (one year of training), Dr. Twomey invited me to be his first Master’s Degree student, therefore I continued another two years of study in Perth conducting a Manipulative Therapy randomized clinical trial (RCT) with Dr. Twomey. The results of our study was published in the Australian Medical Journal in 1981. While conducting the RCT, I worked in two private practices in Perth where I collected data for our RCT. Additionally, I spent allot time in Brian Edward’s and Bob Elvey’s private practices, which was an invaluable clinical experience.
Are you trained in any specific areas of manual therapy (e.g., Maitland, McKenzie, etc.)? If so, why did you choose that area?
As one can surmise, from the answers to the above questions, the main emphasis of my OMPT training was in the Maitland/Australian approach. The rationale to study the Australian approach revolved around the clinical reasoning concepts that are inherent to that philosophy. I learned that the clinical reasoning concepts allowed me to integrate any OMPT concepts into the Australian clinicial reasoning paradigm.
What advice would you give to new grads aspiring to pursue residency/fellowship training?
Find a good mentor who understands you as a person and has an eclectic understanding of our physical therapy profession. Often your first mentor is a professor at the university where you have completed your DPT training. Seek advice from your mentor about choosing your first job and in subsequent years about career decisions as they arise. Your first employer will likely be most influential upon your career and should provide you with ongoing mentoring.
Try to acquire a job which offers mentoring by a graduate of an accredited American Board of Physical Therapy Fellowship and Residency Education (ABPTRFE) residency or fellowship program. Additionally, some clinics will offer tuition reimbursement for Residency and Fellowship training if you commit to work at the clinic of employment for 2-3 years. Don’t be bashful to ask for tuition reimbursement!!!
Embrace the “life-long learning” concept and continue to educate yourself throughout your career to improve your clinical and patient management skills.
Our profession has adopted the medical model of education as it relates to Residency and Fellowship post graduate training. If you choose a clinical pathway as a DPT professional, I strongly urge you to pursue Residency and Fellowship training in your chosen specialty.
I can confidently add to this question; that if I did not pursue fellowship training in OMPT, I likely would not have had a career that spanned 42 years. I was never bored with clinical care since the clinical reasoning concepts I had learned early in my career and that continued to evolve throughout my career, instilled self-assessment and self -analysis skills of my performance as a clinician and teacher. Self-assessment on a regular basis helped me grow as a clinician and enhanced my problem solving skills to the point where my patients over the past 30 years of my career were those which had seen multiple physicians and physical therapists. Needless to say, my patients challenged me significantly and I learned to always accept the challenge of difficult and tough patients. The balance of the evidence based triad of best evidence, patient preferences and clinical experience/expertise dictated my clinical practice and teaching.
Lastly, keep up deliberate clinical practice. You have to practice to climb the ladder of clinical expertise!!! You will learn more from your patients than you will from reading the literature since not all patients fit into the “Nice” evidence informed “Box.”