Fellowship Journey: Part 2

As I continue to introspect over my fellowship journey with Sports Medicine of Atlanta (SMA), I wanted to share some thoughts on mentorship and outcome measures.
Mentorship: One of the benefits of fellowship is the amount/degree of mentorship that is required.  I was very fortunate to interact with several mentors who were able to challenge my beliefs and rationale for treatment.  These individuals included:

  • Francois Prizinski, PT, DPT, OCS, FAAOMPT, COMT, DAC
  • Kenneth Learman, PT, PhD, OCS, COMT, FAAOMPT

Throughout mentorship, I was not only able to observe other individuals treat, but also have them observe me.  The level of interaction was quite different than  that we get with clinical education.   Fellowship mentorship truly assesses your ability to critically think and clinically reason (cognitively and metacognitively)—at least within SMA.    I was often asked, “What do you think is going on” and “Why do you think that way”.   They weren’t simply looking for, I suspect there is a lax ACL because Lachmans was +“.  They were instead looking for, This individual came down from a jump, when she noticed a “pop”.  This pop may have truly been an ACL rupture or it may have been an auditory input cueing the brain to alter the action program of the lower extremity, as a means of defense.  When looking around at her teammates, she noticed their reactions, and because they were emotionally reactive, her response potentially could have been driven by the firing of mirror neurons.  We need to look at her movements in closed and open environments and assess her reactions to care as we add/subtract several types of inputs”  This level of thinking helped me understand the amount of “noise” that can influence the nervous system.
When I began fellowship, I knew I would get 1:1 work with my “manual skills”, but I didn’t realize how much my thinking, thoughts and beliefs would be involved.  For this, I am extremely grateful.

Outcome Measures:  When I began fellowship, my primary mentor, Francois Prizinski, worked with me to identify several goals for completion.  One of these goals was the development of a “course”.   The course we planned was built upon my interest of expressing the clinical utility of pain science.   Several years later, this course has evolved into several written and state-approved courses, which I am teaching to clinicians, residents and fellows.  I was afforded the opportunity to interact directly with other clinicians who had successful clinical education courses and was able to fine-tune my ability “to teach” (doctoris).  IMG_0327

Other Thoughts: Overall, I think there is a misconception that “fellowship” training is the mastery of a bunch of “tricks”.   It is quite contrary (at least with SMA).  Don’t get me wrong, becoming a “manual therapist” requires the development of many fundamental skills, but overall it helped develop the thought process of not only when to use a skill, but “why” it might work.
Moving forward, I have transitioned from the role of the mentee, to the mentor.  I am fortunate to be working with some bright individuals and tomorrow, I will be receiving and analyzing a narrative review for submission for publication on mirror neurons (and their potential clinical utility in PT practice), from one of the newest fellowship candidates, Mark Powers.  While I embrace this current opportunity, I hope I am able to create a similar experience (that my mentors created for me) in those whom I interact.


As therapists, we must never stop questioning why things work.  We must embrace the dynamic and wonderful complexity of the human being, because when we begin to treat the diagnosis, and not the individual, we have failed.  Fellowship, helped me understand this.
Joseph Brence, PT, DPT, COMT, FAAOMPT, DAC

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Critical Thinking

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