As stated in a previous post, I recently completed my orthopaedic residency with Scottsdale Healthcare. One of the prime focuses of orthopaedic residencies is preparation to sit for the Orthopaedic Certified Specialization Exam (OSCE). This is accomplished with lectures from various perspectives. In one of the final lectures, we discussed case examples with multiple choice answers to determine what we thought the answer should be and then how we thought it should be answered for the OCSE.
To some, these may sound one in the same. However, with completion of the residency we have come to an understanding how evaluating and treating our patients with considerations of any movement impairments that lead to the injury is essential. Unfortunately, this is different from how much of orthopaedic physical therapy (in school, on the NPTE, and the OCSE) is typically taught. As Jim stated in an earlier post, we need to move from a pathoanatomical perspective to a kinesiopathological perspective when treating our patients. If you review your notes from school or any material for preparation for the NPTE or OCSE, you may notice that orthopaedic pathology is listed by the injured tissue and, thus, intervention and evaluation techniques are directed at that injured tissue. For example, the pathoanatomical model may direct you to treat tendinopathy with eccentric exercises or a herniated disc may be treated with mechanical traction. The kinesiopathological model instead would direct the clinician to evaluate and treat based on movement impairments that lead to the tissue irritation. This is the equivalent of treating the original cause of the symptomatic tissue, instead of just treating the symptomatic tissue.
During my final few days of the residency, I took some time to decide if it was appropriate to sit for the OCSE. This may sound like a "no-brainer" at first glance, but I wasn't sure it was worth getting specialized in material that was primarily based on the pathoanatomical model. Unfortunately, with how long the process is for question development for the OCSE and research in general, much of the material on the exams is outdated by at least a few years (this does not even take into account the frustrations of focusing on higher levels of evidence). In the end, I decided it would still be beneficial to pursue orthopaedic specialization. While a large portion of the exam is focused on the pathoanatomical model, some still includes a look at movement impairments and the original cause to injuries. Additionally, there is a view in the physical therapy community that those with an OCS are experts in the orthopaedic area. It never hurts to be aware of and appropriately apply information from the OCS as much of it is still clinically relevant. Basically, we must always remember where we come from. We should be aware of the previous methods of treating and evaluating injuries, so that we can critically assess what should and should not be incorporated in our care. It can be difficult reviewing and memorizing material that you likely won't apply clinically, but it has a beneficial result of raising the status/awareness of the clinician in both the patient and health care community upon successful completion.
James Heafner DPT, Chris Fox DPT, and Brian Schwabe DPT, CSCS are recent graduates of Saint Louis University's Program in Physical Therapy.