Feature Commentary

Clinical Mentoring: Study Groups for Diplomates & Other MDT Practitioners

Robin McKenzie regularly emphasized the importance of sharing knowledge and passing on skills and information. As a former Diploma tutor in MDT private practice for more than twenty-five years, I felt well-positioned to extend myself to help strengthen our community of practitioners.

Step 1: A Diplomate-Only Study Group

The first study group I developed was among my former Diploma students. I sketched out what a study group might look like, identified goals and objectives, and then, in early 2013, floated the idea out to this community of more than twenty individuals around the world.

What developed is a thriving monthly study group, with participants who meet once a month by conference call and internet to buckle on our critical thinking caps, discuss difficult and perplexing cases, problem-solve and share a collegial exchange of ideas.

Additionally, the study group provides an opportunity for networking and referrals across the United States, sharing of pertinent literature and enjoying each other’s company. Over its first three years, the group has experienced the birth of two children, job promotions and the release of a book, “A World of Hurt,” co-authored by Melissa Kolski, PT, OCS, Dip. MDT.

Now into our third year, the core group of five Diplomates rotates clinical leadership responsibility on a monthly basis. One week in advance of the scheduled meeting, participants receive an initial evaluation (with clinical review notes documenting the course of treatment) from the person presenting the case, allowing time for each participant to review the case. The cases are presented on a rotating basis for several reasons: each participant has the opportunity to hone their presentation and leadership skills, each participant can get feedback on difficult cases in their respective practices and each leader can introduce new ideas to the group.

In addition to clinical discussions, the topics of practice management, mentoring of students and patient handling skills have been broached. MDT World Press readers can get a sense of the value of the study group by reading feedback provided by group participants:

Melissa Kolski, PT, OCS, Dip. MDT
“For three years we have met with Todd and three to four other Diploma practitioners. It has been an invaluable experience of clinical problem solving and reasoning.  Monthly, I appreciate the experience of talking through cases. Presenting has become a helpful way to return to the fundamentals of MDT and explore other clinician's clinical pearls.

It is so nice to throw ideas around with like-minded clinicians. Since we are East Coast / Midwest, we also have had some good referral opportunities between us.”

Kay Scanlon PT, DPT, OCS, Dip MDT
“What does our online study group do for me? I look forward to our 1-hour meeting for inspiration, education and reflection each month.  Thinking about this, there are three main points that come to mind when I try to summarize the benefits obtained in this process.

  1. I work in isolation, like many of us who are in solo practices.   Day in and day out, I hear: “It’s my SI joint”, “My doctor says my pain is due to arthritis”, “it’s a facet problem”, or that all too common one: “I’ve been told I need to strengthen my core!”   It can be tough to downplay all this rhetoric you are bombarded with on a daily basis and return to your mechanical reasoning at times.  Having the study group meeting once a month helps me focus on classification rather than become distracted by all the chatter from patients.  It also reinforces the analogies and examples we provide to patients to help them understand their problem.
  2. I take away something from every discussion we have.  Sometimes, I’ll have a patient walk in the door the very next week similar to the case we discussed on our group.  Sometimes, I can reach a solution more rapidly that I may have previously, but more often I am able to recognize something a bit unusual that I may have missed in the past.
  3. This study group builds confidence!  It is not always easy to present a case you have struggled with in front of your peers.  Having to provide sound clinical reasoning, accept constructive comments and summarize a case in clear, concise language is confidence building in and of itself.   We do this with our patients every day, but sometimes need to step it up and do the same with our MDT peers.

I would encourage anyone wishing to learn and improve their understanding of MDT to consider forming a study group such as ours.  Setting a consistent time each month allows participants to prepare and block time out for self-study.   Send the case to your study partners ahead of time so they have a chance to review and formulate questions.  Find a few like-minded individuals and start your own group.  You won’t be sorry you did!”

Kristel Maes, PT, DPT, Dip MDT
“The Diploma program has given me the confidence and skills to treat my patients effectively, efficiently and according to the latest research. Finishing the Diploma program was like the last day of summer camp, and you wonder how things will go afterwards. Three years ago, Todd Edelson started a Diploma study group and, although I was the latecomer in the group, I have had significant benefits from these monthly online meetings. As few Diplomates get the privilege to work onsite together, we oftentimes are isolated on our islands and have no audience to bounce off our intriguing patient cases. Being able to present our patient cases and get some insight into treatment plans has helped continue to develop my clinical reasoning skills.”

Marie-Louise Merkx-Quinn, PT, DPT
“Being part of the McKenzie Diploma study group has allowed me to continue to grow, learn and be passionate about MDT.  With a peer group that has one common body of knowledge and reasoning skills, I can ask for advice, be humble, and be challenged on a monthly basis.  Simultaneously, this peer group with similar and different challenges in their work environments has grown over the years into a close-knit circle of colleagues, where knowledge, critical thinking and clinical reasoning is encouraged and stimulated.  Thank you for allowing me to be part of this group, and continuously 'sharpen the saw’!”

Step 2: An MDT Practice Study Group

With the success of the online, Diplomate study group, and fielding a regular stream of calls from healthcare practitioners requesting an opportunity to ‘shadow’ in either my New York or New Jersey clinic, the notion of on-site study groups became realistic. After discussion with the McKenzie Institute USA branch’s Executive Director, Stacey Lyon, we tested the ideas of holding study groups for Part B and above clinicians in Manhattan and Northern New Jersey. Kicking off in March 2016, 15 participants from as far south as the Philadelphia area, as far west as the Pennsylvania border, and as far north as Kingston, NY – each 100 miles away – arrived at my offices. The attendees were hungry to associate, and it was a pleasure to host them.

The format of the local study groups is similar to the online study group. We use a case study to stimulate the clinical reasoning process from evaluation through treatment and discharge. A formal discussion of force progression and the hands-on application of techniques are integral parts of the program. The participant has the opportunity to not only refine techniques, but also to understand when and why a particular technique should or should not be used.

Most of the participants in the study group stated they worked in isolation, whether or not there were other physical therapists in the clinic. They had the feeling that there was nobody in their work setting who spoke a common language. Others expressed that even just one meeting was helpful in attaining the Credential in Mechanical Diagnosis and Therapy (Cert. MDT). Everyone expressed great interest in continuing with the study group, and we subsequently grew to 18 participants in May. We will continue on a bi-monthly basis.

Key Points for Study Group Success:

  • Must have an expert in the room
  • Must have structure to the session
  • Must have a leader
  • Use electronic media to publicize and receive responses
  • Refreshments

I would encourage Diploma-level therapists with the inclination and capacity to share their knowledge and skills to form study groups and continue to stimulate MDT practice, professionalism, collegiality and networking. Many thanks to Stacey and the staff at the USA branch of the McKenzie Institute International for their support in these endeavors.