FORT SAM HOUSTON, Texas - Since July 2007, five physical therapists have been perfecting their skills through research and caring for wounded warriors at Brooke Army Medical Center to help define the future of physical therapy.

Capt. Daniel Rhon and Maj. Norman Ayotte of the Army; Air Force Capt. Ben Hando; Navy Lt. Cmdr. Leslie Hair and Lt. Cmdr. Duneley Rochino, are students in the U.S. Army-Baylor University doctoral program in orthopaedic manual physical therapy.

"We are taught to be an advanced clinician which is an important skill to have when dealing with the complex patient," Hair said. "This program is the pinnacle of being a clinician."

The only program of its kind in the Department of Defense, the training combines the doctor of science degree with fellowship training in a full-time residence program. It focuses on a rigorous and formal academic curriculum with intensive clinical training in the advanced management of complex orthopaedic conditions.

"There are only 14 other programs in the nation that provide this type of clinical fellowship experience, but few of them are full-time programs and fewer still have the academic and research rigor," said Maj. (Dr.) Skip Gill, graduate program director and associate professor of the program.

The fellowship is credentialed by the American Physical Therapy Association and overseen by BAMC Graduate Medical Education. The degree is accredited by Baylor University Graduate School.

"At BAMC, we have a challenging patient population that spans the spectrum of musculoskeletal diagnoses, and faculty with clinical expertise to guide the students during mentorship," Gill said. "Being in close proximity to the AMEDD Center and School offers the ability to share faculty between programs and coordinate on research efforts."

To be considered for the program, applicants must be active-duty physical therapists with at least a master's degree in physical therapy. Candidates are competitively selected from the Army, Navy, Air Force and Public Health Service. Slots are allocated to each service depending on availability.

"Academically, the program builds upon the entry-level professional training of each candidate, typically 60 or more graduate credit hours beyond the master's level," said Dr. Gail Deyle, deputy director of the program, associate professor and the program's founder. "The doctor of science degree is considered a terminal degree by most universities for the purpose of determining tenure status and rank."

Army selected candidates must apply to a long-term civilian training selection board that ranks applicants by their military records and their letters of intent for the training opportunity, Gill said.

"Each of the services has a similar competitive process. Only the more competitive applicants actually apply to the board," he said.

When Rochino applied, he was worried about getting in, because of being stationed on the USS Nimitz and then in Naples, Italy, isolated from mainstream physical therapy for six years.

"I did as much as I could on my own to be a good clinician, a good officer and be competitive," Rochino said, "but I knew I was going up against people who have had a lot more exposure to the latest and greatest ideas. I had heard this was going to be tough, but everything I heard was an understatement."

With a month to go before graduation, Rochino is optimistic.

"This is probably the best program for physical therapy in the United States period," said Rochino. "The clinical skills learned by the students are placed within a flexible framework of thinking, allowing us to make the best decisions for our patients as quickly as possible."

Like Rochino, Hando had some doubts about being accepted in the program. But, he applied, because the doctoral program was one of the reasons why he joined the military.
"I was realistic about my chances of getting in ... that they were low. I applied once and was rejected," Hando said. "But I kept applying and became fairly optimistic that if I persevered I would eventually get accepted."

The success of the program derives from the faculty, a group of national and international recognized leaders in the field, who serve as academic professors and clinical mentors. The students see patients half-days with intensive one-on-one mentorship four to five hours per week. The rest of the day students are taught courses, such as anatomy, biomechanics, physiology, statistics, lab and practical courses or conduct research.
Sometimes training consists of 16- to 18-hour days.

"A physical therapist, who does not attend this type of program, will never have their practice scrutinized and analyzed for the better after leaving their initial entry-level training," Rhon said. "The meticulous daily mentorship from a group with such vast knowledge and experience is priceless."

The program provides an ideal training environment to develop physical therapy skills as clinicians, researchers, teachers and leaders, Hando said.

"We have many of the leaders of our profession teaching us and passing on their expertise," Hando said. "We are involved in high-level research that will change the way our profession is practiced in the future. We are also offered the opportunity to contribute to this in a meaningful way."

The research that Hando speaks about is the capstone project of the program. Each student is required to develop a topic, conduct research and write a manuscript for publication. In addition to individual research projects, students participate in large group-projects, many of which have won national awards.

This year's clinical research topics ranged from the treatment of lumbar spinal stenosis by Rochino to the effects of manipulative treatment for hip arthritis by Hando to investigating the role of the low back muscles contraction in people with low back pain by Hair.

Each student's research will be published in a peer-reviewed medical journal.
"As difficult as it has gotten, and as little time as I have had with my Family over the last 18 months, even with the frustrations involved with a strenuous work schedule, I have never regretted coming to this program," said Rhon. "I think I will always look back on my career and realize that this was a huge pivotal and strategic point in my life that laid out the foundation for the rest of my career."

On Dec. 18, Rhon, Ayotte, Hando, Rochino and Hair will be the seventh class to graduate. After graduation, these uniquely trained physical therapists will be used as clinical experts and mentors, who are capable of being independent researchers and aligning clinical practice with the best research evidence for orthopaedic physical therapy.

Typically, graduates of the program are assigned to larger military clinical settings to increase interaction with other physical therapists. In the past, several graduates have deployed, become faculty for the AMEDDC&S entry-level program, or completed a postdoctoral research fellowship, said Deyle.

"My experience in the program and since has convinced me there in no better program in the nation," said Gill, a 2004 graduate. "The students are great, too, always striving for the best out of their minds and hands, but always with the best out of their hearts in caring for the patients."

(Jen Rodriguez works in the Brooke Army Medical Center Public Affairs Office)