Second-Order Consequences: The Unexpected Effects of Applying to FOX’s Geriatric Residency Program

By Megan Mitchell, PT, DPT

Geriatric Clinical Resident

I applied to FOX’s Geriatric Residency Program because I believed it would provide me the opportunity to further develop my clinical knowledge, critical thinking, and the ability to receive feedback. As a new graduate, I was missing the years of clinical experience that make some clinicians excellent, and I wanted to be excellent. I wanted to give excellent care to my patients, and I knew that a residency program would provide me with the resources to do so. With that mindset, I applied to FOX’s Geriatric Residency Program. I was set out to improve one aspect of my life oblivious to the potential influence it would have on others.

There is a term that behavioral economists use often: second-order consequences. It means that every action has a consequence, and each consequence has another consequence. That is what has happened to me. I have been the beneficiary of second-order consequences. In just four short months, the tools that have been taught to me to be a better clinician have bled into almost all aspects of my life. I am reaping the benefits of it, and you could too.

Start with “Why” … Then Learn how to Answer “But Why”

One of the first things you learn in residency is how to answer the question “Why?” Not just how to answer it, but to anticipate that the question will be asked and to make decisions based on how it should be answered. For instance, you know from the start of mentoring that when you choose an intervention for the client you are going to be asked the reasoning behind that decision – the “why.” Knowing this expectation, prior to each intervention chosen, I have learned to think carefully about what the purpose of the exercise is and what outcome I am trying to achieve.

In the first month of residency, you are hyper-focused on answering the simple question “why?” to each exercise. However, the questions increase in complexity as time passes. Now it’s not just “why?” but “why this particular exercise over another?” “why this exercise at this speed, at this intensity, at this point in your session?”

Now this line of questioning is something you expect from a residency program. I knew my thought process was going to be challenged. And it has made me infinitely better as a clinician because of it. What I wasn’t expecting was how this line of questioning would cause me to see and interact with the world more intensely.

Changed Perspectives: Learning How to Dig Deeper During Residency

Before residency, I would describe my thought process and interpretation of events as shallow. Not in a judgmental way, but what I mean to say is that I took everything at face value. I hardly questioned what I read, observed, or interpreted. And I hardly put in the work to take any information to the next level. Not because I was lazy, but because I was a victim of the Dunning-Kruger Effect. I didn’t know that I didn’t know.

Let me give an example: podcasts.

Prior to residency, I would hear the interviewer ask a question, the interviewee answer, and then the interviewer move on. “Describe to me your morning routine.” “I wake up at 5 am, take 10 deep breaths, meditate, run, eat breakfast…” And to me, that was entertaining, insightful and useful. I didn’t know that I should be examining deeper.

But I do now.

The interviewer should have followed up with: “How did you develop this routine?” “How do you know this is working for you?” “Why 10 breaths instead of five or 15?”

Being a FOX Geriatric Resident has shifted my perspective to think more critically about why I am doing something, how I came to that decision, and how that decision will then impact future decisions and actions.

Residency Expands your Critical Thinking on Both the Macro & Micro Level

I’ve started to anticipate the “Why?” in almost everything I do. Asking myself before I act: Why am I doing this? What benefit will it serve? Sometimes the answer is simple: because it’s fun. But other times it makes me question if I am spending my time in the best way, or is there something else I could be doing that would have more of an impact?

When creating a plan of care for our patients we need to have the ability to zoom in on the details of their impairments while also zooming out to see how those impairments and goals fit into the larger picture of their life. Where are they now? Where do they need to be? What is the most effective and time-efficient way to get them there?

Learning the skill to efficiently flip back and forth between the micro and the macro view has not only helped me create an effective and efficient plan of care for my patients, but it has illuminated where I am in life and what I need to do to get to where I want to be. It’s the balance between making smart decisions for who I am today while also benefiting the person I will be in five years.

Go Fast. Go Purposefully. Go for FOX’s Geriatric Residency Program.

There’s a reason physics differentiates between speed and velocity. Velocity is the speed with a direction. Residency has given me direction. It has propelled me on the path of clinical excellence and leadership. Given me the tools required to manage multiple projects at once. To consistently seek out and learn, to constantly review old materials. To be able to organize my thoughts, conduct meetings, and sell my ideas.

You might apply to FOX’s Geriatric Residency Program to become a skilled clinician, but I am certain you will come away with more. I am thankful for the unexpected second-order consequences of my acceptance into FOX’s Geriatric Residency Program.