Physical Medicine & Rehabilitation Residency Rotations and Yearly Objectives

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The PM & R Residency Program at the University of Rochester is a four-year program accepting candidates at the PGY1 level. We participate in the National Resident Match Program (NRMP) for three PGY1 positions each year. The candidates must apply through ERAS. The minimum qualifications include the following; a medical degree; i.e., an M.D or a D.O., successful completion of USMLE STEP 1, and J1 Visa or permanent resident status, if not a US or Canadian citizen.

In order to make a successful transition from a first-year resident PGY 1, to a PMR specialist competent to practice independently in a variety of settings at the end of the PGY 4 year, requires the assimilation of vast amounts of information and the acquisition of specific skills. Each year there are specific goals and objectives to be met prior to graduating to the next level. Appropriate supervision and guidance are given to each resident as they progress in their knowledge and skills. The program director meets with each resident formally at least twice per year, and more frequently, if desired. At these meetings the program director and the resident discuss his/her progress and formal evaluations, and identify areas for further growth and study. Listed below is a summary of the resident rotations and objectives for each resident year.

PGY 1 Level

PGY1 -- Internship
During the first year, residents complete a preliminary year of training in internal medicine (including ICU and Geriatrics), emergency medicine, neurology and surgery. The most important PM&R objective for first-year residents is to develop proficient clinical skills. By the end of the first year, residents should be able to demonstrate competence in history-taking, physical examination, and establishing a management plan. Knowledge of general internal medicine and its subspecialties is essential for subsequent management of clinical problems frequently encountered with patients in a PM&R setting. The clinical assignments and evaluations during this year are the responsibility of the residency program where they rotate.

PGY 2 Level

The goals of the PGY 2 year are the acquisition of the core PMR information base and basic PMR skills. This would include the following:

• Familiarity with the presentation, natural history and recovery for the major rehabilitation diagnoses, and become reasonably proficient in the management of their inpatient care (TBI, SCI, stroke, amputation, joint replacement and other orthopaedic conditions).
• Understanding neurogenic bowel and bladder, and the prevention and management of complications secondary to bedrest and immobility.
• Ability to perform a functionally oriented history and examination, including neurologic and musculoskeletal aspects.
• Familiarity with and use of major functional scales.
• Knowledgeable about the training and roles of other rehabilitation professionals, team care, and the role of the rehabilitation physician.
• Ability to develop a medical and rehabilitation plan of care upon admission and to develop plans for continuing care post-discharge.
• Understanding of the unique problems of geriatric patients.
• Development of appropriate communication skills necessary to interface with the patient, family and the team.
• Ability to organize effective and succinct admission and daily notes, and discharge summaries appropriate to rehabilitation of the patients.

The majority of the PGY 2 year is spent working on the inpatient units, with responsibility for 10-14 patients. There may be some outpatient and consult assignments. The "Introduction to PMR" series helps new residents to begin feeling comfortable with the field of PMR as rapidly as possible. The faculty attendings work closely with the new residents, granting more responsibility as indicated by the resident's level of ability. Residents may participate in the supervision of a senior medical student.

PGY 3 Level

The PGY 3 year is a mix of inpatient, outpatient (including EMG), and consultations.

Educational objectives for the PGY 3 year include:

• Increased independence in the care of inpatients.
• Ability to evaluate patients on other services for advice on management, or regarding their appropriateness for transfer to rehabilitation.
• Beginning acquisition of knowledge regarding the evaluation and management of common rehabilitation outpatients (usually musculoskeletal or continuing of care for inpatients).
• Ability to perform basic electrodiagnostic studies with moderate supervision.
• Demonstrate team leadership skills.
• Provide assistance to medical students and junior residents.
• Increased knowledge of orthotics and prosthetics.
• Successful completion of formal courses offered during the year.

PGY 4 Level

The PGY 4 year is outpatient focused, with emphasis on gaining competence in the management of patients commonly seen in PMR outpatient settings, and competence in electrodiagnosis. Residents have ample elective time to also gain enhanced experience in selected areas, or exposure to subspecialty areas (eg. industrial rehabilitation, sports medicine, neuromuscular disease clinic, medicine, multiple sclerosis clinic, pediatric and adult rheumatology, cardiac and pulmonary rehabilitation, pain treatment center, spine clinic, childrens' disability center and childhood early intervention evaluations, comprehensive outpatient rehabilitation programs, VA hospital PMR clinic, amputee clinic, rural PMR outreach, spasticity management (botulinum toxin injection, baclofen pump evaluation and management, SCI fertility clinic, electrodiagnosis and evoked potentials (multiple sites in both PMR and Neurology).

In addition, each PGY 4 resident will do 3 - 4 months of a "chief resident rotation", which is designed to be a "real world" practice experience. This experience combines a small inpatient service with consultative and outpatient work. Each resident also serves for 3 - 4 months as administrative chief resident, responsible for scheduling, on-call schedule, setting up the Teaching Day schedules and communication. The PGY 4 resident is expected to take a leadership role in assisting and teaching junior residents and medical students.

Research: Two months will be spent doing research. Residents are expected to complete a project such as a poster presentation, literature review with presentation, completion of a manuscript prior to completion of their residency training. Residents can compete for funding through the Resident Rehabilitation Research Training Program.

Residents choose to begin the process of choosing a topic or project during the PGY 2 year.

The educational objectives for the PGY 4 year are as follows:

• Learn appropriate management of outpatients with acute and chronic musculoskeletal pain/injury.
• Learn appropriate ongoing outpatient care of patients with neurological impairment and disability.
• Learn appropriate rehabilitation management of patients with connective tissue disorders.
• Become proficient with soft tissue injections.
• Become capable of aspiration and injection of common joints.
• Understand the fundamentals of cardiac and pulmonary rehabilitation.
• Obtain broad exposure to pediatrics.
• Become competent in performance of basic electrodiagnostic techniques.
• Demonstrate appropriate leadership and administrative skills.
• Demonstrate ethical behavior and decision-making.

The residents at PGY 2, 3, & 4 levels are offered didactic courses in the following areas:

• Anatomy
• Ethics
• EMG
• Financial Basics
• Geriatrics
• Hands-On Musculoskeletal Course
• Leadership
• Pediatrics
• Psysiatric therapeutics
• Psychology
• Prosthetics & Orthotics
• Research
• Rheumatology