The first year in our Program as a PM&R PGY1 resident involves completion of preliminary training in internal medicine (including ICU, hematology/oncology and geriatrics), inpatient pediatric medicine, cardiology, neurology, endocrinology, and radiology. The primary objective for first-year residents focuses on developing fundamental clinical skills. By the end of the first year, residents should demonstrate competence in history-taking, physical examination and establishing a treatment plan. Knowledge of general internal medicine and its subspecialties is essential for subsequent management of clinical problems frequently encountered with PM&R patients.
The majority of the resident’s second year as a PGY2 is spent on the inpatient rehabilitation units. Introductory PM&R lectures help new residents rapidly become comfortable with their specialty and the field in general. Attending physicians work closely with residents, allowing more responsibility as indicated by the resident’s level of ability. Beginning in PGY2 year, residents participate in teaching a 1st-year medical course: SCOPE (Skills in Complete Physical Examination.) Residents also supervise 3rd and 4th-year medical students during their elective in PM&R. During the second year of training, the primary emphasis is to acquire the core PM&R knowledge base and basic PM&R skills, including:
- Familiarity with the diseases, natural history and recovery for major rehabilitation diagnoses (traumatic brain injury, spinal cord injury, stroke, amputation, joint replacement and other orthopaedic conditions, to name a few), and reasonable proficiency in managing inpatient care
- Understanding neurogenic bowel and bladder conditions
- Prevention and management of complications related to bed rest and immobility
- Performing a functionally oriented history and examination, including neurologic and musculoskeletal aspects
- Familiarity with major functional scales
- Knowledge of the training and roles of other rehabilitation professionals, team dynamics and the role of the rehabilitation physician
- Documenting effective and succinct admission, daily notes and discharge summaries appropriate to rehabilitation of patients
- Understanding the unique problems of geriatric and pediatric patients
- Mastering the appropriate communication skills necessary to interface with the patient, family and the team
- Developing a medical and rehabilitation plan of care upon admission, and plans for continuity of care post-discharge.
The third year of training (PGY3) is a mix of inpatient- and outpatient-related activities (including electrodiagnosis), and consultations. Educational objectives include:
- Demonstrated independence in the care of inpatients
- An ability to evaluate patients on other services for advice on management, or appropriateness of transferring them to the rehabilitation unit
- Knowledge regarding the evaluation and management of common rehabilitation outpatients (usually musculoskeletal or follow-up care for inpatients)
- Performance of basic electrodiagnostic studies with moderate supervision
- Team leadership skills
- Providing assistance to medical students and junior residents
- Knowledge of orthotics and prosthetics
The fourth year of training, (PGY4) is primarily outpatient-focused, with an emphasis on gaining competence in the management of patients commonly seen in PM&R outpatient settings as well as competence in electrodiagnosis. PGY4 residents enjoy elective time to gain enhanced experience in selected areas, or exposure to subspecialty areas. The educational objectives are:
- Management of outpatients with acute and chronic pain and injury
- Ongoing outpatient care of patients with neurological impairment and disability
- Rehabilitation management of patients who have connective tissue disorders
- Proficiency with soft tissue injections and use of ultrasound guidance
- Performance of aspiration and injection techniques for common joints
- Performing multiple spinal injections
- Understanding the fundamentals of cardiac and pulmonary rehabilitation
- Competence in the performance of electrodiagnostic techniques
- Leadership and administrative skills.
- In keeping with the new ACGME procedural requirements, the program is tailored to expose the residents to the specialties’ where the procedural training is provided.