During PGY2-4 years attending physicians work closely with residents, allowing more responsibility as indicated by the resident’s level of ability. Residents acquire core PM&R knowledge including gaining familiarity with the natural history and recovery for major rehabilitation diagnoses, performing functionally oriented history and examination (neurologic and musculoskeletal), and mastering the appropriate communication skills necessary to interface with patients, family and the team. Residents are trained on developing a rehabilitation plan of care, continuity with patients, and focus is placed on developing leadership skills. Diagnostic and procedural training is emphasized in outpatient rotations and includes ultrasound, EMG, ultrasound guided injections, spinal injections, and injections for management of spasticity including botulinum toxin injections and intrathecal baclofen management.