The advice below provided here is not intended to be a comprehensive list of resources. This guide should be used as a companion as you go through medical school of how to get into a PM&R residency.
1st YEAR MEDICAL SCHOOL
The 1st year of medical school is very exciting but can be overwhelming due to the volume of learning involved. Your primary focus should be acclimating to your new environment and learning how you learn best. Most medical schools include an “Introduction to Clinical Medicine” type of course that is designed to help translate your didactic learning into a clinical setting.
- Contact a physiatrist that is affiliated with your school and try to set up shadowing opportunities.
- Get involved (or even run!) your medical school's PM&R interest group.
- If there is no physiatrist affiliated with your school, contact the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and review its Frequently Asked Questions. This document has been created from actual medical students inquiries and can be one of your best resources!
- Join AAPM&R for FREE! Yes, it is free to be a member as a student. Click here to complete an application today.
- Using the AAPM&R search engine, you can find a Physiatrist in your area to reach out to for additional shadowing opportunities.
- Consider keeping a journal while in medical school to document and reflect on your experience and also to record stories that might be useful in your personal statement when you apply for residency positions.
The summers in medical school are definitely a time for rest and relaxation after a tough year! It is also a perfect time to gain more experience in the field. Some ideas include:
PAID SUMMER EXTERNSHIPS
Some Departments of PM&R offer summer externships that provide a mixture of research and clinical experiences.
- Check with your PM&R department to see if there are any summer Research opportunities. If your school does not have a PM&R department, there is likely related research in another field. Check your departments of neurology, neurosurgery, orthopedics, pediatrics, and internal medicine (i.e., rheumatology, geriatric medicine) for possible research opportunities.
- The Association of Academic Physiatrists (AAP) offers the Rehabilitation Research Experience for Medical Students (RREMS) program. This program allows first-year medical students to experience research within the specialty through an eight-week summer elective.
- If you will be spending your summer near a PM&R residency program, contact the program director to see if there are any opportunities for you to participate.
Another fun way to get exposure is to become a summer counselor at a summer camp for children with disabilities or adaptive sports camp.
Some examples include:
- Schwab Rehabilitation Hospital in Chicago, IL hosts Camp Schwab every August and accepts enthusiastic volunteers.
- Texas Scottish Rite in Dallas, TX hosts many camps for children with various disabilities throughout the year.
- Peak Potential (founded by pediatric physiatrist Dr Jen Fu Cheng at Children’s Specialized in NJ) helps children with disabilities rock climb and reach new heights at the NJ Rock Gym (various locations in NJ including Princeton and Fairfield). https://www.facebook.com/PeakClimb/timeline
- Get involved with organizations in your area such as Adaptive Adventures, an organization which works with people with physical disabilities.
- There are also local and national adaptive sports organizations which you can get involved in such as the Special Olympics.
- If your medical school has a PM&R department, contact them to see if you would be able to set up a shadowing opportunity with the department (oftentimes, you can combine this with research).
- If your medical school does not have a PM&R department, contact the Academy to help locate physiatrists and try to set up shadowing opportunities. You may also try contacting PM&R programs in your area as well.
- Try to set up opportunities in a variety of settings (i.e., inpatient, outpatient, electromyography/nerve conduction studies, interventional spine, sports medicine, pediatrics, spinal cord injury, brain injury, joint injuries and amputee management).
- Clinical rotations for the first year medical student should be focused on getting to know the field and if it is a good fit for you.
2ND YEAR MEDICAL STUDENTS
Doing well on the USMLE/COMLEX exams will only strengthen your application, and these scores are becoming more important as PM&R has become more competitive over the past few years (especially with the more competitive programs) Click here to see the most recent reports compiled by the NRMP regarding Match results.
At the end of the 2nd year, medical students should understand:
- Basic musculoskeletal and neuroanatomy
- Elements of a history and physical
- How to perform a basic musculoskeletal and neurologic exam
3RD YEAR MEDICAL STUDENTS
Finally, you have reached the clinical portion of your training—get excited! Every school has a set core curriculum for mandatory rotations. However, there is some variability in terms of duration of rotations and/or possible electives that students are offered.
Between your 3rd and 4th year, it is also highly advisable to undertake a clerkship in PM&R. Please find below a list of these provided by the Association of Academic Physiatrists (AAP) by clicking here.
Most away rotations at other institutions require 3rd and 4th year medical students go through the VSAS application/website, which usually has a list of away rotations by specialty that are accepting students that year (once logged in, go to the “Electives” tab and select “Physical Medicine and Rehabilitation” from the “Specialty” pull-down menu). Your medical school may need to provide you with further information on how to register and log into VSAS.
"PM&R Knowledge Now" is also a resource available to medical professionals that provides information on common PM&R related topics (similar to UpToDate but for PM&R topics, many of which are not covered on UpToDate):
When you are doing rotations in other specialties, try to think about these PM&R-related objectives which you will commonly see in our field:
- Understand diagnosis and treatment of chronic pain problems
- Learn to assess airway and pharmacologic considerations perioperatively
- Learn EKG interpretation
- Consider indications, benefits and goals of cardiac rehabilitation
Critical Care Medicine
- Learn about critical illness polyneuropathy and myopathy
- Learn about tracheostomy and ventilator management
- Learn about wound care wound care
- Understand how to assess a rash
- Learn about diabetes management and understand how it can lead to complications such as vascular disease, neuropathy, chronic wounds, amputation, and other impairments
- Learn about outpatient management, working with both adults and children requiring primary care for either medical issues, preventive screening, routine follow-up, or other common medical needs
- Learn about sports medicine and other musculoskeletal management, pain management, how various medical conditions can lead to impairment/disability
- Learn about what qualifies a patient to be on Disability
- Learn the indications, risks, contraindications, and management of percutaneous endoscopic gastrostomy (PEG) tubes
- Learn about stoma management
- Learn about assessment of nutritional status
- Learn about transplant hepatology
- Investigation and management of more common conditions such as diarrhea and constipation
Hematology / Oncology
- Learn about late effects of chemotherapy, infectious complications
- Understand how to investigate causes of anemia
- Learn about anti-coagulation, as well as duration of treatment for DVTs, PEs and strokes
- Learn about treatment of common infectious diseases (i.e., urinary tract infections, pneumonia, infectious diarrhea) and consider how they might present and be treated in a less common population (i.e., spinal cord injury, traumatic brain injury, stroke, post- operative joint replacements, etc.)
- Learn about infectious issues with transplant patients
- Learn about common genetic disorders that might present in a pediatric PM&R practice such as Down Syndrome, Cystic Fibrosis, the Muscular Dystrophies, Fragile X, and Spinal Muscular Atrophy
- Learn about kidney transplant, dialysis indications
- understand the indications and considerations for fistula care
- Become proficient at your neurologic exam
- Learn management and complications of acute stroke, Guillain- Barre Syndrome, Multiple Sclerosis, ALS, myasthenia gravis, Lambert-Eaton, Parkinson’s Disease
- Gain exposure to electromyography/nerve conduction studies
- Learn the indications and surgical management for acquired brain trauma, spinal cord/column injury, vertebral disk herniation, central nervous system (CNS) tumors, and spasticity
- Learn to interpret imaging and how they correlate to physical exam findings, treatment, and functional prognosis
- Learn musculoskeletal anatomy and physical exam techniques
- Learn indications for surgical and non-surgical management of musculoskeletal injuries
- Learn basic peripheral joint injections
- Learn to interpret imaging and how they correlate to physical exam findings, treatment, and functional prognosis
- Learn basic splint management, staple and suture placement and removal
- Understand the mechanics of swallowing
- Learn about the indications for a tracheostomy, management and risks
- Learn how to change and manage a trach and decannulate
- Learn about normal and abnormal development
- Management of chronic medical conditions including cerebral palsy, muscular dystrophy, spina bifida, and scoliosis and how they relate to function
- Learn about pulmonary rehabilitation, pulmonary toilet
- Practice reading chest-xrays
- Learn about addiction, substance abuse, post-traumatic stress disorder (PTSD), delirium vs. dementia, how to assess for capacity to make medical decisions
- Learn indications for imaging for neurological and musculoskeletal conditions
- Learn radiographic anatomy and interpretation
- Learn medical management for chronic rheumatological conditions.
- Learn basic peripheral joint injections or aspirations
- Gain exposure to various surgical areas including Cardiothoracic, Vascular, Plastic, Transplant, Surgical Oncology, Trauma, Burn, Oral and Maxillofacial, Orthopedic, Podiatric surgery
- Learn about many surgical procedures and what they entail, as well as how they may impact function post-operatively
- Learn to order appropriate urologic studies, supplies, and medications for patients with neurogenic bladder due to spinal cord injury, stroke, brain injury, and other neurologic disorders
- Gain skills in catheter placement and learn about the different catheters that are available to patients
- Learn about various procedures available to patients with bladder/urologic issues
- Disaster Medicine, Medical Ethics, Biomedical Engineering, Hospice and Palliative Care, Pain Management, Sports Medicine, Diving Medicine
4TH YEAR MEDICAL STUDENTS
Your 4th year is another exciting and pivotal point in your medical training. All the more reason for you to have a game plan and stay organized! There are many things that you need to keep track of as you transition from 3rd year to 4th year. Some things that you want to keep in mind as you plan your 4th year (make sure to also check out the Step-by-Step Guide to Applying for PM&R Residency page):
Starting EARLY is always a good step. Aim to submit your applications through ERAS as close to the opening date for applications as possible. Some programs fill up their interview spots early so the earlier the better.
PERSONAL STATEMENT TIPS:
- Writing a good personal statement does take a lot of time and self-reflection.
- Have others proofread your personal statement and allow them enough time to do so.
- Your personal statement is a very important part of the interview process.
- It is your opportunity to set yourself apart from other applicants. There are many opinions about what elements make a good personal statement.
- Being too conservative can be just as risky as being too bold.
- The opening sentence is the most important line in the personal statement. It should invite the reader to keep reading.
- Draw on personal and/or patient experiences to help relay why you want to go into PM&R. You could refer to your journal for ideas and stories.
- Include why you think that you would be a good physiatrist.
- Make sure that your grammar and content flows for easy reading.
- Finish with a strong closing paragraph.
- Have multiple people (faculty, friends, family, etc) provide you feedback and criticism on your personal statement. A good piece of writing always benefits from multiple drafts.
Letters of recommendation
- Most programs require 3 letters of recommendation for residency.
- A letter from a physiatrist is not a requirement at all residency programs but it is HIGHLY advised, especially if your medical school has opportunities for you to rotate in PM&R PM&R letters of recommendation are also becoming more important as the specialty becomes more competitive and most applicants provide at least 1-2 letters of recommendation from PM&R faculty.
- Most PM&R programs require a preliminary year (intern year), most commonly in Internal Medicine or Surgery. It is strongly advised that you get a letter of recommendation from either Internal Medicine or Surgery if you are applying to these respective fields for prelim year. Please note that some Internal Medicine preliminary year programs may require up to 4 letters of recommendation (this usually includes the Internal Medicine departmental letter, which is a general letter your medical school’s Internal Medicine department should be writing for every medical student applying for an Internal Medicine prelim year). Most prelim programs accept (and sometimes even expect) the PM&R letters of recommendation you are already using for your PM&R program applications
- Your medical school will give you guidance on how to obtain your letters of recommendation.
- Choose letter writers that you know will write strong letters of recommendation.
- Make sure you provide your letter writers with plenty of time to write your letter.
- Stay in regular communication with your letter writers to make sure they send their letters to ERAS at the appropriate time.
- Setting up an audition/sub-internship is a good way to showcase your abilities and evaluate whether a program is a good fit for you.
- Be a keen, motivated, hardworking (for the right reasons!) team player so that they take you on.
- You may apply for away rotations via VSAS or contact a PM&R program directly if they do not use VSAS.
Scheduling Step 2 of USMLE/COMLEX
- Remember to schedule your Step 2 Exam during a time when you are able to study. Studying and taking Step 2 may be difficult if you are on a busy rotation and/or PM&R audition rotation. However, also keep in mind not to take it too late in the year if you think that your Step 2 scores are vital to your application (more PM&R programs now prefer to have your Step 2 scores prior to offering interviews, but it is not always necessary)
Electronic Residency Application Service (ERAS)
- Both allopathic and osteopathic residency programs use ERAS. The application service typically starts on July 1 of your 4th year. For a complete timeline, please check the ERAS website.
- The opening date for your ERAS application to be sent to the programs of your choice is typically on September 15 (please check the ERAS website and timeline to verify this as the ERAS timeline sometimes changes year to year).
Physical medicine and rehabilitation is an amazing and exciting field! The depth and breadth of our knowledge is one of our greatest strengths. Take advantage of every rotation to think “like a physiatrist,” i.e., don’t just think about their medical complaints but also the effect of those conditions on their function and how patients may be able to return to or maximize their functional levels. Our field applies to every medical specialty and patient population and there are numerous opportunities to tailor your future practice to your particular interest.
Good luck! 2015 Resident Physician Council Board