1st AND 2nd 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.
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
Some ways you can gain exposure to PM&R at this level of training include:
- Contact a physiatrist that is affiliated with your school and try to set up shadowing opportunities.
- If there is no physiatrist affiliated with your school, call the American Academy of Physical Medicine and Rehabilitation about its Medical Student Mentorship Program.
- You can contact the Academy office and see if there is a physiatrist located in your area.
SUMMER BETWEEN 1ST AND 2ND YEAR
The summer between your 1st and 2nd year is 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:
- Contact the Academy to help locate physiatrists and try to set up shadowing opportunities. PM&R is a wonderful field with great depth and breadth! Try and set up opportunities in a variety of settings (i.e. inpatient, outpatient, electromyography/nerve conduction studies, interventional spine, sports medicine, pediatrics).
- Check with your PM&R department and see if there are any summer research opportunities. If your school does not have a PM&R department, there is likely related research in different fields. Check your departments of neurology, neurosurgery, orthopedics, pediatrics, and internal medicine (i.e. rheumatology, geriatric medicine) for possible research opportunities.
- If you will be spending your summer near a PM&R residency program, contact the program director and 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.
- There are also paid summer externships in PM&R at:
3RD YEAR MEDICAL STUDENTS
Finally, you have reached the clinical portion of your training! 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. Listed below are some PM&R-related objectives to focus on your rotations:
- Neurology
- Hone your neurologic exam.
- Learn management & complications of stroke, Guillain-Barre Syndrome, multiple sclerosis, ALS, myasthenia gravis, Lambert-Eaton, Parkinson's Disease.
- Exposure to electromyography/nerve conduction studies.
- Neurosurgery
- 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.
- Orthopedic surgery
- 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.
- Pediatrics
- Learn about normal and abnormal physical and cognitive development.
- Learn management of chronic medical conditions including cerebral palsy, muscular dystrophy, cystic fibrosis, and scoliosis and how they relate to function.
- Radiology
- Learn when and what type of diagnostic imaging is appropriate for neurological and musculoskeletal conditions.
- Learn radiographic anatomy and interpretation.
- Rheumatology
- Learn medical management for chronic rheumatological conditions.
- Learn basic peripheral joint injections
- Urology
- 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.
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:
- Personal Statement
- Starting on your personal statement EARLY is always a good step. 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 essay. Being too conservative can be just as risky as being too bold.
- Here are some tips:
- The opening sentence is the most important line in the essay. 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.
- 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.
- Letters of recommendation
- Most programs require 2-3 letters of recommendation for residency. A letter from a physiatrist is not a requirement at all residency programs but it is HIGHLY advised. Your medical school will give you guidance on how to obtain your letters of recommendation.
- Audition/sub-internship rotations
- Setting up an audition/sub-internship is a good way to showcase your abilities and evaluate if a program is a good fit for you.
- 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.
- 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 Web site.
Conclusion
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 and think “like a physiatrist.” As you can see, physiatry is one of those fields that applies to every medical specialty and patient population. No matter what rotation you are on, ask yourself the following questions:
- Is your patient safe to go home?
- Can your patient go back to work after being discharged from the hospital?
- How has your patient's new diagnosis and medical treatment impacted their role as a father/mother/child, ability to enjoy leisure activities, work, and live independently?
Medicine is very fast paced and it is very easy to get caught in the science and clinical aspects and forget about the patient. Stop and think about these questions from time to time. Asking questions like this will make you a great patient advocate and physiatrist.
Good luck,
2010 Resident Physician Council Board
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