Medical School Roadmap to PM&R

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 schools PM&R interest group.
  • If there is no physiatrist affiliated with your school, contact the American Academy of Physical Medicine and Rehabilitation (AAPM&R) about its Medical Student Mentorship Program.
  • Join the AAPM&R for FREE!!!! Yes it is free to be a member as a student
  • Through the AAPM&R search engine you can find a Physiatrist in your area.
  • 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.

SUMMER OPPORTUNITIES

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.

RESEARCH
  • 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. http://physiatry.org/?page=programs_RREMS
  • 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.
VOLUNTEERING

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:

CLINICAL ROTATIONS
  • Contact the Academy to help locate physiatrists and try to set up shadowing opportunities.
  • 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).

2ND YEAR MEDICAL STUDENTS

Although PM&R residency programs are not as focused as other specialties on USMLE/COMLEX scores, aim to do well on these exams as it will only strengthen your application.

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).
    http://physiatry.org/?page=clerkships&hhSearchTerms=national+and+clerkship

The AAPM&R has made a list of books that maybe useful as a companion or reference during your rotation:
    http://www.aapmr.org/career/students/PMRspecialty/Pages/medstudm.aspx

"PM&R Knowledge Now" is also a resource available to medical professionals that provides information on common PM&R related topics:
    http://now.aapmr.org/Pages/default.aspx

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:

Anesthesiology

  • Diagnosis and treatment of chronic pain problems
  • Assessing airway and pharmacologic considerations perioperatively

Cardiology

  • Learn EKG interpretation
  • Consider indications, benefits and goals of cardiac rehabilitation

Critical Care Medicine

  • Learn about critical illness polyneuropathy and myopathy
  • Tracheostomy and ventilator management

Dermatology

  • Wound care
  • How to assess a rash

Endocrinology

  • Learn diabetes care and understand how it can lead to complications such as vascular disease, and amputation

Gastroenterology/General surgery

  • Learn the indications, risks, contraindications, and management of percutaneous endoscopic gastrostomy (PEG) tubes
  • 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
  • How to investigate anemia
  • Learn about anti-coagulation, as well as duration of treatment for DVTs, PEs and strokes

Infectious disease

  • 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.)
  • Infectious issues with transplant patients

Medical Genetics

  • Learn about common genetic disorders that might present in a pediatric PM&R practice such as Down Syndrome, Cystic fibrosis, muscular dystrophy, Fragile X, and spinal muscular atrophy

Nephrology

  • Learn about kidney transplant, dialysis indications
  • Indications and considerations for fistula care

Neurology

  • 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
  • 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.
  • Learn basic splint management, staple and suture placement and removal

Otolaryngology

  • 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

Orthopedic Surgery

  • Musculoskeletal anatomy and physical exam techniques
  • Basic peripheral joint injections
  • Interpretation of imaging studies and their correlation to your exam findings and prognosis.
  • Basic splint/orthotic management
  • Learn how to remove staples and sutures

Pediatrics

  • 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

Pulmonary

  • Learn about pulmonary rehabilitation, pulmonary toilet
  • Practice reading chest-xrays

Psychiatry

  • Learn about addiction, substance abuse, post-traumatic stress disorder (PTSD), delirium vs. dementia, how to assess for capacity to make medical decisions

Radiology

  • Learn indications for imaging for neurological and musculoskeletal conditions
  • Learn radiographic anatomy and interpretation

Rheumatology

  • Learn medical management for chronic rheumatological conditions.
  • Learn basic peripheral joint injections

Surgery

  • Cardiothoracic, Vascular, Plastic, Transplant, Surgical Oncology, Trauma, Burn, Oral and Maxillofacial, Orthopedic, Podiatric surgery

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.

Other

  • 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:

Personal Statement/Application

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.
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.
  • 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.
  • Stay in regular communication with your letter writers to make sure they send their letters to ERAS at the appropriate time.
Audition/sub-internship rotations
  • 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.
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 website.
  • The opening date for your ERAS application to be sent to the programs of your choice on September 15.

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 to think “like a physiatrist,” i.e., don’t just think about their medical complaints but also the affect of those conditions on their function. 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!!! 2013 Resident Physician Council Board

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