Roadmap to a Fellowship
Disclaimer: AAPM&R does not hold itself responsible for
statements made by any contributor.
Statements or opinions expressed within this document reflect the views of the
authors and not the official policy of AAPM&R.
The field of physical medicine and rehabilitation (PM&R) offers a wide array of
areas in which physicians can build their interests and practices. The diversity
in the field affords residents many options – and investigating these areas
during residency can be overwhelming.
AAPM&R’s Resident Physician Council created this “roadmap” for residents wishing
to pursue fellowships. This roadmap serves as a guide to assist in choosing
their career path - whether directly entering into practice or obtaining
fellowship training. The goal is to provide a guideline that emphasizes
important aspects of this often confusing process.
During the PGY-2 year, most residency programs are designed to expose residents
to many different aspects of PM&R; residents should seek out as many different
practice settings as possible. They should decide what aspects of the field are
of interest and ask attending physicians regarding their practices - what they
like, what types of patients do they see, what types of treatments they
prescribe, etc. As residents transition from PGY-2 to PGY-3 years, they should
use their interests to formulate ideas regarding their future practice. However,
the diversity of the field allows many physicians to combine two or more areas
of interest; residents should not feel confined to one setting and should
recognize this potential during their job search (fig. 1,
PDF download).
A PGY-3 should research the types of fellowship or job opportunities available
in their field of interest, consult with senior residents and attendings, and
use Internet resources to guide their search. A PM&R physician should be
comfortable with the fundamentals of musculoskeletal and inpatient
rehabilitation – many use fellowships as a means to further enhance their
residency training.
Fellowship Timeline
PGY-2 Year
-
Obtain broad exposure to all aspects of PM&R
-
Build on experiences and consider what type of practice:
-
Think about the practice setting:
-
Seek advice from attendings and other residents regarding interests. Finding a
mentor can be helpful at this stage
-
Consider the location – including housing, schools, recreation
-
Attend conferences on topics of interest – begin networking
-
Join national organizations, which can provide valuable information for
fellowships and jobs. These organizations may provide discounted membership and
conference rates for residents
Examples include:
PGY-3 Year (Early)
-
Attend conferences on topics of interest – begin networkingg
-
Choose elective rotations in areas of interest
-
Present at journal clubs and resident lectures on topics of interest – this is
a great opportunity to formulate research ideas
-
Consider a fellowship and begin preliminary research – use the Internet, and
discuss with attendings, current fellows, and senior residents
PGY-3 Year (Mid)
-
Choose elective rotations in areas of interest
-
Develop research on a topic of interest – submit poster presentations to
conferences, publish
-
Shadow attendings who have practices in geographical areas that are a
potential future practice location
-
Decide on type of fellowship to pursue
-
Collect information on fellowship programs. Use AAPM&R’s fellowship database,
as well as other national organizations’ resources. Contact programs and collect
the necessary application materials
-
Ask attendings for letters of recommendation, and ask them early
PGY-3 Year (Late)
-
Choose elective rotations in areas of interest
-
Apply early – be diligent in noting application deadlines, as they may vary
significantly
-
Composing personal statements can be arduous, so prepare in advance
-
Obtain official documents such as board score reports before the application
process so they are accessible when needed
-
An updated CV is a must
PGY-4 Year
-
Arrange interviews early, as the adage goes – the early bird catches the worm
-
Hit the interview trail. As with residency interviews, this process may be
expensive, so plan ahead
-
Await offers and be prepared to make decisions quickly as they arrive
Fellowships
Currently the subspecialties of spinal cord injury (SCI), pain medicine, and
pediatrics require ACGME-accredited residency training (PGY-5) in order to sit
for board certification. Traumatic brain injury (TBI) does not require further
board certification to practice; however fellowship training is encouraged and
may be required in some academic settings. Neurorehabilitation fellowships may
combine TBI and stroke elements in one program, while other may not; residents
should become familiar with each program’s design. Other fellowships include
research that often is funded via research grants. The
Association for Academic
Physiatrists and the National Institutes of Health Web sites include links
available for programs such as the K-12 grant for those interested in a
research-based fellowship or an academic position.
Pediatrics and Spinal Cord Injury
Beginning in 2006, all fellowship positions in pediatric rehabilitation require
ACGME accreditation. If a resident pursues a pediatrics fellowship after
completing PM&R residency training, a two-year fellowship is required; if a
resident completes both PM&R and pediatric residency training, a one-year
fellowship is available. SCI fellowships are accredited by ACGME and require
subspecialty training for one year in order to sit for the certification
examination. A list of ACGME-approved fellowships in pediatrics and in SCI, in
addition to certification requirements for each, can be found on the American
Board of Physical Medicine and Rehabilitation’s (ABPMR) Web site at
www.abpmr.org/certification/subspecialty.html.
Musculoskeletal and Sports Medicine
When considering a practice in musculoskeletal or sports medicine, residents
should keep in mind that many specialties (including internal medicine, family
practice, emergency medicine, and pediatrics) offer fellowship training and
board certification in sports medicine. These programs generally do not offer
positions to PM&R residents, and physiatrists are currently ineligible to sit
for the American Board of Medical Specialties’ sports medicine board
certification. Within PM&R, musculoskeletal and sports medicine fellowships are
available. These fellowships usually are based in the outpatient setting, and
with various programs providing training in epidural spinal injections,
peripheral joint injections, and ultrasound diagnostics. These programs are
designed to supplement the musculoskeletal exposure residents receive during
their fellowship, build expertise in the area of biomechanics and sports
management of the injured athlete, and provide research opportunities for those
who wish to pursue an academic career.
Pain Medicine
Pain medicine fellowships are numerous and diverse, and are becoming
increasingly more competitive. These fellowships are offered through PM&R,
anesthesia, and a few neurology departments (fig
2 PDF download). Many anesthesia programs, as well
as a handful of PM&R programs, are ACGME accredited. Beginning in 2005,
physiatrists must complete an ACGME-accredited pain medicine residency program
to sit for the ABPMR board certification exam in pain medicine.
Residents interested in pain medicine fellowships should become familiar with
the types of interventions and the types of practices. This information serves
as a necessary guide for residents as they choose fellowship programs.
Anesthesia programs may, for example, focus heavily on pharmacology or general
pain management and may also train fellows in procedures such as stellate
ganglion blocks, nerve stimulators, etc.; PM&R programs may be largely based in
lumbar spine interventions. PM&R programs may also offer musculoskeletal and
sports training as available in the sports fellowships discussed above. The
types of training will differ between individual programs, so it is necessary to
research them. For anesthesia and neurology programs, ask what programs have
offered positions to PM&R residents in the past and if any physiatrists practice
in their departments – these factors may be important when distinguishing
between programs.
As fellowships become increasingly competitive, it is recommended that residents
become familiar with the application process and with the multitude of programs
available. AAPM&R and PASSOR’s Web sites provide excellent resources for such
information.
| Brian M. Bruel, MD, MA |
Cara Camiolo Reddy, MD |
| 2005 Secretary |
2005 Vice President |
| AAPM&R Resident Physician Council |
AAPM&R Resident Physician Council |
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