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Physical Medicine and Rehabilitation Residency Program

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Program Overview

Physical Medicine and Rehabilitation Residency Program is offered through the Division of NeuroRehabilitation in the Department of Neurology at the Washington University School of Medicine.

The Rehabilitation Institute of St. Louis, Barnes-Jewish Hospital, St. Louis Children's Hospital, Shriner's Hospital, Ranken Jordan Hospital and VA system are participating institutions that serve as a training base for the PM&R Residency Program.

The Program is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). The program offers outstanding clinical experiences in all aspects of adult and pediatric clinical rehabilitation, musculoskeletal medicine, interventional physiatry and electrodiagnostic medicine.

The Program provides residents with comprehensive Core didactic curriculum, which covers all aspects of Rehabilitation Medicine. In addition to core curriculum, there are monthly clinical case conferences, journal club and several lecture series in Neuromuscular & Electrodiagnostic Medicine, Musculoskeletal Core and Evidence-Based Brain Recovery Core.

There are many challenges in the constantly expanding field of rehabilitation. Our Program makes all efforts to incorporate new areas of training into the clinical and academic curricula.

The main objective of the PM&R residency program is to provide trainees with clinical skills necessary to acquire competencies in clinical practice of rehabilitation medicine. Every effort is made to keep the program flexible and to provide the most effective way of clinical and academic training based on the unique talents of each resident.

Program takes into consideration special clinical, academic and research interests of each resident and helps to channel their career growth and development.

We believe that our PM&R Residency Program will prepare residents well for a career in either private practice or academic medicine, as well as Board certification in Physical Medicine and Rehabilitation.

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Training options

PM&R Residency program offers two training tracks: 4-year categorical and 3-year advanced tracks.

Program is approved for a total of 16 resident positions, two at PGY-I level, and 14 a distributed between PGY-II, III and IV levels.

Categorical Track

This 48 month track integrates 12 months of basic clinical rotations (PGY-1) and 36 months (PGY2 – PGY4) of PM&R training.

Advanced Track

Residents who join the program on the advanced track complete 36 months of PM&R training. The prerequisite for this track is a completion of 12 months of basic clinical training, such as a transitional year or internship; these must be accredited by ACGME, Royal College of Physicians, or AOA.

Training Structure
PGY1

This year includes 12 months of basic clinical rotations usually include 6 months of internal medicine and 6 months of selective clinical rotations such as neurology, neuromuscular, rheumatology, radiology, geriatrics, infectious diseases, general rehabilitation etc.

The Hospitalist division faculty of the Department of Internal Medicine at Washington University supervises the core medicine rotations at Barnes-Jewish hospital. Other clinical rotations of the PGY-1 year are supervised by the faculty from other divisions of the Internal Medicine, Neurology and NeuroRehabilitation and Radiology.

PGY2 - PM&R

The emphasis of training during the PGY-2 year is on direct inpatient care of patients with complications of major neurological diseases needing specialized multidisciplinary rehabilitative care. The year is divided into block rotations on the inpatient services at TRISL - stroke, BI, Spinal Cord and General Rehabilitation.

Additional rotations might include VA, O&P, and MSK.

PGY3- PM&R

During the PGY-3 year, residents continue with several blocks of inpatient NeuroRehabilitation rotations and progress to rehabilitation consults at the Barnes Jewish and

Other rotations include pediatric at Ranken Jordan/ St. Louis Children's Hospital (SLCH), specialty rehabilitation clinics, MSK and elective rotations.

While there are many electives available, some areas are more important for the practice of PM&R. These areas include pain management, radiology, rheumatology, sports medicine and other MSK rotations.

PGY4 PM&R

The emphasis of the PGY-4 year is on Electrodiagnostic training, more advanced MSK training, rehabilitation consults and specialized rehabilitation clinics.

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Teaching Faculty

The teaching faculty of the PM&R residency program is composed of both physiatrists and neurologists who are dedicated to practice of clinical rehabilitation and neurosciences. There is a close collaboration with many other departments at Washington University fulfilling the aim of enhancing physiatry residents training. Residents rotate with the group of interventional and musculoskeletal physiatrists in the department of Orthopedics, pain management service in the department of Anesthesia, Radiology department, Geriatrics and Rheumatology in the Internal Medicine Department. Residents acquire skills in neuro-muscular and electrodiagnostic medicine under the guidance of our colleagues in the department of Neurology, as well as with clinical physiatric faculty.

PM&R residents have an opportunity to gain administrative skills through close ties with The Rehabilitation Institute of St. Louis. Residents participate in many hospital committees and get regular presentations from the senior administrative team members of the facility.

Didactic Curriculum

Residency training program provides comprehensive 18 - month cycle Core didactic curriculum organized in blocks by major topics. Core curriculum lectures cover, but are not limited to the following topics: Anatomy, neuro-anatomy, pathophysiology and kinesiology; brain, stroke and spinal cord disorders, neuromuscular and musculoskeletal conditions, sports medicine, cardiopulmonary rehabilitation, industrial rehabilitation, joint and connective tissue disorders, geriatrics, cancer and pediatric rehabilitation, prosthetic, orthotics and assistive devices, electrodiagnostic medicine, physical modalities, ethics, professionalism and business aspects of a PM&R practice.

Other curriculum activities include monthly clinical case conferences, grand rounds, journal clubs and internal medicine series. In addition, there are weekly EMG and MSK seminars and Board review sessions. Each resident is also responsible for presenting a topic of choice at the Resident Seminar.

Journal Club offers residents and faculty up to date information on current research in physiatry and other fields of medicine pertinent to the rehabilitation and helps residents to develop critical and analytic skills with respect to methodology, content, results and outcome data.

Board review seminars facilitate resident's self-directed learning, independent work with referenced literature and encourage group discussions.

Clinical and EMG case conferences are facilitated by the faculty and focus on clinical cases with incorporation of evidence-based data.

Anatomy and Kinesiology series are moderated by the senior residents and provide both didactic knowledge and hands on experience. Virtual anatomy resources are utilized to complement these sessions.

Formal curriculum on such topics as medical ethics, medical/legal issues, cost containment and infection control is developed and sponsored by the GME Consortium. PM&R residents are required to attend lectures of this curriculum. There are numerous other educational opportunities within the Washington University Medical Center which residents are encouraged to attend depending on their relevance and other clinical assignments.

Clinical Rotations

Core Inpatient Rehabilitation rotations are located exclusively at The Rehabilitation Institute of St. Louis (TRISL).

TRISL is a free standing 96-bed comprehensive rehabilitation facility located a few blocks from the medical campus of the Washington University School of Medicine and Becker Medical Library. A multitude of inpatient and outpatient programs are available at TRISL. These programs form a solid teaching base for the training of residents and medical students.

Patient referral sources to TRISL are mainly from Barnes-Jewish Hospital, St. Louis Children's Hospital and other community and regional hospitals of BJC Health Care System.

Comprehensive Rehabilitation Services are structured programmatically and comprise the following programs: Stroke Rehabilitation, Traumatic Brain Injury, Spine and Spinal Cord Injury, Amputee and General Rehabilitation.

Each program provides a continuum of rehabilitative care for inpatients and outpatients. Each program's medical and administrative leadership, program development, teaching and research activities are spearheaded by the Program Lead faculty. Each program has a dedicated team of multidisciplinary rehabilitation professionals (rehabilitation nurses, physical and occupational therapists, social workers, recreational therapists, speech therapists, etc.) who provide highly specialized and comprehensive rehabilitation management.

Inpatient Rotations

Stroke

Traumatic Brain Injury

Spine & Spinal Cord

Amputee

General Rehabilitation

Stroke Rehabilitation and Brain Injury (BI) Training

Residents are involved in the management of all aspects of the medical and rehabilitation care of stroke patient of various etiology, and brain injury patients both traumatic and non-traumatic in inpatient and outpatient settings. Residents are actively involved in rehabilitation team and family conferences. They have an opportunity to participate in specialty stroke, brain injury, concussion, and aphasia clinics and be involved in neuro-psychological testing and brain core evidence-based program.

Spinal Cord Injury (SCI) Training
Residents have an opportunity to be involved in the management of a wide range of traumatic and non-traumatic spinal cord patients in inpatient and outpatient settings to include multiple sclerosis, transverse myelitis, tumors and post surgical degenerative spine diseases, scoliosis, failed back syndrome etc. Residents acquire clinical skills in providing primary care to spinal cord patients along with specific medical and rehabilitative care and complications as related to spinal cord injury.

General Rehabilitation (GR) Training

Residents rotate on GR service at TRISL. Most common diagnoses on this unit include general deconditioning secondary to multiple medical co-morbidities, knee and hip joint replacements, fractures and major trauma. Residents are involved in the management of all aspects of the patient's medical and rehabilitation care and participate in weekly conferences with the rehabilitation team.

Amputee Training
This rotation includes exposure to patients with amputations and co-existing medical conditions. Rotation covers the entire continuum of care for amputee population to include: pre-prosthetic acute inpatient program and prosthetic gait training rehabilitation. Residents are involved in management of all aspects of the patient's medical and rehabilitation care. They acquire clinical skills in wound care, pain management, gait analysis, prosthetic prescription and management.

Outpatient rotations
Specialty Rehabilitation Clinics Rotation

Specialty Rehabilitation Clinics are held at the Center for Advanced Medicine on the Washington University Medical Campus.

Residents participate in Stroke, Brain Injury, Spinal Cord, Spasticity and Amputee Clinics. These are all continuity clinics where residents acquire clinical skills and knowledge in long term rehabilitation management of wide range of neurological conditions, pain management, amputee care, evaluation and management of spasticity to include Botulinum toxin therapy and Intrathecal Pump management.

Musculoskeletal (MSK) Rotation

Residents have an extensive exposure to acute and chronic musculoskeletal conditions and pain syndromes through a variety of clinics in the outpatient setting. They work with physiatric faculty in diverse outpatient setting to include both academic environment and private physiatric practices. Residents acquire skills in various interventional spine procedures, MSK ultrasound, joint and trigger point injections.

Consult Rotation

Residents are involved in the rehabilitation consults at BHJ and SLCH. Emphasis of the consult is to provide parallel and ongoing rehabilitative assessment and recommendations for patients with neurological, musculoskeletal and medical conditions and disorders and associated disabilities.

Residents actively engage with acute medical and surgical teams and well as rehabilitation team to discuss and initiate rehabilitation therapies and recommendations and facilitate transfer to TRISL or provide other recommendations for another level of rehabilitative care.

Resident works closely with the Rehabilitation Liaisons and under the supervision of the attending physician.

Orthotic and Prosthetic (O&P) Rotation

Residents attend clinics and production labs at the local orthotic & prosthetic companies: Prosthetic & Orthotic Design and Hanger. They have an opportunity to work with very experienced practitioners and do hands-on evaluation, casting and fitting of orthotics and prosthetics.

Electrodiagnostic (EDX) Rotation

Residents rotate through the Electrodiagnostic Lab of the Department of Neurology where more than 2,000 studies are performed each year. Residents receive the extensive training in performing NCSs and EMG and attend weekly clinical neuroscience lecture series that cover mechanisms of neuromuscular diseases, nerve and muscle pathology and electrodiagnostic testing and interpretation.

Additional EDX training takes place during MSK rotations and at the VA under the guidance of physiatric faculty.

Over the course of the residency program, residents perform over 200 EDX studies under the direct guidance and supervision of AANEM Board certified neurologists and physiatrists.

Cardiac and Pulmonary Rehabilitation Training

Residents attend cardiac and pulmonary labs at Barnes-Jewish Hospital and gain experience in cardiac exercise stress testing, rehabilitation exercise prescription, pulmonary function testing.

Pediatric Rehabilitation

Residents rotate at the Ranken Jordan (RJ) Pediatric Specialty Hospital, which provides a continuum of care and the intensive transitional care and living support and for medically complicated children and their families. Residents are involved in inpatient and outpatient care of children of all ages. They are supervised by two experienced pediatric physiatrists.

Residents also rotate on a pediatric neuro-rehabilitation inpatient unit and attend outpatient clinics at St. Louis Children's hospital and participate in the Muscular Dystrophy Clinic. Rotation at Shriner's Hospital provides experience in evaluation and management of mostly pediatric orthopedic pathology.

During these rotations residents gain clinical skills and knowledge in diagnosis and rehabilitation management of a variety of pediatric conditions to include spinal cord and brain injury, cerebral palsy, spina bifida, scoliosis, hip dysplasia, and numerous other neuromuscular and musculoskeletal diseases.

VA Rotation

Residents rotate on the Extended Care Rehabilitation Service at the Jefferson Barracks division of the St. Louis VA System. They work under the guidance of four physiatrists and are involved in the evaluation and management of vide range of patients with neurological, polytrauma and MSK conditions in inpatient and outpatient settings. They learn about state, federal and community resources for long term care and support for veterans and their families.

Research Requirements

Residents are required to participate in clinical research projects during their training period and produce at least one paper or case report to be submitted to the peer review journals. All residents are required to submit one poster for the Annual Residents' Day Symposium held in May in the Department of Neurology. Residents are also encouraged to submit their papers or posters to the PM&R related scientific meetings such as American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the Association of Academic Physiatrists (AAP).

All residents are required to submit review abstract to the "Rehab in Review" journal produced by the Emory University Department of Rehabilitation Medicine, which is distributed to many PM&R Departments in the US.

Residents also have an opportunity to participate in interdepartmental clinical research projects at the Washington University Medical Center.

General Information for Application Procedure
Application

To apply for the PM&R residency training program, please submit all required documentation to ERAS (Electronic Residency Application System).

U.S. medical school graduates should contact office of Student Affairs or other designated Dean's office for information and software for ERAS. Foreign medical graduates should contact ECFMG for information and further instructions.

Paper applications are not accepted.

We accept applications from candidates from osteopathic schools and foreign medical graduates.

Graduates of foreign medical schools are required to hold a valid ECFMG certificate.

All applicants are required to complete Step I and II of USMLE.

COMPLEX scores are also accepted.

Application review period starts on – September 15th of the current year.

Deadline for applications is October 31 of the current year.

Interview period: October 15th - December 31st of the current year.

Interview process

Only applications submitted though the ERAS will be considered and reviewed.

Applicants selected for the interview will receive an invitation via email.

This program participates in the National Residency Match and adheres strictly to the rules of the Match.

Applications are accepted for both Categorical and Advanced tracks.

Usually, 2 positions are available for each track annually.

Contact for additional information or questions:

Donna Barbier

PM&R Residency Coordinator

e-mail: barbierd@neuro.wustl.edu

Fellowship

One year NeuroRehabilitation fellowship is available for those who completed prior residency training in PM&R or Neurology. Fellow spends most of the time on Stroke and BI services and has exposure to SCI service and is actively engaged in rehabilitation consult service and in the outpatient clinic.

During fellowship year, trainee often serves as an attending in on the inpatient service.

There is also an opportunity to participate in the research as well.

Contact for fellowship information or questions:

Gail Zeiter

zeiterg@neuro.wustl.edu

Student Clerkship Opportunities

Four week elective rotation is offered for the third and fourth year medical students of the Washington University School of Medicine, and Fourth year students of other allopathic medical schools (schools that award MD degrees).

All requests from medical students from the institutions other than Washington University are considered on a space-available basis and are reviewed by the clerkship director. To request clerkship information or to schedule a rotation, please contact the WUSM curriculum office at 314-747-3854.

Washington University encourages and gives full consideration to all applicants for admission, financial aid, and employment. The University does not discriminate in access to, or treatment of, or employment in its programs and activities on the basis of race, color, age, religion, sex, sexual orientation, national origin, veteran status or disability. Present Department of Defense policy governing ROTC and AFROTC programs discriminates on the basis of sexual orientation; such discrimination is inconsistent with Washington University policy. Inquiries about compliance should be addressed to the University's Vice Chancellor for Human Resources, Washington University, Campus Box 1184, One Brookings Drive, St. Louis, MO 63130-4899 tel: (314) 935-5949.