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Program Overview

The Department of Neurology, Division of Rehabiltation at Washington University School of Medicine offers a comprehensive Physical Medicine and Rehabilitation Residency Training Program. The program is accredited by the ACGME and approved by the American Board of PM&R. Successful completion of this program leads to board certification by the American Board of PM&R. Required training in basic clinical sciences is provided at Barnes-Jewish Hospital as a part of this program.

Physical Medicine and Rehabilitation Residency Program is a part of the Washington University / Barnes-Jewish Hospital / St. Louis Children's Hospital / The Rehabilitation Institute of St. Louis Graduate Medical Education Consortium ( GME Consortium).

For purposes of the ACGME and its Residency Review Committees, the individual institutions (Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children’s Hospital and The Rehabilitation Institute of St. Louis) are known and identified as “participating institutions.”

The GME Consortium oversee all matters pertaining to graduate medical education. In this capacity, the GME Consortium serves as the “sponsoring institution” for all graduate medical education conducted by the participating institutions (BJH, SLCH, TRISL and WUSM). These participating institutions are part of the BJC Health Care System of St. Louis and serve as the main clinical base for training of the PM&R residents. Shriner's hospital for Crippled Children is an aditional participating institution for this program. All participating institutions demonstrate strong commitment to excellence in patient care, education, and research.

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 and to foster their talents and potentials in research and academic arenas.

The program offers extensive exposure to all aspects of adult and pediatric clinical neuro-rehabilitation, musculoskeletal and electrodiagnostic medicine, and is integrated with rich academic curriculum. There are many challenges in constantly expanding field of rehabilitation. PM&R Program makes all efforts to incorporate new areas of training into the clinical and academic curricula.

PM&R residency training program is accredited for15 positions, two of which are at PGY-I level, and 13 about evenly distributed between PGY-II, III and IV levels.

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

Integrated Track

This track integrates 12 months of basic clinical sciences and 36 month of PM&R training. 12 months of basic clinical sciences usually include 6 month of internal medicine and 6 of fundamental basic clinical disciplines such as neurology, orthopedics, rheumatology, radiology, urology, neurosurgery, pulmonary medicine, cardiology, etc. Six month medicine rotation is scheduled in the first half of the PG-I year. Six month of other basic clinical rotations are scheduled throughout PGY-II year.

PM&R Track

Residents who join the program on a PM&R track complete 36 month of PM&R trainng. The prerequisite for this track is a completion of 12 months of basic clinical training, such as a transitional year or internship, which should include 6 months or more of training in family practice, internal medicine, pediatrics or surgery or any combination of these patient care experiences. The remaining 6 month should include any combination of specialties or subspecialties, each for a period of at least 4 weeks.
Transitional year or Internship must be accredited by ACGME, Royal College of Physicians, or AOA in order to meet the admissibility requirements for PM&R residency training.

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Teaching Faculty

The teaching faculty of the Division of Rehabilitaiton is composed of both physiatrists and neurologists dedicated to practice of clinical rehabilitaiton and neurosciences. There is a close collaboration with many other departments at Washington University serving the aim of enhancing physiatry residents training. Residents rotate with the group of interventional and musculoskeletal physiatrists in the department of Orthopedic, pain management service in the department of Anesthesia, Radilogy department; geriatrics, rhematology and palliative care in the Internal Medicine department. Residents acquire skills in neuro-muscular and electrodiagnostic medicine under the guidance of our colleagues in the department on Neurology as well as with clinical physiatric faculty.

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

Didactic Program

Residency training program provides strong comprehensive didactic educational curriculum. Core curriculum is designed as a two - year cycle.
Core curriculum lectures cover, but are not limited to, the following topics: Anatomy, neuro-anatomy, pathophysiology and kinesiology; brain 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,electrodiagnostics, physical modalities, ethics, professionalism and business aspects of a PM&R practice.

Other didactic curriculum activities include clinical and EMG case conferences, grand rounds, journal clubs, board review seminars and resident seminars.

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

Board review seminars facilitate residents self-directed learning and independent work with referenced literature, 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 workshops are moderated by the senior residnts and provide hands on experience in human kinesiology.

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 include Grands Rounds and lectures in the Departments of Orthopedics, Rheumatology, Neurology, Neurosurgery, Internal Medicine, etc.

The Anatomy Dissection Laboratory is available through the arrangement with Physical and Occupational Therapy Schools at Washington University. PM&R residents have an opportunity to attend anatomy lectures and participate in dissection labs with special focus on anatomy of nervous and musculoskeletal systems.

Overview of the Comprehensive Medical Rehabilitation Services

Physical Medicine and Rehabilitation services are located exclusively at The Rehabilitation Institute of St. Louis (TRISL).

TRISL is a free standing 80-bed comprehensive rehabilitation facility located few blocks from the campus of the Washington University School of Medicine and Becker Medical Library. Multitude of inpatient and outpatient programs are available at TRISL. These programs form a solid teaching base for residents and medical students training.

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 Service is structured programmatically and comprises of the following programs:

Stroke and Brain Injury Rehabilitation
Spinal Cord Rehabilitation
Bone and Joint Rehabilitation

Amputee Rehabilitation
General Rehabilitation
Geriatric 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 Medical Director of the individual program. Each program has a dedicated team of multidisciplinary rehabilitation professionals (rehabilitation nurses, physical therapist, occupational therapists, social workers, recreational therapists, speech therapists, etc.) that provides highly specialized and comprehensive rehabilitation management.

Description of Clinical Rotations

Stroke Rehabilitation

This rotation includes an intensive inpatient rehabilitation experience on the stroke unit at TRISL. Residents are involved in the management of all aspects of patient's medical and rehabilitation care. Residents participate in rehabilitation team and family conferences. Teaching and supervision of clinical care is provided by the attending faculty on one-on-one basis. Residents gain outpatient experience in the Stroke and Aphasia Clinics.

Traumatic Brain Injury

Residents rotate on the inpatient traumatic Brain Injury rehabilitation unit and Structures Care unit at TRISL. Team meetings occur twice a week to monitor patient progress closely. Residents are involved in the management of all aspects of the patient's medical and rehabilitation care to include agitation, comfnitive impairement and seizures.There is close on-on one supervision by the attending physician on a daily basis. Traumatic Brain Injury clinic provideds outpatient experience in long term management of complications related to brain injury.

Spinal Cord Injury

Residents rotate on the Spinal Cord Injury unit at TRISL and have an opportunity to be involved in the management of a wide range of traumatic and non-traumatic spinal cord population to include multiple sclerosis, transverse myelitis, tumors and post surgical degenerative spine diseases. Residents are exposed to a large outpatient spinal cord injured population. Residents aquire clinical skills in providing primary care along with spicific medical and rehabilitative care and compilations as related to spinal cord injury. Residents are involved in the comprehansive Spasticity Clinic and gain skills in the management of Intrathecal Baclofen pumps and Botulinum toxin injections.

Bone and Joint

Residents rotate on Bone and Joint inpatient unit at TRISL. Most common diagnoses on this unit include knee and hip joint replacement, fractures and major trauma. Supervision is provided by attending physiatrists. Residents are involved in management of all aspects of the patient's medical and rehabilitation care and participate in weekly conferences with the rehabilitation team.

Amputee

This rotation includes exposure to patients with amputations and coexisting medical problems. Rotation covers the entire continuum of care for amputee population to include: pre-prosthetic acure inpatient program and gait training rehabilitation, outpatient experience through Amputee Clinic and and Home Care experience. Residents are involved in management of all aspects of the patient's medical and rehabilitation care. Residents are taught prosthetic prescription and management. Residents also attend clinics at the prosthetic labs - Prosthetic & Orthtic Design, Hanger and Prosthetics & Orthotics Companies.

General and Geriatric Rehabilitation

Residents rotate on the "Silver" inpatient init at TRISL and learn management of complex geriatric and deconditioning patients. Residents work as a team with geriatric fellow and medicine resident under the direct supervision of the geriatric attending. Residents participate in weekly conferences with the rehabilitation team. Residents also participate in outpatient geriatric clinic under the supervision of the geriatric attendings group.

Outpatient Musculoskeletal and Rehabilitation Rotation

Residents have an extensive exposure to acute and chronic musculoskeletal conditions and pain syndromes though a variety of clinics in the outpatient setting. They work with clinical attending physiatrists on a one-on-one basis in diverse outpatient physiatric practices. Residents aquire skils in interventional spine procedures, arthrosenthesis and trigger point injections.

Electrodiagnostic Rotation

Residents rotate through the Electrodiagnostic Lab of the Department of Neurology. More than 2,000 studies are performed each year. Residents receive introductory lectures on EMG and nerve conduction studies during the clinical neuroscience lecture series. During this rotation, the resident also participates in the neuromuscular clinic and in the neuromuscular inpatient consult service. Regular conferences cover the areas of basic mechanisms of neuromuscular diseases, nerve and muscle pathology, diagnosis, medical and rehabilitaion management. Residents also aquire skills in EDX studies during rotations with a number of physiatric clinical faculty.

During this rotations, residents perform over 200 NCS/EMG studies under the direct guidance and supervision of AANEM Board certified physiatrists and neurologist.

Cardiac and Pulmonary Rehabilitation
Residents on this rotation gain experience in cardiac exercise stress testing, rehabilitation exercise prescription, pulmonary function testing.

Pediatric Rehabilitation
Residents rotate on a pediatric neurorehabilitation inpatient unit and attend outpatient clinics at St.Louis Children's hospital and Shriner's Hospital. Residents gain clinical skills and knowledge in diagnosis and rehabilitation management of a variety of conditions to include spinal cord and brain injury, cerebral palsy, spina bifida, scoliosis, hip dysplasia, and numerous other neuromuscular and musculoskeletal diseases.

Gait Performance Laboratory
Residents gain experience in evaluation of gait disorders using state-of-the art equipment including computer-integrated multi-video analysis system, force plates, and dynamic electromyography unit. They learn to use this advanced technology to better define gait deviations associated with disability and to develop treatment plan. Residents rotate through the laboratory and actively participate in the acquisition and analysis of date. Medical conditions most commonly evaluated in the gait lab include stroke, amputees, spinal cord injury, and cerebral palsy.

Research Requiremens

Residents are required to participate in research projects during their training period and to produce a research paper of publishable quality . Research projects could be in the form of clinical retrospective or prospective research, extensive literature review on a selected topic or a case report. All residents are required to produce a poster which is presented at the Annual Poster Day attended by residents and faculty of the Department of Neurology. Residents are encouraged to submit their papers or posters to PM&R related scientific meeting such as American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the Association of Academic Physiatrists (AAP). Rehabilitation faculty provides mentoring and support for resident's research activities.

All residents are required to submit review abstructs to the "Rehab in Review" journal, a Harvard-based publication which is distributed nationally to many PM&R programs.

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

Residents have an opportunity to attend the annual Assembly of the American Academy of Physical Medicine and Rehabilitation and the annual meeting of the Association of Academic Physiatrists.

Every year, residents at all levels of training take the Self Assessment Examination given by the American Academy of Physical Medicine and Rehabilitation. All residents also take in-service written exams twice a year on selected topics. PGY-4 residents take the Self Assessment Examination given by the American association of Neuromuscular and Electrodiagnostic Medicine.

Every effort is made to keep the program flexible and to provide the most effective way of cinical and academic training based on the unique talents of each resident. Program takes into the consideration special clinical, academic and research interests of each resident and helps to channel their carrier growth and development.

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.

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.

Student Clerkship Opportunities

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

All requests from medical students at 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.