Rotations

PGY-1 Rotations

Our interns who match the categorical positions will experience a well-rounded and academically rigorous year. Interns will rotate in internal medicine with the Washington University Hospitalist service at Barnes-Jewish Hospital for half of the year. Here interns will gain competency in managing complex medical patients and gain confidence in their medical decision making. Interns will also rotate with neurology, rheumatology, radiology, neuromuscular medicine and PM&R during their intern year. Altogether this experience will provide interns the knowledge and the tools they need to transition seamlessly into their training in PM&R.

PM&R Rotations

Our PM&R rotations are broken down into inpatient and outpatient experiences. Typically, residents will spend a healthy portion of their PGY2 year mastering the fundamentals of inpatient rehabilitation medicine. There is also ample time directed towards electives during the PGY-2 year in order for residents to gain early exposure in areas of potential sub specialization that they may be interested in pursuing. As residents progress to the PGY-3 and PGY-4 years, increasing flexibility is provided for the resident to round out their physiatry skills and begin to focus on their areas of interest Opportunities to engage in leadership activities including the education of medical students is available throughout the various rotations.

Inpatient 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 on the Washington University Medical Campus. 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 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.

Stroke (CVA) Rehabilitation and Brain Injury (BI) Training

Residents are involved in the management of all aspects of the medical and rehabilitation care of stroke patients of various etiologies, and brain injury patients both traumatic and non-traumatic in the inpatient setting. Residents are actively involved in leading the rehabilitation team including rehabilitation nurses, case management, respiratory therapy, speech therapy, physical therapy, and occupational therapy. Residents are exposed to neuro-psychological testing and evidence-based aphasia programs.

Spinal Cord Injury (SCI) Training

Residents are responsible for the management of a wide range of traumatic and non-traumatic spinal cord injury patients in this inpatient setting. Multiple sclerosis, transverse myelitis, tumors, post-surgical degenerative spine diseases, scoliosis, failed back syndrome are among some of the spine associated issues that residents will encounter on this service. Residents acquire the clinical skills to provide specific medical and rehabilitative care and will learn to manage complications relating to spinal cord injury.

General Rehabilitation Training

On this service, senior residents will manage patients in their transition from the acute care hospital to the home environment. Diagnoses seen on this unit include general deconditioning secondary to multiple medical co-morbidities, complicated knee and hip joint replacements, fractures, polytrauma, LVADs, transplants (kidney, heart, liver) and post COVID-19. 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. Senior residents on this service will take on a role as mentor and will help in providing education for the junior residents that are concomitantly on the other inpatient services.

Amputee Training

Residents will gain exposure to patients with amputations and co-existing medical conditions. Residents will be responsible for managing the entire continuum of care for their amputee patients to include pre-prosthetic acute inpatient program and prosthetic gait training rehabilitation. With this, residents will be responsible for overseeing all aspects of the patient’s medical and rehabilitation care. Clinical skills acquired during this experience include wound care, pain management, gait analysis and prosthetic prescription.


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 a 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. During this rotation, residents work with physiatric faculty in the Department of Orthopedic Surgery. Residents acquire skills in various interventional spine procedures, MSK ultrasound, joint and trigger point injections, as well as EMGs. Residents may also rotate with private practice musculoskeletal/sports medicine physicans where they are exposed to Independent Medical Evaluations (IME) and worker’s compensation.

Pain Management Rotation

Residents rotate in the Pain Management Center within the Department of Anesthesiology. This clinic offers diverse training in both medical management and interventional procedures as well as working in a multidisciplinary team. Residents will be exposed to a high volume of fluoroscopic and ultrasound guided interventional pain techniques including epidurals, various nerve blocks, neuraxial blocks, joint injections, neurolytic procedures, radiofrequency lesioning, and spinal cord stimulator trail and permanent placement.

Consult Rotation

Residents are involved in the rehabilitation consults at Barnes-Jewish Hospital. 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. This resident works 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 approximately 3,000 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.

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 and are supervised by two experienced pediatric physiatrists.

Residents also rotate on the pediatric PM&R service at St. Louis Children’s hospital. There are opportunities to participate in several pediatric specialty clinics including neurorehabilitation, Muscular Dystrophy Clinic, and orthopedics. During this rotation residents gain clinical skills and knowledge in the 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 Rotations

Residents rotate on the Extended Care Rehabilitation Service and the Spinal Cord Injury Service at the Jefferson Barracks division of the St. Louis VA System. They work under the guidance of several 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.

Multidisciplinary Rounds (MDR)

Residents have the opportunity to customize this rotation based on their personal interests. Residents are encouraged to spend time during this rotation engaged in clinical opportunities that they feel would be beneficial to their individual growth and goals as a physiatrist. Residents have chosen to work with various forms of therapy (physical, occupational, speech) to gain better understanding of what role these clinicians play in the rehabilitation of patients. Other residents have chosen to work with various Washington University surgical teams who refer many of our rehabilitation patients to us. Some residents chose to gain experience with private practice physicians during this rotation. These are just a few examples, but there are many unique opportunities that residents can choose to participate in during the MDR elective.

Research

Residents who have a significant interest in research can utilize this dedicated time to focus on active or new research projects. Washington University provides endless opportunities with regards to research and this rotation allows residents the chance to contribute meaningful time to these endeavors.