PM&R Residency Program Manual
PM&R Mission Statement - Overall Goals and Objectives

PM&R Mission Statement
The Department of Physical Medicine and Rehabilitation strives to enhance the quality of life and functional independence of persons with injuries and disabling illness through excellence in rehabilitative care and management, the training and education of persons in the discipline of rehabilitation medicine and through the advancement of knowledge through research.

PM&R Overall Goals and Objectives
The Physical Medicine and Rehabilitation Residency Training Program is designed to provide basic and advanced knowledge and experience in the practice of physiatry. The program will familiarize PM&R residents with all aspects of clinical practice, treatment and rehabilitation strategies, including professional clinical experience in both inpatient and outpatient rehabilitation settings. The program additionally includes a research component that emphasizes scholarship and original contributions to the field of physical medicine and rehabilitation while reinforcing publication and presentation skills, as well as providing experience in the administrative aspects of PM&R.
Residents participating in the program are expected to develop and demonstrate the competence, skills and knowledge necessary to diagnose and manage a variety of neuro and musculoskeletal injuries and diseases. Program emphasis is on critical clinical, electrodiagnostic and psychosocial evaluation, and the planning and provision of effective care. The PM&R Residency Program also encourages the development of teaching and leadership skills. Residents are expected to promote team efforts and thereby assure the deliverance of comprehensive, quality patient care.  The program is additionally capable of accommodating personal career goals including independent scholarly activities and research. All PM&R Residents are required to obtain competence in the six areas listed below, to the level expected of a new practitioner:

Patient Care:  The training program mentors Residents to become competent in providing patient care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health through a combination of teaching, observation, practice and experience. Through clinical rotations and relationships with Attending physicians, the training program provides the opportunity for the resident to develop the attitudes and psychomotor skills required to modify history taking technique to include data critical to the recognition of functional abilities, and physical and psychosocial impairments which may cause functional disabilities; perform the general and specific physiatric examinations, including electromyography, nerve conduction studies, and other procedures common to the practice of physical medicine and rehabilitation; make sound clinical judgments; and design and monitor rehabilitation treatment programs to minimize and prevent impairment and maximize functional abilities.

Knowledge of patient evaluation procedures: Through didactic sessions and clinical observations, residents develop an understanding of evaluation procedures used to diagnose a variety of disorders affecting the neuromuscular and musculoskeletal systems.  In addition to medical evaluations, and careful assessment of the neuromuscular skeletal system, residents learn appropriate rehabilitative evaluation procedures including disability assessments, the benefit of various orthotic and prosthetic devices and vocational recreational activities while on their clinical rotations.

Skills in evaluation procedures: Residents learn how to take an appropriate physiatric history with emphasis on the neuromuscular and musculoskeletal systems. The residents also learn how to perform electrodiagnostic studies including other invasive and non-invasive methods used to evaluate the neuromuscular and musculoskeletal systems. The department has an EMG lab, and Residents have six months of EMG rotations between years 3 and 4.

Knowledge of differential diagnosis: Residents develop the ability to synthesize gathered clinical information and arrive at logical medical diagnosis throughout their clinical rotations. This process includes consideration of the patient’s clinical signs and symptoms and laboratory and radiological data.  Pathophysiological processes, along with the environment, genetic, habitual and motivational factors are also reviewed.

Knowledge of appropriate treatment: Once the state of the patient’s disease and its resulting disability is fully appreciated, the residents will be able to design a treatment plan consisting of the appropriate medical, surgical, and/or physical treatment prescriptions.  This will include the conventional physical and occupational treatment modalities as well as the appropriate psychological, social, vocational, and recreational strategies. In their treatment plan the residents will also consider neuropsychological and speech and language development programs. On clinical rotations Residents become familiar with specialized rehabilitative equipment such as prosthetic and orthotic devices and ambulation aides and become capable of appropriately prescribing prostheses, orthoses, wheelchairs, and other assistive devices. 

Medical Knowledge: Residents increase medical knowledge about established and evolving biomedical, clinical, and cognitive sciences, as well as the application of this knowledge to patient care. This includes knowledge about the diagnosis, pathogenesis, treatment, prevention, and rehabilitation of those neuromusculoskeletal, neurobehavioral, cardiovascular, pulmonary, and other system disorders common to this specialty in patients of both sexes and all ages. This program includes education in the principles of bioethics as applied to medical care, and the residents participate in decision-making involving ethical issues that arise in the diagnosis and management of their patients. Residents gain medical knowledge on all clinical rotations, and through teaching and supplemental readings recommended by their Attendings. Residents also gain medical knowledge from didactic lectures, The Journal Club and Braddom Club, Board Review sessions, Morbidity & Mortality Conferences, team meetings, consultations with other specialists and work with other healthcare providers.

Knowledge of basic and clinical sciences: Residents observe normal and abnormal neuromusculoskeletal disease and injury on their clinical rotations.  Thiey review anatomy, physiology, and pathology of the central nervous system, neuromuscular, musculoskeletal, cardiopulmonary, peripheral vascular, and urogenital systems under the supervision of rotation Attendings, and through didactic lectures and supplemental readings..

Practice-based Learning and Improvement: Residents obtain practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care. The training program stresses the importance of self-evaluation, continuing medical education, and continued professional development.

Knowledge of research: Residents learn the principles of experimental design and statistical evaluation from didactic lectures and work on their Research rotation. This enables them to critically analyze professional literature in the field of physical medicine and rehabilitation and discover topics that require or inspire further investigation. The residents gain hands-on research experience by participating in a research project under the guidance of Physical Medicine and Rehabilitation faculty. Residents are encouraged to complete research studies, present them at a national meeting, and submit them to a peer-reviewed journal for publication.

Interpersonal and Communication Skills: Residents obtain competent interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals. This program provides the opportunity for the resident to develop the necessary written and verbal communication skills essential to the efficient practice of physiatry.

Leadership skills: Residents acquire leadership and communication skills when guiding the treatment teams and coordinating and managing the efforts of the professional medical and allied health team members. They augment these skills through committee work, and participation in national conferences and meetings.

Knowledge of teaching principles: The residents also augment interpersonal and communication skills through learning the principles of teaching via several different teaching and learning processes that occur in an academic setting. These processes include observation, residents work closely with Attendings to fully understand the concepts involved in being a PM&R physician. Once residents have a grasp of this knowledge, they implement it and begin teaching through patient and family education, running the allied health team meetings, helping other junior residents and medical students when questions arise, and making presentations to colleagues and other interested professionals.

Professionalism: Residents become competent in professionalism through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds. This program stresses physician accountability. It offers mentors, role-model clinicians, and an environment that demonstrates the values of professionalism, such as placing the needs of the patient first, maintaining a commitment to scholarship, helping colleagues meet their responsibilities, maintaining a commitment to continued improvement, and being responsive to society’s healthcare needs. Residents may participate in community service, professional organizations, and institutional committee activities. This program also stresses humanistic qualities. Attendings and Residents have the welfare of their patients as their primary concern. Residents acquire competency in demonstrating humanistic qualities when fostering the formation of appropriate patient/physician relationships. These qualities include integrity, respect, compassion, professional responsibility, courtesy, sensitivity to patient needs for comfort and encouragement, and an appropriate professional attitude and behavior toward colleagues. Professional ethics are emphasized as well. This program fosters a commitment to professional ethics in Residents that is demonstrated by a spirit of collegiality and a high standard of moral behavior within the clinical setting in the care of patients, in the education of Residents, in conducting research, and interacting with funding organizations.

Systems-based Practice: Residents obtain competence in systems-based practice, demonstrating an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care through their experiences with working in the healthcare system and with community resources in their residency years. Residents receive instruction on the social and economic impact of medical decisions on patients and society and the need to be the primary advocate for patient’s needs. They also receive instruction regarding the principles, objectives and process of performance improvement and program evaluation, risk management and cost effectiveness in medicine at various didactic lectures, and through the teaching of their Attendings. This program provides the opportunity for the Resident to be able to effectively and efficiently coordinate an interdisciplinary team of allied rehabilitation professionals for the maximum benefit of the patient through an understanding of each allied health professional’s role; the ability to write adequately detailed prescriptions based on functional goals for physiatric management; and the development of management and leadership skills.

Administrative Skills: As the practice of physical medicine and rehabilitation invariably involves a large amount of administrative responsibilities, Residents will be exposed to a variety of administrative tasks such as program development, quality assurance, staff evaluations, and the coordination of educational inservices and lectures. Residents receive lectures as part of the didactic series on administrative aspects of PM&R practice. These lectures include topics such as insurance requirements, medical legal and regulatory aspects, and organizational structure including financial and cost effective practices.