Training Overview

Training Overview

PM&R Residency Program Manual
PM&R Residency Training Overview

PM&R Residency Training
The Physical Medicine and Rehabilitation Residency Training Program at the University of Virginia is accomplished through didactic teaching, clinical training, teaching responsibilities, and research.

PM&R Didactic Teaching: A PM&R lecture series is held Monday through Thursday from 12:15 p.m. to 1:15 p.m.  Attendance is mandatory unless absence is approved. On Fridays residents may pursue independent or joint board review.

The daily lecture series is grouped by core competency and subject matter. Subjects include: Spinal Cord Injury, Head Injury, Stroke, Prosthetics and Orthotics, Electrodiagnosis, Physiatric Therapeutics, Cardiopulmonary Diseases, Rheumatological Diseases, Musculoskeletal Medicine, Research, and ethics. In the first six weeks of residency, PGY2s attend an introductory lecture series that includes an introduction to the team approach to health care, community resources, cost effectiveness and practice and delivery systems in the UVa-HealthSouth System. PM&R faculty, guest lecturers, and other health care professionals present didactic lectures. The six ACGME competencies of Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice are included in the didactics program.

PM&R Grand Rounds are scheduled twice a month. PM&R faculty, other speakers from other medical center disciplines and members of the local, regional, and national medical communities are invited to speak on topics related to the competency curriculum.

PM&R Clinical Training: PM&R residents receive their clinical education from PM&R and other University faculty through daily rounds and one-on-one interaction and supervision on the 50-bed inpatient service, the inpatient consultation service, the electrodiagnostic service, the pediatric rehabilitation service, and several outpatient clinics in the Division of Spine and Sports Care including Rheumatology, Pain Management and Orthopaedic clinics.

Inpatient Ward Service: PM&R residents rotate through the inpatient PM&R bed service at the UVa-HealthSouth Rehabilitation Hospital. The inpatient service is divided into four teams: Neurorehabilitation, Spinal Cord Injury, Geriatric Orthopedics/Joint, and General Rehabilitation. Residents are closely supervised by PM&R faculty. Patient evaluations, treatment plans, and treatment team issues are part of daily discussions.

Inpatient Consultation Service: PM&R residents see inpatients through consult requests from other departments at the University of Virginia Health Sciences Center, and the Kluge Children’s Rehabilitation Center (KCRC). PM&R residents evaluate and consult on patients with respect to their need for physical, occupational, speech therapies and/or other rehabilitation strategies, such as medications. The residents also offer recommendation for possible admission to the PM&R inpatient service at UVa-HealthSouth. After residents present their findings to a PM&R faculty member, a decision is made as to the patients’ optimal treatment regimen (inpatient and/or outpatient rehabilitation evaluation and treatment).One PM&R resident will rotate on inpatient consults at the main hospital. One attending physician will be assigned to staff consults with the residents. Consult requests appear on the Medical Information System (MIS).

PM&R Outpatient Rotations: PGY3 PM&R residents spend a total of six months in outpatient rotations, including: Spine and Sports, Prosthetics and Orthotics, Rheumatology, Orthopaedics, Pain Management, Cardiopulmonary Rehabilitation, and Geriatrics. Residents on the EMG/Neuromuscular Clinic rotation also see patients with neuromuscular diseases and spasticity. PGY4 Residents spend one week with recreation therapists, and three weeks in Occupational Medicine. Additionally, some intern years include a month of outpatient care at University Medical Associates.

Electrodiagnosis: Training in electrodiagnosis consists of one month of didactic lectures on electrodiagnosis, and six months of practical training on the electrodiagnosis rotation. During the six-month electrodiagnosis rotation, PM&R residents gain increasing responsibility as skills improve in the performance of electrodiagnostic procedures. The senior resident has the opportunity to assist faculty in supervising and teaching the junior resident. The residents are also able to observe different methods and equipment used by various faculty members. All residents are exposed to enough clinical material (an average of 300 EMGs) and training to qualify for the AANEM examination. PGY3 and PGY4 residents are strongly encouraged to participate in the annual self-assessment examinations sponsored by the AANEM.

PM&R Supervisory Training/Teaching Experience: During PM&R residency, residents gain strong supervisory and teaching experience. Each resident is assigned to present to their fellow residents at Journal Club. PM&R residents also teach medical students, Neurology residents rotating in the department, and patients and families at educational classes and family meetings during inpatient rotations. Residents are given increasing supervisory responsibilities as they advance through the levels of training. Under the supervision of PM&R faculty, senior (PGY4) residents are responsible for the supervision and training of third year residents on the electrodiagnostic service. 

PM&R Research: All PM&R residents accomplish an approximate three-month rotation in research during their training.  The resident is advised and encouraged to become part of a project early in their course of study.  Optimally, a final draft of the research paper is submitted for publication to a peer-reviewed journal following the completion of the research rotation, and/or for presentation at a national meeting. 

PM&R Training Program Years
PM&R residents may choose to do their preliminary year of training at the University of Virginia (4-year Categorical Program) or enter the program in the PGY2 year following the satisfactory completion of an internship year elsewhere (3-year Advanced Program).  The Residency Program has 14 positions and is fully accredited by the ACGME.

PGY1 Internship Year in PM&R: For those residents who choose to do their preliminary year at the University of Virginia, the internship is divided into six months of Internal Medicine, two months of Neurology, and surgical services that may include: Neurosurgery, Orthopaedics, Vascular Surgery, and Urology.  Physical Medicine and Rehabilitation residents develop strong fundamental clinical skills during their first year of training, and work with physicians who serve as important referral sources for their rehabilitation practices in the future.

PGY 2 Inpatient Rotations in PM&R: Building on the foundation of the internship year, the second year program exposes the resident to a variety of inpatient rehabilitation experiences.  Specialized programs have been developed in stroke and brain injury, spinal cord injury, general rehabilitation and orthopedic/joint rehabilitation.  Residents participate in daily multidisciplinary inpatient rounds and are introduced to techniques of rehabilitation team management, therapy prescription, and functional goal setting. 

PGY 3 Rotations in PM&R: Residents in their third year of training rotate through a variety of outpatient and inpatient programs including the PM&R Spine and Sports Care Clinic, Pain Management Center, Electrodiagnostic/Neuromuscular Service, Orthopaedics, SCI/Acupuncture Clinic, Prosthetics and Orthotics Clinic, Outpatient Rheumatology, Cardiopulmonary Rehabilitation and Outpatient Geriatrics, and Inpatient Consultation services. Residents have continuity of care with patients they see on inpatient consultations, treat in the UVa-HealthSouth Rehabilitation Hospital, and see as outpatients in the PM&R Clinics (msk, SCI, acupuncture) and on the Outpatient Geriatric rotation. Residents are required to take the USMLE Step 3 exam by the end of the PGY3 year.

PGY 4 Rotations in PM&R: The senior year there will be another six months of outpatient clinics:  Three months are outpatient electives, two months are outpatient pediatrics therapy, and one month is recreational therapy and occupational medicine. The senior year rotations also enable the resident to further his or her clinical, teaching and research skills. Senior residents participate in the teaching of junior residents and medical students during a 3-month rotation on the Electrodiagnostic service.  Residents participate in a research rotation during the fourth year, and optimally submit their work for presentation at a conference and/or for publication.  

PM&R Residency Program Clinical Components
Time spent during the three-year/36-month span of the PM&R residency program by residents in Inpatient Rehabilitation, Outpatient Rehabilitation, Miscellaneous Rehabilitation, and EMG:

Inpatient Rehabilitation:
3 months of PGY2   General Inpatient Rehabilitation
3 months of PGY2   Inpatient Neurological Rehabilitation
3 months of PGY2   Inpatient SCI Rehabilitation
3 months of PGY2   Inpatient Orthopedic Rehabilitation
1 month of PGY4    Inpatient pediatric Rehabilitation
13 months of Inpatient Rehabilitation Total

Outpatient Rehabilitation:
6 months, 1 wk of PGY3 Outpatient Clinics            
5 months, 3 wk of PGY4 Outpatient Clinics
12 months of Outpatient Rehabilitation Total 

Miscellaneous:
3 months of PGY3 Misc. (Consults)
2 mos, 1 wk of  PGY4 Misc. (Research)
5 months & 1 week of Miscellaneous

Electrodiagnosis:
2 mos, 3 wks of PGY3 EMG/Neuromuscular       
3 months of PGY4 EMG/Neuromuscular       
5 months & 3 weeks of EMG/Neuromuscular

Total Number of Program Months: 36 months

Sample PM&R Residency Training Schedules

PGY1- Intern
Internal Medicine - 6 months
Neurology - 2 months
ER - 1 month
Orthopaedics - 1 month
Vascular Surgery - 1 month
Urology - 1 month

PGY2 - Inpatient Rotations
Neurorehabilitation Service - 3 months
General rehabilitation Service - 3 months
Spinal Cord Injury Service - 3 months
Orthopedic/Joint Service - 3 months

 

PGY3 - Outpatient Rotations
Electrodiagnosis Service - 2 mos, 3 wks
Outpatient SCI Clinic - 1 week
PM&R Outpatient/Rheumatology/P&O Clinics
- 3 mos
Pain Management Center - 1 month
Outpatient Orthopaedics - 1 month
Cardiopulmonary Rehabilitation - 2 weeks
Geriatrics - 2 weeks
University Hospital and KCRC Consults - 3 mos

PGY4 Rotations
Electrodiagnosis Service - 3 months
Research - 2 mos, 1 week
Outpatient Clinic - 3 weeks
Outpatient Electives - 3 months
Pediatric Outpatient - 1 month
Pediatric Inpatient - 1 month
Occupational Medicine - 3 weeks
Rec Therapy - 1 week