A minimum of four years of graduate medical education is required to complete residency training in the area of physical medicine and rehabilitation.
The first year of graduate medical education (internship/transitional year) is dedicated to the development of fundamental clinical skills. This experience includes six months in family practice, internal medicine, pediatrics, general surgery or a combination of the above. The remaining six months may be in primary care field or a more specialized field, including:
- Neurology: To learn a good neurologic exam. This is a critical skill in differential diagnosis and is of great benefit in EMG.
- Neurosurgery: To learn neuroanatomy. Many rehab patients have had or will undergo a neurosurgical procedure.
- Orthopaedic Surgery/Sports Medicine: To learn a good musculoskeletal exam and how to manage patients after orthopaedic procedures and acute musculoskeletal injuries.
- Pediatrics: To learn functional development. This is important for students with an interest in pediatric rehab.
- Radiology: To learn how to read diagnostic films
- Rheumatology: To learn joint injection techniques. Rheumatic diseases comprise a significant portion of the physiatric population.
- Urology: To learn how to order urologic tests. Bladder management is an integral part of caring for patients with spinal cord injury, stroke and many other physiatric disorders.
As part of the remaining three years of training, residents are required to spend a minimum of one year—and no more than two years—caring for hospitalized patients to provide inpatient services, including general rehabilitation, stroke brain injury spinal cord injury and pediatrics.
At IU School of Medicine, PGY2 residents in the physical medicine and rehabilitation program includes six months inpatient rehabilitation emphasizing general rehabilitation, stroke and traumatic brain injury and six months outpatient rehabilitation emphasizing consultations, musculoskeletal medicine, EMG, occupational medicine and sports medicine.
PGY3 residents spend three months in EMG, three months in inpatient rehabilitation (emphasizing spinal cord injury), two months in outpatient rehabilitation (emphasizing consultations, musculoskeletal medicine, EMG, occupational medicine and sports medicine), one month in inpatient pediatric rehabilitation, one month in outpatient pediatric rehabilitation, one month in radiology, and one month in sports medicine.
The PGY4 trainees spend two months in inpatient rehabilitation (emphasizing community orthopedic rehabilitation), six months in outpatient rehabilitation (emphasizing musculoskeletal medicine, EMG, prosthetics and wheelchair prescription), three months in electives and one month writing (research).
Because they are structured around an individual’s professional interests, PGY4 electives are as diverse as the residents themselves. Residents have pursued electives in a wide range of specialty areas, including
- flouroscopic-guided injections
- musculoskeletal ultrasound
- pain management
- sports medicine
[Tip] Residency programs vary in the number of months allotted to inpatient services. When choosing a program, students may want to consider this, particularly if they have preferences for specific patient types they hope to see.
Some residency programs offer a four-year program that integrates the first year of basic clinic training into the curriculum; but most PM&R residencies, including the one at IU School of Medicine, are three-year programs that offer positions beginning at the PGY-2 level, requiring medical students to complete a transitional/preliminary year before beginning the PM&R residency.
Research is required or encouraged at most institutions. While each program has its own parameters, a maximum of six months within a four-year residency program is typically permitted for research.