The Physiatrist in Training Council (PHiT) Ambassador program consists of resident liaisons from most PM&R residency programs. We recently asked our PHiT ambassadors to answer questions submitted by medical students and compiled the ambassadors' anonymized responses by question. Review their helpful feedback below.
Disclaimer: Responses are the opinions of the residents, and not those of AAPM&R.
Table of Contents
Preparing for Residency
- Are there any creative ways to get involved in the field outside of research or interest groups?
- How much does research weigh in the selection process?
- How many PM&R audition rotations would you recommend applying to and why?
- Any advice for those of us starting interviews soon?
- Practice techniques?
- What not to do?
- Post interview communication?
- Did you call the prelim programs if you received an interview at a PM&R program?
- Should we treat prelim/TY interviews differently than PM&R program interviews?
- What were some good questions you found to ask interviewers during interviews?
- What are some surprises that you have run into during residency that you wish you would have looked into/asked about during the interview process?
- What is your take on thank you notes after an interview?Email vs. handwritten note?
Selecting a Residency Program
- What are important factors to consider when picking a PM&R residency in your opinion?
- When choosing a residency program, what were some important aspects of a program that you found appealing, specifically to MSK or Sports Medicine interests?
- IF APPLICABLE: Advice for non-traditional student (second- or third-career) - Dos & Don’ts?
- Other than location what attracted you to your residency program?
- If you plan to do a fellowship, how important is it to go to a residency program that offers that fellowship?
- What factors influenced how you ranked residency programs?
- What is one thing you wish you had done differently when applying to/interviewing at residency programs during your fourth year?
Completing Your Residency
- What is your typical study schedule? Any favorite resources?
- IF APPLICABLE (DOs): Have you found that your osteopathic training helped you in residency? Any tips for the residency application process for osteopathic students?
- IF APPLICABLE: Did you have children during residency? If so, how did you manage?
- IF APPLICABLE: Are you involved in RMSTP program?
- Can you suggest pointers for “shining” (standing out) on PM&R rotation?
- How did you learn about PM&R?
- I find it difficult to tell people what PM&R is (quickly).Please describe the field of PM&R in a succinct manner.
- As a physiatrist, long-term care is often integral to caring for your patients. Do you see yourself as the primary health care coordinator/provider for some patients?
- What is PM&R’s greatest strength as a specialty? What makes an ideal PM&R candidate?
- PM&R has evolved so much over the years. Where do you see the future of the field heading? In terms of technology, treatment options, etc.
Preparing for Residency
Are there any creative ways to get involved in the field outside of research or interest groups?
- Reach out to PM&R attendings and residents and express your interest. They may have opportunities of shadowing, sports game coverage, or clinic exposure.
- There are volunteer opportunities at organizations that participate in adaptive sports in the community, like rock climbing, cycling, swimming, wheelchair football, wheelchair basketball, golf, tennis, power lifting, kayaking, sailing, water skiing, track and field, horseback riding, judo, yoga, CrossFit, power soccer, and sled hockey. A simple Internet search for “adaptive sports” in your state or region will likely yield some options.
- Yes! Some programs offer summer programs for medical students to work in PM&R and learn more about the field. We had a PGY1 medical student who worked with us for the summer. I think this is a great way to gain ultimate exposure to the field and solidify interest.
How much does research weigh in the selection process?
- I was fortunate to have wonderful research mentors and access to resources that helped me to publish and present at national meetings during medical school. Pre-residency research experience varies depending on which medical school residents come from and residencies understand that. If you have experience, that’s a bonus but it’s not the end of the world if you don’t. If you have the opportunity, I would highly recommend pursuing a research project.
- Ask your mentor(s) in medical school to help you find a project that has a relatively high likelihood of you being able to complete it in the time you have and that has a primary investigator who is interested in your academic growth. Ideally, he or she would have some time to mentor you along the way also. If you are not able to find a project, try to develop a basic understanding of evidence-based medicine (hopefully your medical school introduces you to it).
- It is great if you have experience, but don’t worry if you haven’t been able to have a project to publish prior to residency—just demonstrate that you can think critically and are interested in a research experience in residency. Most residencies require that you have a project in order to graduate. If you aren’t overly interested in research, that’s okay too; but as competent clinicians we should at least be able to analyze a scientific paper for the sake of clinical translation.
- It is always helpful to have something to talk about even if it is not related at all to PM&R. Just having at least one research project that you know well and can talk about intelligently will truly be enough for any prelim, TY, or PM&R interview. Even if it was something that was just submitted as a paper or an abstract, as long as you can discuss what you learned from participating in the project, that will fill the time and answer the question sufficiently.
How many PM&R audition rotations would you recommend applying to and why?
- I think that unless you have an unusual circumstance, it is nice to do at least 2 rotations.
- I applied to 3 and did 1 visiting audition rotation and 1 at my home institution, which is where I most wanted to go. In hindsight, I potentially should have applied to more since they get high volumes of applications. I don’t know the ideal number to participate in, but didn’t want to spread myself too thin or be too stressed during interview season. They can be expensive (housing, etc.) and residency programs understand if you are unable to do 1. If you can, I would recommend doing 1 because it helps you gain exposure to a different system and patient population and helps you to explore a program and area of the country you are interested in.
- I would recommend shooting for 3 as a solid baseline. Four would be great if you can swing it in your schedule and 2 would be a decent amount, if that is all you can manage. The advantage of auditions is that the program gets to know you, and as long as you do a good job, it is always more likely that they will be willing to rank you higher since they have seen your work ethic and personality first- hand. I know at my program, resident input on the rotating medical students plays a huge role in the match.
Any advice for those of us starting interviews soon?
- Relax and be yourself. Most of the attendings are extremely friendly and they just want to get to know you.
- As far as specialties go, PM&R reputedly has one of the most laid back interview processes. It's always a good idea to be prepared to answer the questions: "Why did you choose PM&R?" or "Why did you choose to apply to this program?" but you likely won't be asked to give a step-by-step approach to agitation management in a brain injured patient or how to choose what back pain patient to refer for a surgical consult. Most interviews are conversational, and I felt that most of my interviewers were mostly focused on wanting to get to know me better as a person, not a screening process. Practicing with friends or family is a good idea; I think that practicing with co-students who are applying to other specialties is beneficial, too.
- My general advice is to try to enjoy the interview process. It can be a long few months, but I tried to think of it as a way to get to know various programs and see what is on the forefront of the field. Being able to discuss PM&R during the interviews also reaffirmed my interest in PM&R.
- It's OK to be nervous, it happens to everybody and it's expected. This is especially true with your first interview, which will likely be the toughest. Apply broadly and don't be too picky. It's a much nicer feeling declining interviews than trying to beg for interviews later in the season. Do some research on the program and the city before you go. It goes a long way to show the program that you're actually interested in being there. It's tough from a programs perspective, they're trying to gauge whether you'll fit into what their values are and that you'll actually decide to spend 3-4 years of your life (potentially far away from family/friends) with them. If you got the interview, you should know that they already think you are qualified and that they think highly of you as a candidate. The hard part is out of the way, you now need to go in there and be yourself. Show them what makes you different and try to make a genuine connection. This isn't always easy, there may be programs that extend an interview invitation that may be far from your top choice, but keep an open mind. You never know where you'll end up.
- I practiced with my wife. So, I would recommend practicing with someone who is honest with you and understands what the interview process is like.
- Personally, I study by writing notes and rereading them, so for interviews, I wrote down my answers for some common interview questions. I also wrote down a few sentences to a paragraph about my most significant experiences listed on my resume, which allowed me to refresh my memories of the experience and reflect on it so I could more easily recall the experience if I was asked about it. I practiced answering common interview questions with my then boyfriend, and also practiced out loud to myself.
- Be prepared to talk about anything that is on your resume so that you are not taken off guard if you are asked to expand on an experience that is listed. Write down details about the day after each interview, such as who you met, interview questions that went particularly well/poorly, and things that surprised you about the program. This will be helpful when you go to make your rank list.
- I definitely recommend some mock interviews with a mentor/experienced faculty member. It's good to go over commonly-used questions, and definitely try some tough questions to see how you handle it. But don't overdo it.
- As above, don't overdo the mock interviews, you don't want to sound too rehearsed. Try to be natural and don't try to be something you're not. Most places want to know the real you. Also, be professional from the moment you enter the city to when you're back home on your couch. You never know who you'll run into.
- If your medical school has a mock interview program for residency, definitely take advantage of it. If not, at least have a friend perform a mock interview prior to interview season. The whole goal is be comfortable in a face-to-face setting. Also look up a list of common interview questions and have a talking point for each one of those questions. It is better to not have a word-for-word rehearsed answer (which may come off as disingenuous), but make sure that you do have something to say for every question. It is important to do your homework on each program prior to interview day, and if you are given a list of your interviewers, do a quick Google search to see what they do within the program. You may have interests that align, which will make the interview go much smoother.
What not to do?
- Don’t talk about the great lifestyle we get. Yes, PM&R gets pretty good hours most of the time (although I am up typing this at midnight on a call night), but attendings don’t want to hear about that.
- Don’t try to lie your way through an answer; if you are not familiar with a topic that is asked about, you can be honest and redirect the question.
- Complain! The residents that you’ll be spending your interview days with are your future colleagues. If they get the sense that you have a bad attitude, they will be unlikely to advocate for you. Most programs will not actually have the residents participate in the ranking process, but you should be aware that residents are encouraged to speak up if they see red flags.
- Do not try to act the way you feel the program wants you to act (a.k.a. BE YOURSELF). Interviewers are typically seasoned at the game and can sniff out when applicants are not acting like their natural selves. Plus, as much as programs are trying to find a good fit, the interview process is also important for you as the applicant to find a program that fits your needs and interests well.
Post interview communication?
- I would send an email/thank you letter to people you interviewed with and residents you thought you connected well with.
- I hand-wrote thank you cards to all of my interviewers (usually on the plane ride home), but plenty of the other residents I know sent emails. I would definitely communicate with them in one way or another; I would try to incorporate an anecdote from our interview to personalize them a bit.
- I feel that many programs don’t take into consideration whether a student sent a thank you card, but that being said, I still felt most comfortable sending a “thank you” to all my interviewers.
- I would recommend sending everyone you come into contact with a handwritten thank you note (interviewers, program directors, program coordinators, etc). When it comes time to rank, email the programs you are most interested in so that are you fresh in their memory.
- I wrote everybody I was in contact with (program coordinator, interviewers) a thank you email. They took time out of their days to meet with you, so it's polite to thank them. I know some people send cards/hand-written letters. Also a nice gesture, but I don't think a program will take you because of that. The content of your application and interview are vastly more important.
- I would typically send a thank you email to all those I interviewed with as well as the program director and program coordinator at each program. Later in the interview season (about 1 to 2 weeks prior to when rank lists were due), I sent an email to the program director and program coordinator of the top 3 programs on my list. I would emphasize to do this selectively as the emails may lose meaning if sent to everyone (and will unlikely make or break your application anyway since programs do receive a lot of "love letters" when rank lists are due). Most importantly, do not make any false promises in your communications.
Did you call the prelim programs if you received an interview at a PM&R program?
- Calling or emailing the prelim programs that you applied to is perfectly fine, if you received an interview to a PM&R program in the area. Most programs that I applied to were courteous, even if they didn't offer an interview spot right then.
- I personally did not, but I think this could be a reasonable idea if you received a PM&R interview.
- It never hurts to make a polite phone call. The worst thing they can say is that you still will not be offered an interview.
- Not sure I'm answering this right, but I did get asked at all prelim interviews what I was applying for. A good amount of prelim programs also asked me if I had any interviews in my desired specialty. One program even told me that their decision was going to be affected by whether I had interviews for an advanced position or not (luckily I did).
- I did for the PM&R programs that were toward the top of my list. It is always a good idea to do so even for programs that you are only somewhat interested in even if you have not received many prelim program interviews though.
Should we treat prelim/TY interviews differently than PM&R program interviews?
- Yes, prelim/TY programs don’t care what you subspecialty want to go into, they want to know what would make you a good fit for their program for a year.
- Prelim interviews are different than PM&R interviews, but I didn't have a specifically different approach that I took. Most programs will ask what you think you will gain for your specialty by doing a TY/prelim program. I would get 2-3 points down that you practice to be prepared to answer that question.
- I think the only difference is that for each, it is wise to have a reason for why you are applying to prelim year, or TY year. For example, I wanted to gain more experience in medicine and feel confident treating the most common pathologies, CHF, MI, Diabetes, HTN, etc., and therefore expressed this to prelim programs.
- In my program, half of the residents did a TY year, half did a prelim year, and I feel that we have similar experience and comfort level dealing with medical management.
- I found that the prelim interviews were a bit more serious than the PM&R interviews, but no need to prepare in any special way.
- I don't think so. Same thing goes for both; you want to be confident, be yourself, and be prepared.
- I don't think so. The prelim/TY programs know that the year is a stepping stone to PM&R for you but they are really just interested in whether you will work hard and try to learn throughout the year. If you come off as passionate for PM&R, you are naturally an attractive applicant for the prelim/TY program.
What were some good questions you found to ask interviewers during interviews?
- Are there multidisciplinary clinics that are a part of the residency Q4?
- What are the research requirements?
- Does the program use a jeopardy system for coverage?
- What changes do you see occurring within the program during the next 4 years?
- What do they believe are the strengths and weakness of the program?
- What have the residents from the last 2 graduating classes gone on to do? Fellowships vs. jobs?
- What surprised you about the program, good or bad?
- What are the call schedule and stipends/funding for national events like?
- What are the rotation schedules?
- How many EMGs will residents get?
- What is quality-of-life like for residents?
- What type of supervision structure is in place for residents?
- I am particularly interested in ______. What formal and informal learning opportunities should I expect and how open is the program on creating new opportunities?
- Do you feel that the program is well-rounded and prepares the trainees for either practice or fellowship?
- How does your ancillary staff interact with the residents?
- What kind of education do you have on billing and coding?
- What opportunities will I have to work on my presentation skills while enrolled in your program?
What are some surprises that you have run into during residency that you wish you would have looked into/asked about during the interview process?
- I would have asked more about the specific rotations that residents do, and how much exposure you get to both inpatient and outpatient. It is also important to know when you will get those rotations. While it is traditional to do a lot of inpatient as a PGY-2, it makes it harder to make decisions about fellowship and career plans if you don’t get exposure to certain aspects of PM&R until later in your training.
- Ask about the support system you will have—medical training is a marathon, not a sprint, and it is ok to ask for help along the way. As medical students, we work so hard to get into a residency program, then to complete our intern year, and finally make it to our residency of choice. We don’t want to be too burnt out when we get there. Ask how the program helps support residents’ work-life balance and overall health and well-being. Take care of yourself and ask for help if you need it; doctors are patients (and people!) too.
- I would have asked more about call schedules and general schedules overall because your daily schedule plays a huge role in your overall quality of life.
- I would have asked more about the specific amount of exposure than you will get to each sub-specialty, especially some of the smaller sub-specialties such as PEDS, P&O/amputee, cancer, etc.
Selecting a Residency Program
What are important factors to consider when picking a PM&R residency in your opinion?
- It is important to assess your goal patient population and if the residency has enough exposure to that patient population. Not only patient population, but you should assess if the residency offers your niche of interest. It is fair to ask about written and verbal board passage rates, and if the rates are low, what is being done to improve this. Personally, I was unsure of my goal patient population and niche so I opted to rank well-rounded, diverse patient populations, and hard-working residencies.
- It’s important to assess whether you will fit in with the culture of the program, which can be assessed by doing an elective/away/audition rotation at the program and/or during interview day. Try and picture if you would want to work with the attending physicians and residents for the next 3 years. Also, the quality and quantity of teaching from attendings, fellows, and other residents and the quality and quantity of formal noon lecture series and weekly lecture series is important. You can gain insight into this by asking current and previous residents at the program. The variety of patients that you will take care of, in terms of medical complexity and in terms of socioeconomic status, is important to assess because by the end of residency, you want to be comfortable treating a wide variety of patients. You may also want to assess where and in what type of setting the graduating residents have found employment, and what types of fellowships residents sought out, if they desired to pursue a fellowship. It is also important that you are able to do more than the minimum ACGME requirements for procedures like EMGs, botulinum toxin injections, peripheral joint injections, and axial epidural, SI, and facet joint injections. If one is interested in participating in research, then ask the residents what types of research projects they have worked on previously and what the process of finding a mentor and/or getting IRB approval was like.
- Important factors include: a) inpatient vs. outpatient experience ratios; b) level of support given by the program to residents; c) is the program housed in a stand-alone facility or attached to an acute care hospital; d) are the residents genuinely happy; e) where do residents end up?
When choosing a residency program, what were some important aspects of a program that you found appealing, specifically to MSK or Sports Medicine interests?
- In regards to MSK or Sports Medicine, I asked if they had those rotations, how often could you take those rotations, and who was the attending(s) for that rotation. I found locations that offered multiple electives appealing. Also, I asked about a regimented ultrasound course and the number of ultrasound-guided procedures residents averaged.
- The quality and quantity of sports coverage should be assessed, which can range from physical exams for athletes, sideline coverage of high school or NCAA sports, and volunteering at marathons, 5Ks and 10K races, triathlons, etc. In addition, one should assess opportunities for dedicated Sports or MSK rotations and elective opportunities in these areas. Students should also inquire into the hands-on opportunities for peripheral joint injections, trigger point injections, and exposure to diagnostic ultrasound and to platelet-rich plasma injections.
- Appealing aspects would include whether the program offered MSK ultrasound experience as well as other opportunities to work with MSK/sports medicine physicians.
IF APPLICABLE: Advice for non-traditional student (second- or third-career) - Dos & Don’ts?
- As far as interviews and applications go, highlight how your previous job/field contributed to your personality or approach and how that will influence your patient care and how it behooves the field of PM&R as a whole. Use your unique history to your advantage. Make it a topic during interviews.
- PM&R accepts a wide variety of candidates in their residency programs. Having prior careers in my opinion helps your professional maturity and grows your work ethic and hunger to succeed. Never be defensive about your prior careers. Talk about what made you pursue medicine after experiencing your prior careers, convey your passion about medicine to your interviewers. My residency program has had several residents in their mid 30s who have had prior careers, and they all did well in medical school and excelled as residents.
- I think it was great going into PM&R from a second career. You have an interesting story to tell and set yourself apart from a lot of applicants.
- Second-career applicants are interesting and memorable candidates. Tell why you switched and be genuine.
Other than location what attracted you to your residency program?
- I went on 16 interviews for PM&R residency. Each interview was different and highlighted different strengths of each program. My residency program attracted me based on their interview process. It was organized, timely, and efficient. And as it turns out, my residency is organized, timely, and efficient. Other attractive variables were the supportive faculty that I interviewed with, the promise of hard work, and the likability of the current resident community.
- I was drawn to my residency program by the diverse group of attending physicians and residents who created a warm and stimulating learning environment. Schwab is a safety-net hospital that provides physiatric care for low-income and vulnerable populations. In addition to training in this setting, we rotate at the University of Chicago Medical Center and the University of Illinois Hospital & Health Sciences System where we treat complex patients, and we rotate at NorthShore University Health in Evanston where we work with subspecialty groups in the outpatient setting. Our training in both community and university-based settings, prepares us to practice physiatry in a range of environments after graduation. Also, the residency program has well structured educational activities like daily noon lectures by the attendings, weekly Thursday morning lectures, which is protected pager-free time, anatomy in December in the cadaver lab at the University of Chicago Pritzker School of Medicine, as well as monthly ground rounds with speakers from all over the country. In addition, there are ample opportunities for procedures like EMGs, botulinum toxin injections, peripheral joint injections, and axial epidural, SI, and facet joint injections, and these opportunities start as a PGY-2.
- My residency program had many positives other than location. It is a smaller PM&R program that affords residents opportunities that may not be possible in larger programs. It is also attached to a level 1 trauma center. As such, this comes with the perks of being able to see "TRUE TBIs" and traumatic SCIs. This is also helpful in the wee hours of the morning when you may need to curbside residents in other specialties. Lastly, my program is one that truly gives residents a voice in how we are trained. Our director and other faculty members truly work to ensure that we are thriving.
If you plan to do a fellowship, how important is it to go to a residency program that offers that fellowship?
- I would defer this question to fellowship directors. I believe the answer may vary based on the fellowship.
- I am at a residency program that does not offer fellowships. Historically, at my program the residents who choose to do fellowship have matched at some of their top fellowship choices and have not been limited by the lack of fellowships offered at our program. Fellowship programs take a number of factors into consideration when selecting candidates, like letters of recommendation in the desired specialty, residency performance evaluation, personal statements, perceived commitment to the specialty and interest in the program, evidence of professionalism and ethics, leadership qualities, and many more factors.
- While I don’t plan on doing a fellowship, I do believe that training at a residency program that does offer your fellowship of interest does carry some weight.
What factors influenced how you ranked residency programs?
- Several factors influenced how I ranked programs. I have a natural affinity to the south (due to great weather, southern hospitality, proximity to my family in the Carolina’s), so that was definitely a factor. During the interview and away elective process, I wanted to find a program with diverse yet friendly residents who I would get along with. The interview process also mattered a lot with faculty, I wanted a program director who I felt I got along with well and who I could feel comfortable approaching during my residency training. Strength and rigor of the curriculum also mattered a lot to me. Categorical programs were also preferable since I did not want to relocate after a medicine/surgery prelim or transitional year. I kept up with programs that I felt strongly about, and I’m happy to note I matched at a program that fit all the categories above.
- When ranking programs, I focused on "gut feeling" (i.e., how the dinners the night before went, how I interacted with other residents and felt I'd fit in, overall vibes I got from residents/faculty); location (size of city, how close is it to home, how difficult would travel home be, what people do for fun in city); how the interview went (were the faculty welcoming); how happy the residents seemed and the program overall (mainly was it well-rounded and a supportive environment). Ultimately, gut feeling was what prompted me to rank my #1 over my hometown program. I had a great time at the dinner the night before, which both residents and faculty attended. Everyone was welcoming, happy and it seemed like a good fit. I would strongly encourage going to the dinners the night before interviews if your schedule allows. It gives you a good opportunity to see residents outside the work environment and ask them more casual questions.
- A. Stand-alone Facility: I felt that I would have a better sense of the field if I did my residency in a stand alone rehabilitation facility. It felt that PM&R programs that were connected to an acute hospital had sicker patients which could put the emphasis on acute medical care and not rehabilitation itself. B. Location: What was interesting to me was that some of the best PM&R programs were spread all over the country. In my opinion, a strong support group such as family and friends is paramount to surviving residency, so I chose a program that was closest to home.
- The most important factors in constructing my rank list were: (1) the “feel” of the program, (2) the reputation of the program and (3) location. Throughout my interview trail, it was apparent that different programs had different vibes. It was important to me to know that I would “fit in” with the program, and that my future colleagues would become my lifelong friends. The reputation of the program was also important to me because I wanted the best education I could get. We have 3 years to learn the broad scope of PM&R from inpatient to outpatient. If I did not pursue a fellowship, I wanted to know that I would be ready for independent practice. Finally, location was important to me. I wanted to be within driving distance of my family and friends, who truly make up my support system. Trust your instincts on interview day, ask around about programs, and read up on them to determine if they are the right fit for you.
- Location, feel of the city. Are there young energetic people, fun restaurants, bars? Is the facility clean, updated, and well-staffed? I rotated at programs I thought I would like to really get a feel for the program and the people/staff.
- Program reputation, overall program strength in all rehabilitation domains, fit and feel during interview day, significant other (e.g., fiancée), weather/location (region of country as well as urban vs rural), in that order.
What is one thing you wish you had done differently when applying to/interviewing at residency programs during your fourth year?
- Don’t check in bags unless you have to! Traveling can get expensive. Consolidate your traveling bags as much as you can to save money. Also, have a good traveling/rewards credit card during the process, as you can earn at least a couple of free flights, if you interview enough. I wish I had geographically consolidated my interviews more (went on plenty prelim and PM&R interviews).
- When interviewing, I wish I would have asked more about Cancer Rehabilitation and what exposure the residents get during training. Of course, I wasn't very familiar with Cancer Rehab back then so at the time I would not have been as interested. I would recommend taking detailed notes about call schedules, how vacation days work (days at a time or weeks at a time), how heavily the rotations rely on residents. All in all, there are a ton of great rehab programs out there and you'll get good training wherever you go. It comes down to what you enjoy doing in your free time and how you're able to utilize that time off (because it is sparse) to stay well-balanced in residency in my opinion.
- Traveling and interviewing at many PM&R and preliminary programs can be a wonderful experience, but it can also be very stressful and exhausting. If you have a healthy number of interviews, I would consider only going to the programs you could truly see yourself in.
- I wish I had better prepared for each interview, and asked around about programs. Find out what stands out most about each program, and what they are proud of. Also try to connect with your interviewer during the interview. This will help their impression of you, although I did find it pretty challenging to do so.
- I would advise you rotate at programs you think you want to rank because it’s hard to know a program just based on a one-day interview. During fourth year, be sure to take time off to prepare for internship especially if doing a prelim, and always write thank you letters.
Completing Your Residency
What is your typical study schedule? Any favorite resources?
- Not great, but I try to read here and there. Board review books that I received in residency are good resources. I would spend time refreshing on the brachial plexus as well since that is really important and keeps coming back over and over again (EMG).
- I generally try to focus study on the topic of the rotation I'm on and whatever topic we're covering at didactics. Great general resources are Cuccurullo's PM&R Board Review, Braddom's PM&R, and Frontera's Essentials of PM&R. Cuccurullo is essential for a general overview, and is my go-to text. The other 2 are good for a more in-depth knowledge. For EMG, you can't go wrong with Shapiro. For MSK, I use Brukner & Khan. There are some good flashcard books and applications (Mathur's PM&R Flashcards). The AAPM&R me® website has some free question banks and a paid question set, which are useful for studying for the annual Self-Assessment Exam.
- About 3 times per week, I try to sit down and read an article (ex. PM&R), or Cuccurrullo on the topic that is pertinent to patients I saw that week.
- Our program gave us the Cuccurullo board review book. I review the sections that correspond to my rotation prior to starting each month.
- My study schedule is really rotation-dependent; during more relaxed rotations I obviously have more time to study. I will say to try to at least put aside a few hours a week, but I know sometimes that's easier said than done. Personally, I like Cuccurullo. It is full of board-relevant information. I also use the Q&A review by Dr. Weis.
- My study schedule varies based on my rotation/post-graduate year. I am currently finishing up my PGY-2 year which is heavily inpatient (and thus a bit busier than PGY-3 and PGY-4 years). This past year, I did not do much formal studying but instead looked-up topics on UpToDate and PubMed for anything I saw on the floor or in clinic. I am currently on EMG and transitioning more to the outpatient aspect of things so am starting to study more formally for topics. I set aside about an hour each night when I get off to read and occasionally do some light reading on the weekends. My favorite resources are Cuccurullo and PM&R Q&A for general PM&R, Preston and Shapiro for EMG, and Netter's Concise Orthopaedic Anatomy for MSK medicine.
IF APPLICABLE (DOs): Have you found that your osteopathic training helped you in residency? Any tips for the residency application process for osteopathic students?
- Yes. My physical exam training in the capacity of palpation for tissue texture changes and physical exam maneuvers have been exceedingly valuable. Also, the parasympathetic and sympathetic innervation levels have been incredibly helpful in spinal cord medicine. PM&R is a holistic field, your osteopathic training is innately holistic. Continue to nurture that aspect of your practice while on audition rotations. Students often have downtime on audition rotations, so offer your osteopathic manipulation skills.
- You have a major advantage being osteopathically-trained. We bring a lot of modalities and anatomical knowledge to the table.
IF APPLICABLE: Did you have children during residency? If so, how did you manage?
- I did not have children during residency. Several co-residents have kids and some of their spouses stay home and help take care of the kids. I’ve also seen the other side of things, where both parents are residents at work, and have their children at daycare throughout most the day while they’re at work. It’s tough and expensive, but doable.
IF APPLICABLE: Are you involved in RMSTP program?
- RMSTP is focused on developing research careers within the specialty. You can apply as a pre-applicant as a resident.The program provides support and training for individuals interested in an academic career substantially devoted to research.
Can you suggest pointers for “shining” (standing out) on PM&R rotation?
- PM&R is filled with interested, caring, and kind people. As long as you also share those traits, you will stand out. It would be beneficial to know and understand FIM (Functional Independent Measure) scores as well as the disposition of each of your patients. The disposition is important because it helps you clarify the barriers needed to overcome in order to plan a safe discharge home. If you would like areas to study: anatomy, sports medicine, basics of traumatic brain injury and spinal cord injury, are my recommendations.
- You can stand out on your PM&R rotation by:
- (1) owning your patients: be the team member who knows the most about your patients and know their social history, their prior level of function, and disposition options.
- (2) Be inquisitive: read about your patients’ physiatric issues and follow them in their therapies.
- (3) Prepare weekly or biweekly 3-5 minute talks: use this time to discuss interesting clinical questions that arise while rounding and then teach your team about the topic.
- I would definitely suggest showing that you are interested by reading about common PM&R problems/diagnoses. These may vary depending if you are on an inpatient vs. outpatient rotation, however the principles of “shining” on any other rotation apply here. Show interest, take initiative and ask your attendings/residents about what areas they believe you may need to improve upon as well as in what areas you are showing strength.
- Try to go more above and beyond than you would as a normal medical student, for example, look up journal articles and maybe occasionally approach an attending with a relevant genuine question. Don’t overdo it and don't make the residents look bad because their feedback about you is weighed heavily.
How did you learn about PM&R?
- I actually read about PM&R online! It sounded interesting, so I started emailing people in my community that were PM&R doctors that I found online and asked if I could come shadow them.
- I first learned about PM&R through Sports Medicine as a high school cross country runner with overuse injuries. Later in college, I had the privilege of working with adults with disability. I became interested in a field that saw a wide variety of patients, with a focus on neuro and musculoskeletal medicine and function.
- To be honest, I am a first generation college student, medical student, and I did not even know a single physician in my family or friend group growing up. I will admit that when I entered medical school, I had never heard of our wonderful specialty of PM&R. Fortunately, our medical school had a close connection with a local physiatrist who gave an optional lecture in the middle of my first year on “What is Physiatry?” There was free food involved, so naturally the majority of the class showed up. As he was describing the specialty I kept thinking to myself: "Wow! This sounds like something that might be a good fit for me!” After the lecture, a few of my peers even approached me to reinforce the same idea. Afterwards, I approached him and asked him to be my mentor. He agreed, and he provided guidance and shadowing opportunities for me over the coming years.
I find it difficult to tell people what PM&R is (quickly). Please describe the field of PM&R in a succinct manner.
- Inpatient: Our goal is to find the best option to get you home as quickly and as safely as possible. Outpatient: Helping increase functionality in a myriad of ways.
- This question can be asked during your interviews, and it is one that you should be prepared to answer at any point. PM&R is somewhat nebulous, given it is expanse, and the answer is different for every person. In my mind, PM&R is a specialty focused mainly on preserving and restoring physical and cognitive function in the face of both chronic and acute issues that affect them. It is about supporting patients through difficult times in their lives and developing plans given their unique circumstances. Well... that's a pretty vague answer, but each unique field within PM&R will have that as their primary goal. It's all about function, baby.
- A specialty in medicine that aims to improve a patient’s function and ability to go about their daily lives. Physiatrists, which are Doctors of PM&R, have special training that encompasses neurology and musculoskeletal medicine.
- You will probably be asked to answer this question several times during your interview season. I don’t think it is an important to have a rehearsed, technical answer as it is to tell your interviewer what the field genuinely means to you.
- We do non-operative treatment of neuromuscular disorders. That's the quickest I can try to describe it, obviously it's much more complex than that. We have a big focus on patient's function and quality of life. It's not so much treating an acute issue and moving on, we're always trying to improve our patients lives. It's an extremely diverse field, but the core concepts mostly hold true.
- In a very simplified manner, I look at PM&R in 2 parts. Part 1 is Physical Medicine, which is predominantly outpatient and deals with musculoskeletal medicine. We evaluate and treat a variety of MSK issues with non-operative management using tools ranging from PT/OT to peripheral joint and spine injections. Part 2 is Rehabilitation, which is predominantly inpatient and deals with any patient that requires an intensive course of therapy to return to their level of function prior to the injury or disease that put them in the hospital. Common patients include those who have suffered a stroke, TBI, SCI, or are status post amputation and are often followed as an outpatient in continuity clinic post-discharge. There are other pockets within PM&R such as wound care and cancer rehabilitation, but all in all, the field aims to help patients regain function within every aspect of life, no matter the issue. Patient-centered, rather than pathology-centered, care is our true focus.
- I would say PM&R is a combination of multiple specialties, including anesthesia, neurology, and family medicine. We are similar to anesthesia since we can specialize in pain subspecialties involving interventional spinal procedures and manage acute/chronic pain patients. Similar to neurology, as our inpatient census relies on intensive rehab of CVA, traumatic brain injury and spinal cord injury patients. We believe in holistically treating patients, similar to internal/family medicine patients. We can offer several things through PM&R that other specialties provide, plus more (such as intense wound care, regenerative medicine, etc.).
- PM&R is a field that is very multidisciplinary in nature. We use a team approach to focus on functional goals for our patient, whether that be in acute inpatient rehab following a Neuro/MSK/Ortho insult or in the outpatient setting focusing on pain control, mobility and keeping your patient as active in the community as possible.
- PM&R is all about functionality. Whereas other specialties in medicine focus on acute problems and acute answers, we think outside the box and think of ways to improve a patient's functionality and achieve some independence. In other words, other specialties may save your life, but in PM&R patients get their life back.
- The way I have learned to describe PM&R is: physical medicine and rehabilitation. “Physical medicine” is the outpatient aspect of PM&R, best known for musculoskeletal medicine, sports medicine and pain management. “Rehabilitation” is the inpatient aspect of PM&R, best known for its focus on amputee, spinal cord injury, brain injury and cancer rehab medicine. Overall, we are specialists of the nerves, muscles, and bones.
- PM&R is the medical discipline focused on disability and identifying ways to promote function and independence, whether it be by reducing pain, recommending therapies (e.g., PT, OT, or speech), or treating spasticity.
As a physiatrist, long-term care is often integral to caring for your patients. Do you see yourself as the primary health care coordinator/provider for some patients?
- Not yet, but am starting continuity clinic soon, and while I am not expecting to acutely manage medical issues, I guess I will probably be more interactive in care, figuring out ways to improve patients’ functionality.
- That's a good question, and I feel like physiatrists definitely do become the "go-to" care provider for many patients, especially those with chronic issues that fall under the care of the specialty.
- I believe that depending on the area of physiatry that you practice, you can be a primary health care coordinator for a patient. For example, I felt that while rotating through my SCI and brain injury rotations in the outpatient setting and then also in the VA inpatient setting, physicians do often follow patients throughout their lives and assist with coordinating in their care. Especially in SCI, physiatrists have a unique knowledge base that other specialties don’t have and I feel SCI patients are often most comfortable with their physiatrist. There are other areas, for example sports medicine or interventional pain, where the practitioner is less of a care coordinator.
- Certainly while people are on the rehab unit, we manage all of their medical co-morbidities. On the outpatient side, I have noticed that physiatrists do help manage sleep, pain, mood, paperwork, and coordinate care with other services such as urology, orthopedic surgery, and neurological surgery.
- I can definitely see myself doing acute inpatient rehab. It's nice still using some of the medical knowledge we've spent so much time learning. Our patients can be very complex, and often times we do end up being the primary coordinator of a patient's care with some help on medical issues from a family medicine or IM physician; especially when it comes to orthotics, prosthetics, wound care, and spinal cord patients. Not many other physicians are well-versed in these fields and a lot of times we end up taking care of a majority of the issues for these patients.
- Yes.This especially holds true among the TBI and SCI populations where we follow them over the span of their lives and often understand the complications from the respective injuries better than their traditional PCPs.
What is PM&R’s greatest strength as a specialty? What makes an ideal PM&R candidate?
- I love PM&R because it focuses on function and what is most important to the patient. I don’t think there is such a thing as an ideal candidate, there are lots of different types of candidates that could make great PM&R docs.
- It has a focus on function and how disease affects a person’s quality of life; it emphasizes care of the whole person, no matter how old or at what stage of life. With its breadth and depth, providers are able to empower patients to make lifestyle changes and educate them on a variety of treatments available to them, many of which may be performed or prescribed by the physiatrists themselves. An ideal PM&R candidate is compassionate, hardworking, can communicate effectively and be a good listener, be a team player on a multidisciplinary team, think critically and use evidence-based medicine, and be willing to learn about health care utilization and systems-based practice in the setting of the challenges (access to care, cost, etc.) that we as providers face today.
- Of course as a PM&R resident, I am naturally biased to thinking that our specialty is among the greatest. I think our greatest strength is the focus we put on a patient’s quality of life rather than just focusing on their pathology. I cannot tell you how many times I have had an interaction with the patient who had a traumatic and nearly deadly event. Those patients were literally rescued from the scene by the EMTs, resuscitated in the emergency department, kept alive and recuperated in the ICU, stabilized on the general medicine floor, and then transferred to rehabilitation. When it comes down to it, so many medical professionals played a role in their rescue and recovery. But it is immensely gratifying that most of the time the physicians and the PT/OT team are who they remember the most. That is because we are the ones that spend countless hours with them working every single day to get them back to a level of functioning where they can either be independent or be less dependent on their loved ones. This gives them such a sense of self worth and autonomy.
- Despite what has transpired before they enter the rehabilitation unit, most everyone’s primary goal is to be able to manage in the home setting or in their next step in the system as independently as possible. I have experienced such a joy to watch my patients grow from a state of extreme debility to a state of independence or near independence on a regular basis.
PM&R has evolved so much over the years. Where do you see the future of the field heading? In terms of technology, treatment options, etc.
- PM&R has a great future ahead of itself. The field will continue expanding in the future, with regenerative medicine and wound care taking more focus in rehab medicine. Interventional spinal and pain physiatrists will continue to be in demand as primary care physicians are now limited with their opiate prescriptions based on the latest opiate guidelines. Ultrasound guided musculoskeletal medicine will also continue to prosper in the future. Annual reimbursements continue to rise for physiatrists also. Residency training programs will thus continue to get competitive.
- PM&R is so exciting because it is constantly changing and is so broad. I think diagnostic/therapeutic ultrasound is a technology that will continue to become an important part of our practice in the future. Due to the opioid crisis nationally, rehab physicians are also likely going to be taking on more chronic pain patients and trying to focus on other pain management techniques.
- PM&R is a field that is intimately interconnected with technology. From state-of-the-art prosthetics to the use of virtual reality in therapy, PM&R will evolve hand-in-hand with the advances in science and technology. The next 20 years will be very exciting for us.
- I see a bright future for PM&R. There is a tremendous amount of research being done in both the outpatient and inpatient sides. For musculoskeletal medicine, PRP is becoming a popular treatment option. For spinal cord injury, the exoskeleton and virtual reality programs are helping patients regain their function.
- There are advancements in many different areas of PM&R so it’s hard to identify a universal technology. Medical apps, devices, drug and modality interventions are always evolving.
- PM&R is the ideal field to champion regenerative neuromusculoskeletal medicine because of the strong foundation in anatomy and physical examination. Similarly, PM&R physicians are ideal pain medicine doctors. We need to remove pain as the fifth vital sign and emphasize reduction of pain while maximizing function. We should also be the field to weigh in on acute trauma as consultants in order to prevent secondary complications. Physiatrists should be primary care physicians' go-to musculoskeletal specialist. PM&R physicians should be consulted simultaneously (or before) our orthopedic surgical colleagues when trying to diagnose MSK pathology. I believe that PM&R should also be the leaders of pragmatic clinical trials, or studies designed to figure out if an intervention works rather than a classical RCT that attempts to identify cause and effect relationships. PM&R is a holistic field and we adopt treatments—from acupuncture to medial branch blocks—so long as they work for the individual patient. Thus, we should be leading research using pragmatic clinical trials as ways to illustrate what works in our health care system without necessarily explaining the why or how. This will also improve the research base in rehab, as it is often difficulty to quantify the positive effects of our specialty.