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Program Overview

The Department of Physical Medicine and Rehabilitation Residency Training Program at the Hospital of the University of Pennsylvania strives to fulfill its stated philosophy and goals and is consistent with the Essentials of Accredited Residencies in Graduate Medical Education: Institutional Requirements and the Program Requirements for Residency Training in Physical Medicine & Rehabilitation.

We offer both a categorical and an advanced program which provides clinical, didactic and research training in rehabilitation at the Hospital of the University of Pennsylvania (HUP), Pennsylvania Hospital (PaH), Childrens Seashore House of the Childrens Hospital of Philadelphia (CSH), and Philadelphia Veterans Administration Medical Center (PVAMC). All hospitals are staffed with Board Certified and/or Board Eligible physiatrists, and have outstanding professional libraries, as well as laboratories, radiology and pathology departments. Each faculty has active inpatient and outpatient clinical services with a full complement of qualified professional allied health staff.

Clinical Experience - 4 year program

The clinical experience has been designed so that the resident assumes greater responsibility for patient care as he/she progresses through the program. Clinical teams have been developed in subspecialty areas: Neurorehabilitation, Musculoskeletal Rehabilitation, Pediatric Rehabilitation, and Electrodiagnosis.

PG-1 Year

The program for the PM&R intern year consists of 4-week rotation periods as follows: Internal Medicine (three rotations); Neurology, Physical Medicine & Rehabilitation, Pediatrics, General Surgery, Neurosurgery, Orthopedic Surgery, and Family Practice (one rotation each).

Additionally, the PGY-1 intern has two elective months; these months need to be chosen from the following elective rotations:

• Trauma Surgery
• Radiology
• Psychiatry
• Emergency Medicine

Schedules for the two elective rotations are made in advance; but intern preference must be made known as soon as possible after the first day of training.

The Residency Director shall receive a report on the progress of each PGY-1 resident in accordance with institutional and program GME policies (normally at the end of each rotation period). Our department shall be proactive in monitoring the educational progress of PGY-1 residents who are completing internship training at the University of Pennsylvania.

PG-2 Year

The PG-2 year consists of 12 months of rotation on inpatient rehabilitation units at HUP and affiliated hospitals. Specific expertise is developed in direct clinical care of hospitalized patients under the direct supervision of a physiatrist.

The HUP Piersol Unit rotations provide specialty experience with musculoskeletal rehabilitation and neurorehabilitation patients who are medically complex. The residents primary responsibility is to care for his/her assigned inpatients. The inpatient rotation at PVAMC provides experience in general rehabilitation.

The Pediatric rotation at Childrens Seashore House is under the direction of physicians who are certified in both Pediatrics and Physical Medicine and Rehabilitation. This rotation consists of inpatient experience on the Neurorehabilitation Unit. The resident is exposed to pediatric disabilities associated with the congenital and acquired diseases in the neurologic and musculoskeletal areas. This rotation also provides a review of the rehabilitation and developmental techniques and examination of neurologic, musculoskeletal, emotional, and psychological milestones of both the normal child and the child with a disability.

On the inpatient units, comprehensive training requirements for the resident include responsibility for history taking, physical examination, writing medical orders, therapy and equipment orders, and requesting consultations to be obtained as needed in Medicine, Surgery and other specialties. The resident learns how to orchestrate patient care with a team approach that includes: Nursing, Psychology, Occupational Therapy, Physical Therapy, Speech Therapy, Vocational Counseling, Therapeutic Recreation, Social Work and Case Management. Initially, the resident participates in patient care evaluation conferences, family conferences and in discharge planning. As the resident progresses during this year, he/she attains full responsibility as Program Manager in an inpatient rehabilitation facility. Supervision lessens as the resident progresses through these rotations. The variety of inpatient training sites provides the resident with a well-balanced exposure to specialty and general inpatient rehabilitation during the PG-2 year.

PG-3 Year

The PG-3 phase of the residency program emphasizes neurorehabilitation and musculoskeletal rehabilitation consultation, an introduction to electrodiagnostic studies, neurorehabilitation and musculoskeletal rehabilitation outpatients, pediatric outpatients, and supervision of the junior residents.

The consultation service exposes the PGY-3 resident to a wide variety of clinical materials inherent at a more acute level of intervention. Initially, the resident consults with the attending and then advances to answering consults with presentation to the attending. During this rotation, defining level of post-acute rehabilitation is taught. Evaluation for transfer to rehabilitation units or services is done by the consult resident after review by the attending. A variety of rehabilitation units and services are available within the health system. Collaboration with the allied health team is a major part of consultation work.

The consultation/outpatient/EMG service at the PVAMC permits the study of trauma, radicular syndromes, post-fracture care, and general medical and surgical problems, including stroke, peripheral neuropathy, cardiopulmonary disorders and amputation. The resident also participates in weekly consultation rounds at the VA Nursing Facility, and is provided with experience in electrodiagnostic studies.

PG-4 Year

During the PG-4 year, intensive basic training in Electrodiagnostic studies is emphasized. The residents also rotate through the Neurorehabilitation and Musculoskeletal Rehabilitation Outpatient Service at HUP, which provides experience with diverse patient populations in a variety of outpatient medical and community settings. The Neurorehabilitation outpatient resident develops skills in directing a multidisciplinary outpatient rehabilitation team. The Neurorehabilitation Outpatient resident also participates in the Outpatient Spinal Cord Injury clinic 1/2 day per week at Magee Rehabilitation and in the Brain Injury, Spinal Cord Injury and Stroke clinics at HUP. The Musculoskeletal Outpatient resident participates in the Spine Center based within our department and in Sports Medicine sessions. Three months of elective time provide the resident with flexible electives chosen from the Rehabilitation Medicine elective menu.

Didactic Sessions

The Department of Physical Medicine and Rehabilitation at HUP sponsors the weekly Didactic Seminar Series, which are held each Tuesday and Thursday mornings. Faculty from the University of Pennsylvania School of Medicine as well as allied health professionals lecture and make presentations on specific topics in the curriculum. The curriculum for the Seminar Series is on an 18-month cycle and is based on the Study Guide of the American Academy of Physical Medicine and Rehabilitation, and Program Requirements of the American Board of Physical Medicine and Rehabilitation.

In addition to the weekly Didactic Seminar Series, each hospital affiliated with the HUP program is expected to provide didactics to the residents. At HUP, the regularly scheduled didactics and conferences are: Journal Club, Musculoskeletal Conference, Research Seminar, and Clinical Case Conferences. At HUP, the clinical case conferences are rotation-specific: Piersol Inpatient Service (Team Conferences, Patient/Family Conference, and Gym Rounds), Neurorehabilitation and Musculoskeletal Rehabilitation Inpatient Consultation Services (Acute Care Rounds, Trauma Rehabilitation Conference, and Piersol Admissions Committee Meetings); Neurorehabilitation Inpatient Consultation Service (Neurology/Neurosurgery Discharge Planning Rounds). Residents are required to participate in clinical case presentations, M&M conferences, and didactic presentations regularly.

Residents are expected to attend the annual Inter-Institution Specialty Courses in Orthotics, Prosthetics, and Electrodiagnostic Studies, which are offered in collaboration with the Physical Medicine and Rehabilitation Residency Training Programs at Thomas Jefferson University and Temple University. PG-2 residents are required to attend the Postgraduate Functional and Clinical Anatomy of the Back and Limbs, at Temple University. Resident course attendance is as follows:

PG-2 Orthotics, Prosthetics, Post-graduate Functional and Clinical Anatomy of the Back and Limbs
PG-3 Electrodiagnostic Studies
PG-4 Orthotics, Prosthetics, Electrodiagnostic Studies

Research

Residents are strongly encouraged to do research. Research mentors are selected by residents and provide guidance for specific projects. As a resident in the PG-4 year, the elective rotation provides the resident with an opportunity to finalize a research project. Journal Clubs are held monthly as part of the didactic seminar series. Resident research is featured at the Departments Annual Research Day.