Physical medicine and rehabilitation positions itself in a unique place in the spectrum of medical specialties. While claiming no organ system as a territorial domain, physiatrists strive to achieve the best functional outcome for their patient regardless of the involved pathology. Thus, physical medicine and rehabilitation gamers resources from all branches of medicine and applies them to the rehabilitative plan.
The intuitive goal of a physical medicine and rehabilitation residency is to develop the medical school graduate into a practicing physiatrist. While conceptually simple, this transformation is a challenging undertaking because of the numerous facets of physiatric expertise. The fundamental concepts of this developmental process are described below:
- Balance of clinical expertise: As noted above, the spectrum of physiatric practice is quite broad. The scope of physical medicine and rehabilitation is defined by a number of national organizations, including but not limited to, the American Academy of Physical Medicine and Rehabilitation and me American Board of Physical Medicine and Rehabilitation. The resident physiatrist must be exposed to all facets of physiatry and subsequently attain a basic competency in each of these clinical arenas. Additional expertise in a particular subspecialty of physiatry should be available to the resident physician, if desired, but not at the expense of inadequacies in fundamental knowledge of every aspect of physical medicine and rehabilitation.
- Balance of physiatric practice: The core component of medical practice is the clinical management of patients. Thus, residency training must always focus on the educational requirements to attain clinical competency. Residents must be adept in all of the different venues in which physiatrists provide care (primary management, consultation, diagnostician, etc.). Excess of a particular skill, with & resultant under- exposure to other skills, should be avoided. Other aspects of modem medicine (e.g. practice management, research communication skills, medical-legal matters) should be introduced during training but not at the expense of an adequate clinical education.
- Successful recruitment: The nature of all medical residencies is somewhat temporary. In order to maintain a stable equilibrium, new residents must be recruited into a residency program at the same rate that current residents graduate. Excellence within a residency program can only be maintained if high quality medical students enter the program. These individuals must be nurtured with the same intensity as residents already within the program. The primary mechanism of successful recruitment is the creation a learning environment that is both enticing and desirable to the medical school graduate. This residency program functions most successfully when the total resident population hovers in (the upper teens. Current recruitment efforts should strive to maintain this census. However, the local and national medical landscapes are constantly changing. Residency demographics may be required to change if the environment seems best suited for either a higher or lower number of residents.
- Maintenance of a current physiatric knowledge base: Modem medical practice necessitates that practitioners pursue a lifelong commitment to continuing education. A residency training program must provide several mechanisms for this educational process to continue both for the attending staff and for the physiatrist-in-training. It is incumbent upon a residency program to insure that the dissemination of clinical knowledge to residents remains both constant and current. The program must also inculcate into training physicians the appropriate habits of self-directed learning.
- Renewal: All successful organizations adapt themselves change. In order to continue the tradition of excellence that this residency program has enjoyed, self-analysis must be regularly undertaken. If this inquiry recommends change, then evolution should be enthusiastically embraced.
John Melvin, MD, MMSc
Chair, Department of Rehabilitation Medicine
Ralph Marino, MD
Director, PM&R Residency
Michael Mallow, MD
Associate Program Director
Physical Medicine & Rehabilitaion
25 S. Ninth Street
Philadelphia, PA, 19107
We participated in the National Residency Match Program and utilize the Electronic Residency Application Service (ERAS).
- Challenging Pain Syndromes
- The international society of physical and rehabilitation medicine: The WAY FORWARD - II
- ISPRM discussion paper: Proposing a conceptual description of health-related rehabilitation services
- Lumbar sympathetic treatment in the management of lower limb pain
- Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: Implications for disaster research