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PM&R How-To

Pathway:

In the end, your pathway doesn’t really matter one bit. The pathway system is designed to be an advising system with one “mandatory” rotation specific to the pathway. Since Drexel does not have a pathway specific for PM&R, choose something that interests you and run with it. 4th years that matched in PM&R have all gone through different pathways; anesthesia, neurology, orthopedics, internal medicine. Depending on the pathway, some pathway directors will substitute a PM&R rotation for your pathway-specific mandatory rotation. If you are interested in doing this, speak with Dr. Fuchs in the Student Affairs office (she is also the internal medicine pathway director) and she will be most able to assist you in doing so.

Local rotations:

Drexel offers one rehabilitation rotation, at Abington Memorial Hospital. Several students have rotated there (Cody Gillenwater [2011] and Ravi Patel [2011]), and the consensus was that it is not a great experience, especially if you are looking to gain exposure to the field of PM&R. There is potentially going to be a rotation at Albert Einstein, though that affiliation is not yet firmly established and students have not rotated there to be able to comment about what it is like.

The best way to gain exposure to PM&R in Philadelphia is to rotate at one of the other local institutions - either Magee Rehabilitation (Jefferson Health System), Moss Rehabilitation (Temple) or University of Pennsylvania Hospital. You can find rotations at these sites on the VSAS website or through each program’s individual website for visiting students. Students from the 2011 class rotated at Magee Rehab and University of Pennsylvania, and of those, would recommend rotating at Jefferson/Magee Rehab. Temple also has a great reputation and other students we met loved their rotations at Temple/Moss Rehab. Try to rotate at one of these sites if you are looking to gain exposure to PM&R, we have detailed three below:

Magee Rehabilitaiton/Jefferson: The program director at Magee, Dr. Christopher Formal, hosted 3 different Drexel students this year (2011) and understands our situation (no program at Drexel). The entire program was very welcoming and everyone had a positive experience. The rotation included two weeks on the spinal cord injury service, one week on the traumatic brain injury service and one week on the stroke service. The afternoons were spent in the outpatient office in spasticity, amputee, stroke and general rehab clinic. Cody Gillenwater (2011) and Ali Flis (2011) did rotations here. Cody also did a research month at Magee.

Moss Rehabilitation/Temple: Students we met enjoyed the rotation at Moss and felt that several of Temple’s strong points were outpatient sports medicine, traumatic brain injury and their gait lab. The residents are very friendly and happy to help in anyway way they can. Several Temple residents rotate on the Abington service each month (the elective available to Drexel students), so if you happen to do the Abington rotation, you can ask them about their experiences at Temple and elsewhere.

University of Pennsylvania: Overall, U.Penn has a very different feel compared to the other two programs in Philadelphia. The general consensus is that the program is centered around the Penn name, instead of being based on a reputation in rehab medicine. This attitude appeared pervasive from the residents to the attending faculty. Students rotating here felt that they rely heavily on the orthopedics and medicine departments to give you solid clinical experiences, as opposed to receiving such experiences via the rehab department. The University of Pennsylvania is the only categorical PM&R program in Philadelphia, which may be a consideration for some. Ali Flis (2011) rotated at Penn.

Away rotations:

The big debate going into 4th year is whether or not to do audition/away rotations. As PM&R is still a small field, there is a slightly different approach to these rotations. First off, audition rotations are not necessary in order to match at your top program. They will, however, help a program get to know you. Three of four of the Class of 2011 graduates did audition rotations at the institutions they matched (Ali Flis, Brian Joves and Ravi Patel), while one did not (Cody Gillenwater). Being from Drexel, you will have to do an away rotation in order to get some solid experience with PM&R since Drexel only offers the Abington rotation currently (see local rotations section). The decision whether or not to do audition rotations comes down to several key points:

-Audition rotations are your chance to shine. Be prepared to work your ass off the entire rotation, even more-so than you do on other rotations

-Doing an audition rotation can hurt your chance at getting into a program if you do not perform well or do not jive well with the program. On this note, it is also a good chance to get a sense of how well the program suits you and how well you fit the program.

-Audition rotations are better than having a letter of recommendation, because they have seen your work ethic and know first-hand how you mesh with their program. Plus, you will likely get a letter from the rotation, so it’s a double-bonus.

As far as audition rotation sites go, Ali Flis rotated at University of Utah (including a research block) and at Magee Rehab. Ravi Patel rotated at Kessler Rehab and at JFK in New York City. Cody Gillenwater rotated at Magee Rehab (including a research block). Brian Joves rotated at UC Davis and Stanford.

The most important thing that should come of your PM&R rotations, wherever you do them, is getting a solid letter of recommendation (or two). As PM&R is a small and very tight-knit community, there is nothing better than getting a letter from a program director that states how well you fit the PM&R role and how they would be pleased to have you in their program. On this note, getting any letter is a positive thing, but getting a letter from someone with an active role in the national PM&R community is even better (think: program director, prominent attending at an academic center, department chair, etc.).

Audition rotations summary:

-Not doing an audition rotation will not hurt you.

-Doing an audition can definitely help you...but it can also hurt you.

-Get a letter (or two) from a program director, PM&R department chair, or other attending who is highly-active in academics locally and/or nationally.

Applying:

The application process is not as intimidating as it initially seems. Get an early start on writing your personal statement, CV and brief descriptions of your activities during medical school and applying won’t be stressful. For PM&R, you must apply to both PM&R programs as well as preliminary year programs.

Prelim year programs:

Prelim year can be done in one of several areas: preliminary medicine, transitional year or preliminary surgery. Which you apply to is completely up to you. Unless you’re a glutton for misery, it is highly-suggested you avoid doing a preliminary surgery year. If that’s your thing, however, go nuts. It is important to know that when you make your rank list, you can submit a different preliminary year rank list for each PM&R program you rank.

For instance, if your rank list is...:

1) Thomas Jefferson

2) Spaulding Rehab (Harvard)

3) University of Texas

...and you interviewed for preliminary medicine positions at each of these places as well as at Hahnemann, your final rank list could look like this (or any other order):

1) Thomas Jefferson

a) Thomas Jefferson prelim

b) Hahnemann prelim

c) Harvard prelim

d) UT prelim

2) Spaulding Rehab (Harvard)

a) Harvard prelim

b) Hahnemann prelim

c) Thomas Jefferson prelim

d) UT prelim

3) University of Texas

a) UT prelim

b) Thomas Jefferson prelim

c) Hahnemann prelim

d) Harvard prelim

PM&R Programs:

Selecting PM&R programs comes down to your personal list of priorities. Most students start by defining geographic regions they want to go, finding what programs are in the area and determining if they are programs that fit their other criteria. Then, expand your region. Or, you can simply start by looking at the FREIDA site (the AMA site with all programs listed...just Google “FREIDA” and it will be the top result) and selecting programs that you think you would like. Visit each program’s website to learn a little about their curricular structure, how large or small the program is, who their current residents are, what fellowship opportunities are available, how heavily residents are involved in research, who the faculty is, etc.. Your best resource when picking programs, however, is current residents or recent applicants. There are several clusters of programs when it comes to quality, with approximately 15-20 top programs, a small cluster of decent programs, and an assortment of lesser-regarded programs. The discussion of programs below (places the Class of 2011 interviewed) should help get you started.

A neat map of programs can be found at this web address:

PM&R Programs

(Google the phrase “PM&R programs map”, then scroll down to the listing “PM&R Programs – Google Maps”)

A few key points regarding applying and interviewing (based on Class of 2011):

1) Apply diversely. You should definitely apply to the top-ranked programs, but also apply to others that are not going to be as competitive.

2) The average number of interviews offered per available residency position for any given PM&R program is around 10:1.

3) The number of PM&R programs we applied to ranged from 20-25.

4) The number of PM&R programs we interviewed at ranged from 8-15. You want to get at least 6 interviews (again, not only at the top-ranked programs, but at a spectrum of programs).

5) The number of preliminary medicine programs we applied to was 10-15.

6) The number of preliminary medicine interviews we attended was 7-10.

7) The number of PM&R programs we ranked was 7-10.

8) The number of preliminary programs we ranked was 5-10.

See below for a list and details regarding program recommendations based on the impressions of Class of 2011 graduates.

Contacts:

If you would like to speak to Drexel graduates that have matched in PM&R, feel free to contact anyone listed below. Included are the name, year of graduation, match location, and email address of those willing to speak with Drexel students interested in PM&R.

|Name |Class |Prelim program |PM&R Program |Email address |

|Ali Flis |2011 |Univ of Utah |Univ of Utah |alexandraflis@ |

|Cody Gillenwater |2011 |Univ of Washington (categorical) |Univ of Washington |codywater@ |

|Brian Joves |2011 |Hahnemann Univ |Kessler Rehab (UMDNJ) |rap562@drexel.edu |

|Matt Roh |2010 |Hahnemann Univ |Baylor/UT Alliance | |

| |2010 |Univ of Utah |Univ of Colorado | |

|Arielle S. |2009 |Hahnemann Univ |Thomas Jefferson Univ | |

|Ajit Pai |2005 | |Virginia Commonwealth Univ |apai@mcvh-vcu.edu |

Programs:

The following is a list of programs visited by Class of 2011 as well as detailed opinions of several programs. The details regarding these programs should be considered opinions, and the best way to evaluate a program is to go for an interview (or ask several residents about their opinions to see if they are in agreement).

Positive Recommended Programs from Drexel 2011 Graduates in PM&R:

University of Washington

University of Colorado

University of Utah

UC Davis

RIC / Northwestern

UMDNJ/Kessler

Harvard/Spaulding Rehab

Virginia Commonwealth University

University of Virginia

Thomas Jefferson University/Magee

Temple University/Moss

University of Michigan

Mayo

UC Irvine

Stanford

Emory University

Carolinas Rehabilitation Hospital

UPMC

UNC

Colombia/Cornell

Ohio State University

UT Houston

Baylor Houston

Schwab Rehab/U of Chicago

National Rehabilitation Hospital / DC

JFK Medical School Program

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Program Name: University of Colorado

Location: Denver, CO

Size (Small, Medium, Larger): 4 residents per year. This is a smaller program that feels like a medium-sized program simply because of the size and scope of the institution (University of Colorado). Residents do not frequently run into one-another at work because they are spread out over 6 different clinical sites. This results in 1:1 resident to faculty ratio, which is as good as you can get!

Inpatient/Outpatient Exposure: CU has a balance of inpatient and outpatient experience, though the balance tips toward inpatient. They provide a well-rounded experience and produce residents ready for practice without requiring fellowships.

Call: Home call, taken 1 week at a time.

Resident Community: The residents were overall an older crowd at CU; some had several children, most were married, and they lived all over Denver. When asked, the residents said they don’t get together that frequently outside of work, and even seeing one-another at work can be rare due to the large number of clinical sites they work. They seem to work well together and enjoy working together, but they all seem to have their own group of friends outside work.

Faculty: Great faculty! Dr. Jha (program director) is new to his position as of a year or so ago, but he might as well have been there for years. He seems like he would be incredible to work with. The rest of the faculty members were very nice and residents said they are great at teaching. Faculty is an asset of the program.

Overall Impression/Highlights: CU has a lot going for them. 1) Denver is super-cool (I’m biased...but it really is super-cool); 2) The faculty are always looking to improve the program, and they take resident feedback seriously; 3) Great training at a SCI model center (Craig Hospital), top-notch interventional pain, msk and sports medicine training; 4) It’s in Denver...did I mention that? 300 days of sunshine a year. Enough said.

Recommend to Drexel students: Highly recommended.

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Program Name: University of Washington

Location: Seattle, WA

Size (Small, Medium, Larger): 9 residents per year (3 categorical positions, 6 advanced positions). This is a larger program.

Inpatient/Outpatient Exposure: Fairly good balance between inpatient and outpatient exposure. Inpatient work is done primarily at UWMC and Harborview Medical Center, while Seattle Children’s and the VA are the other sites. Very good interventional pain and sports/msk exposure, residents mentioned they are able to do a lot of procedures and feel comfortable practicing in all areas of PM&R without the need for a fellowship.

Call: Home call, taken 1 week at a time.

Resident Community: Very friendly and fun group of residents. They get together frequently outside of work, doing everything from going to the local brewery for food and drinks to taking hiking and skiing trips. It is a slightly younger group of residents as well, with a larger number either single or recently married. Several residents do have children. The residents are an active bunch and take advantage of Seattle’s location as much as possible.

Faculty: Stellar faculty. The program director has there for 15+ years and knows everything there is to know about the program and about other top programs. She constantly is making changes to improve the resident experience and modify the residency to provide the best educational experience possible. She has published several articles about resident wellness and the resident experience, so she is very receptive to anything and everything the residents have to say.

Overall Impression/Highlights: The University of Washington is highly-regarded in the world of PM&R. At the University of Washington, PM&R works closely with the orthopedics, trauma and neurology departments, and they understand the role PM&R plays for a patient and how to best utilize our services. Due to the location, UW sees an enormous variety of pathology, as they are the primary care center and the primary level-1 trauma center for Alaska, Washington, Montana, Idaho and Wyoming. UW is also a SCI model system. Several excellent fellowships are available and UW graduates tend to be favored for these positions. Less than half of graduates seek fellowships, and many find jobs in Seattle straight out of residency.

Recommend to Drexel students: Highly recommended.

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Program Name: Virginia Commonwealth University

Location: Seattle, WA

Size (Small, Medium, Larger): 6 residents per year.

Inpatient/Outpatient Exposure: Weighted slightly toward inpatient. There is a great variety of rotation locations, though, and the VA is the largest in the nation. The variety of the veterans experience is quite large, as younger vets come from Walter Reed soon after their return to the US from the wars abroad, and older vets are heavily concentrated in the Virginia/Washington D.C. area. Prosthetics/orthotics is a great rotation at the VA, and residents have the opportunity to learn some of the P&O techniques with their technician.

Call: Home call, taken 1 week at a time.

Resident Community: Very friendly group of residents with diverse interests. Richmond is a small city with loads of activities available in the surrounding area (cycling, hiking, skiing, rafting, Washington D.C., Williamsburg, etc.). The residents are a slightly older crowd it seemed, a lot of married people and several children. They do get together outside of work, more than some other programs but definitely less than the more active programs.

Faculty: GREAT faculty. This is one of their strong suits. The department chair is absolutely hilarious, and cares deeply about PM&R at VCU. The program director is a super-cool guy and a very smart and wise man. Other faculty were also very friendly and extremely academically-driven.

Overall Impression/Highlights: The preliminary medicine program is also a highlight of VCU. This would be a great place to try and get all 4 years. The VCU PM&R reputation is becoming ever-more highly regarded thanks to the dedication of their faculty and chairman. VCU tends to fly under the radar, but most would consider it to be among the top programs.

Recommend to Drexel students: Highly recommended.

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Program Name: Thomas Jefferson University (Magee Rehab)

Location: Philadelphia, PA

Size (Small, Medium, Larger): 7 residents, medium-sized.

Inpatient/Outpatient Exposure: Very heavy inpatient exposure. Jefferson offers the most SCI exposure of any program I applied. Rotation sites include Magee Rehab, Jefferson Hospital, Rothman Institute, and several others. One of several institutions that offers experience at both a stand-alone rehab center and hospital-based rehab units. Magee Rehab is constantly ranked as one of the top rehab centers in the country.

Call: In-house call, schedule varies by rotation you are on and lessens as you become an upper-year resident. Can be as frequent as q4.

Resident Community:  Residents are very cohesive and are extremely willing to help one-another with work, studying, or issues outside of work. They get along extremely well and frequently go out to eat together after work or on the weekend. Residents are on the younger side, with a mix of single and married. Relatively few residents have children (in fact, I’m not sure I know of any at all).

Faculty: The faculty members at Magee are wonderful. The program director is one of the nicest and most brilliant people you will ever meet. He is a great teacher and always has the residents’ best interest in mind. For instance, during conference days, residents do not have to come back and catch up on all their notes, as attendings cover for them on conference days.

Overall Impression/Highlights: Jefferson is a great program that exposes you to both hospital-based rehab (at Jefferson Hospital) as well as rehab at a stand-alone facility (Magee rehab). The residents are great, as are the faculty members.

Recommend to Drexel students: Highly recommended.

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Program Name: University of Michigan

Location: Ann Arbor, MI

Size (Small, Medium, Larger): 6 residents, medium-sized.

Inpatient/Outpatient Exposure: Good blend of inpatient and outpatient experiences. Great outpatient rotations, they are very strong in prosthetics and orthotics and have their own P&O clinic and lab where the prosthetics and orthotics are made. Rotations are at the University hospital, the VA, a UofM outpatient office and select others.

Call: Home call

Resident Community: Great group of residents, very friendly, and they enjoy spending time with each other. Frequently get together outside of work for social events, intramural sports, pub quizzo, etc.. Cooperative work environment, they frequently encounter one another on rotation. Great resident-to-attending ratio, 1-1.5:1.

Faculty: Wonderful faculty members, they are very resident-focused. They constantly re-evaluate the effectiveness of every aspect of the program and make adjustments where needed. Always seeking resident feedback and they respond (within reason) to any issues residents bring up. They would be excellent faculty to work with.

Overall Impression/Highlights: This is a stellar program. University of Michigan is one of the leading research institutions in many fields, and PM&R is no exception. They are very innovative and highly-regarded in the world of PM&R.

Recommend to Drexel students: Highly recommended.

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Program Name: Ohio State University

Location: Columbus, OH

Size (Small, Medium, Larger): 6 residents, medium-sized.

Inpatient/Outpatient Exposure: Ohio State PM&R works in both a stand-alone rehab center and hospital-based rehab units. This is one of several institutions that provides this type of experience. Great gait lab and sports experiences available, though don’t count 100% on being able to work with the football team (everyone in the program wants those spots).

Call: In-house call.

Resident Community: Residents are very nice and get along well. They enjoy working together and are encouraging of one another. Outside of work, they get together less frequently than some programs, but more than others. Columbus is pretty spread out, so residents tend to live all over the place, which can make getting together more of a challenge. Residents are a good spread of ages and stages of life, though tend toward being younger and involved/recently-married or single.

Faculty: Very friendly and dedicated to making the resident education as best it can be. They recently changed program directors (in 2010 or so), though the new director has been with the program for many years as faculty and assistant director. This should yield positive change for the program.

Overall Impression/Highlights: Overall, Ohio State is a great program. They have a good blend of stand-alone rehab center experiences and hospital-based rehab experiences. Residents were not extremely interested in doing research, which was evident from several conversations they had during lunch. The University has ample research available, however, and it would be easy to find/create a cool project. They also offer 3 categorical positions, which are very attractive.

Recommend to Drexel students: Great program, will be for some and not for others. Opportunity to match categorical position.

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Program Name: Spaulding Rehabilitation (Harvard Medical School)

Location: Boston, MA

Size (Small, Medium, Larger): Larger program.

Inpatient/Outpatient Exposure: Variety of experiences, though has a great deal of inpatient exposure. Rotations are at Spaulding Rehab (majority of rehab rotations), Mass. General (for neurology), one of the Children’s hospitals, and a private practice for pain/interventional and prosthetics/orthotics.

Call: In-house call, approximately 5x/mo. during PGY-2, 20x/yr during PGY-3, no call PGY-4.

Resident Community: Friendly group of residents, they enjoy working with each other and feel the work environment is very cooperative. Frequently encounter one another at Spaulding, and some services have multiple residents on them. They gather outside of work as much as any other program in a large city. Few residents have children and many are single or recently-married. Many residents want to sub-specialize and seek fellowships (with great success).

Faculty: Faculty would be great to work with. Spaulding is highly-regarded in the PM&R community, and the faculty are a significant part of this. They are very educationally driven, making this a highly-academic program. Research is prevalent. Faculty are very friendly and strive to make the resident experience as valuable as possible.

Overall Impression/Highlights: Has a great reputation in the PM&R community, one of the top programs in the nation. Spaulding is frequently among the top 5 rehab institutions in the US World News rankings. This is a very academic program, and residents work hard while at the program. This shows in the opportunities available to Spaulding grads, and many go into a fellowship after residency.

Recommend to Drexel students: Highly recommended.

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Program Name: Baylor College of Medicine (in Houston...not to be confused with Baylor University Medical Center in Dallas) – Part of the Baylor/UT Alliance Program

*Same as University of Texas Houston*

Location: Houston, TX

Size (Small, Medium, Larger): 14 residents, a humongous program. Baylor and UT combine rehab programs in Houston to form TIRR (The Institute for Rehab and Research...or something).

Inpatient/Outpatient Exposure: Heavy inpatient exposure. Residents rotate through 3 or 4 of the 18 hospitals in the medical complex (it’s enormous...just like everything in Texas), as well as heavily at TIRR. TIRR is one of the top rehab hospitals in the nation and is highly-regarded in the PM&R community. This is a very academic program, and many residents are highly-involved in research. They have one or two research fellows and residents taking extra time to do research.

Call: In-house call.

Resident Community: This is a very, very, very large program. Residents were all quite nice and enjoyed working together. Due to the sheer size, they are not as close-knit as at other programs, and tend to be spread over multiple institutions (again, due to the size of the medical complex). Houston itself is enormous and traffic is a disaster, which makes gathering outside of work slightly more difficult, but they do get together in smaller groups fairly frequently.

Faculty: The faculty are extremely academic-driven. They are all very nice and would be great to learn from. Faculty carry a high volume of patients, and there is never a shortage of work. There are essentially four program directors (two directors and two assistant directors), and they work extremely hard to make this program one of the top programs. They have a slightly more down-to-business feel than other programs.

Overall Impression/Highlights: Very academic and down-to-business program with loads of inpatient experience. Houston is for some and not for others, and the program directors are very up-front about whether Baylor/UT is a fit for you or not. Residents have a high workload, much more-so than other institutions.

Recommend to Drexel students: Recommended to those seeking a research-driven, academic program.

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Program Name: University of Texas Houston (not to be confused with University of Texas Southwestern in Dallas or University of Texas San Antonio) – Part of the Baylor/UT Alliance Program

*same as Baylor College of Medicine*

Location: Houston, TX

Size (Small, Medium, Larger): 14 residents, a humongous program. Baylor and UT combine rehab programs in Houston to form TIRR (The Institute for Rehab and Research...or something).

Inpatient/Outpatient Exposure: Heavy inpatient exposure. Residents rotate through 3 or 4 of the 18 hospitals in the medical complex (it’s enormous...just like everything in Texas), as well as heavily at TIRR. TIRR is one of the top rehab hospitals in the nation and is highly-regarded in the PM&R community. This is a very academic program, and many residents are highly-involved in research. They have one or two research fellows and residents taking extra time to do research.

Call: In-house call.

Resident Community: This is a very, very, very large program. Residents were all quite nice and enjoyed working together. Due to the sheer size, they are not as close-knit as at other programs, and tend to be spread over multiple institutions (again, due to the size of the medical complex). Houston itself is enormous and traffic is a disaster, which makes gathering outside of work slightly more difficult, but they do get together in smaller groups fairly frequently.

Faculty: The faculty are extremely academic-driven. They are all very nice and would be great to learn from. Faculty carry a high volume of patients, and there is never a shortage of work. There are essentially four program directors (two directors and two assistant directors), and they work extremely hard to make this program one of the top programs. They have a slightly more down-to-business feel than other programs.

Overall Impression/Highlights: Very academic and down-to-business program with loads of inpatient experience. Houston is for some and not for others, and the program directors are very up-front about whether Baylor/UT is a fit for you or not. Residents have a high workload, much more-so than other institutions.

Recommend to Drexel students: Recommended to those seeking a research-driven, academic program.

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