With PM&R away rotations becoming quite common amongst medical students applying to PM&R residencies, the Physiatrist in Training (PHiT) Council wanted to take a moment to provide a guide that we hope will help you to excel on your away rotation. Away rotations can be an excellent opportunity to explore a program you may be particularly excited about, develop a better understanding of the physiatrist’s role in the continuum of care and obtain a letter of recommendation from faculty within the field. A successful away rotation can support your goal of matching into a PM&R residency! As the 2021 NRMP program report points out, letters of recommendation from within the field, commitment to the specialty and commitment to the program are all essential factors program directors utilize when deciding whom to interview and rank (NRMP, 2021).
This article will provide an overview on how to prepare for your away rotation, beneficial resources and tips we hope will help you to shine. It is important to keep in mind that ultimately, your away rotation is less about your rehab knowledge and more about demonstrating your ability to join a physiatry team and positively contribute. That being said, arriving to your away rotation with foundational rehab knowledge will only help to impress those you will work with.
How to prepare
If you know you’re interested in PM&R, it is never too early to start exploring the resources that exist. One helpful resource is the AAPM&R Medical Student Roadmap. This provides a broad overview of the application process. Most PM&R programs will utilize the Visiting Student Learning Opportunities (VSLO) page to advertise their program’s away rotation opportunities. This is a great place to explore the various away rotation options as well as program specifics. This, paired with the specific program’s web page will offer you an abundance of helpful information. Keep in mind, having a broad PM&R exposure will be beneficial when applying to residencies. An additional resource to explore is the PM&R Scholars YouTube series that showcases individual programs. Things worth considering when exploring programs include geographic location and proximity to family and friends, the clinical settings, the patient population served, whether the program has faculty in areas of PM&R that particularly excite you, and whether the program has the resources you believe will help you achieve your professional goals. You will likely find many programs that match your criteria!
Most programs will begin accepting away rotation applications in the spring. Often, programs will ask that applications be sent through VSLO. Most programs will ask for a brief personal statement detailing your interest in an away rotation at their program as well as your CV, so preparing both ahead of time can be helpful.
Resources to review
While these rotations are more about getting to know you, and less about what you know, having a rehab foundation can help you to stand out. One commonly utilized resource is the “Physical Medicine and Rehabilitation Pocketpedia.” This book offers an overview of topics commonly encountered in the rehab floors and clinics and provides you with a great foundation upon which to build. The book “PM&R Secrets” is a similar resource to consider. Both offer a resource you can bring with you on rounds and refer to frequently. For a more comprehensive resource, the website PM&R Knowledge Now® offers an in-depth look at most PM&R topics and is an excellent resource to review for topics relevant to your patients. Other comprehensive PM&R resources are Physical Medicine and Rehabilitation Board Review by Sara Cucurullo, MD and Braddom’s Physical Medicine and Rehabilitation by David Cifu, MD, FAAPMR. These are books that you could likely ask to borrow from the residents or resident room for more in-depth reading.
As physiatrists rely heavily on our physical exam skills, focusing on this prior to your rotation will also allow you to hit the ground running. For most physiatry settings, you will be performing musculoskeletal and neurologic examinations. The American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injuries (ISNCSCI) grading scale can be helpful to review and practice prior to your rotation. While you won’t be expected to have this memorized, it can be beneficial to understand key muscles, dermatomes, and reflexes assessed as part of this exam. Additionally, the website Physiopedia offers a resource to review specific physical exam maneuvers you may want to utilize on your PM&R rotations (e.g., straight leg raise, Spurling's maneuver, Hoffman’s sign, etc.). Lastly, AAPM&R offers an Online Education Subscription that provides physical exam videos as well as neuro-rehab, amputee, and musculoskeletal PowerPoint videos, amongst many others.
Other important grading scales besides the ASIA’s ISNCSCI that you will learn about during your PM&R rotations include the Manual Muscle Testing grading, the Modified Ashworth Scale for grading spasticity, the Glasgow Coma Scale and Ranchos Los Amigos scale for traumatic brain injury patients, and the Functional K Level guidelines.
How to excel on your away rotation
First and foremost, many of the skills that will help you to succeed on your PM&R away rotation are skills that you have been mastering throughout your clerkship clinical rotations. Arriving on time, being a conscientious and active team member, and being eager to learn are key to success.
As was mentioned above, having resources readily available to reference such as PM&R Knowledge Now® can help you to demonstrate a deeper understanding of rehab pathologies and your attitude as a learner. Often, you will find down time when residents are working on notes or other clinical responsibilities. This can provide an excellent time for you to perform a deeper dive into a rehab topic and offer a five-minute summary to promote a collaborative learning environment. We can all learn from each other, never shy away from an opportunity to share an interesting fact you learned with the team!
As a medical student, you have the advantage of additional time to contribute to the team in unique ways. Look for ways to shine as a team player, such as taking a comprehensive social history. Keep an eye out for tasks your team may need assistance with and ask if you can help with these tasks.
It can be beneficial to seek feedback from both faculty and residents. Check-in regularly with your resident for smaller specific feedback. “How was my note? How can I improve my presentation tomorrow? Am I doing this exam maneuver correctly?” are just some quick questions you can ask during a moment of down time. Halfway through your rotation or weekly, seek more general feedback. “Can we sit down for a couple of minutes in the next day or two to go over my performance and feedback?” is just one way to phrase this request and provide the resident or attending time to develop feedback and flexibility on when to deliver it. With their guidance, try to create a few specific goals you can work on improving throughout the latter half of your rotation. This will provide an opportunity to demonstrate your growth throughout the rotation.
One unique thing about PM&R rotations are the many opportunities to observe your patients in therapy and interact with an interdisciplinary team. There are many rehab team members to learn from such as rehab nurses, physical therapists, occupational therapists, speech therapists, rehab social workers, neuropsychologists and unit coordinators. Learning from these rehab team members will give you a holistic overview of the patient’s rehabilitation program and emphasize your interest and attitude as a learner.
While you are on your away rotation, it can be enjoyable and helpful to seek learning experiences outside of your clinical rotations. Examples of such include sports coverage with residents or free clinics residents may volunteer at. Every program will have different opportunities and it never hurts to ask around to find out!
Lastly, never forget to enjoy your experience! Away rotations are a unique opportunity to explore different residency programs and the field of PM&R. They are also a great opportunity to explore the city surrounding the program. You will likely meet individuals you will consider colleagues and friends throughout your career, no matter where you end up matching. The PHiT Council wishes you the very best and we hope you enjoy your journey into PM&R! We look forward to seeing you at the upcoming Annual Assembly in San Diego, CA (or online) from November 6-10.
Works Cited
National Resident Matching Program, Data Release and Research Committee: Results of the 2021 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2021