1. What are the best things about your specialty?

• The broad knowledge base and variety of subspecialties allows a physiatrist to tailor a practice to their interests.

• Physiatrists work in hospital settings, community clinics and/or academia.

• The discipline focuses on helping patients improve their quality of life.

• There are lots of opportunities for procedural skills if you want hands-on work such as ultrasound and fluoroscopic guided injections and electromyography/nerve conduction studies.

• Physiatrists work closely with many specialties in a multidisciplinary team focused model of patient care.

• There is good work-life harmony.

• There is opportunity to augment income with 3rd party assessments such as independent medical examinations.

2. What are the worst things about your specialty?

• Limited knowledge and recognition of the specialty within medicine.

• Broad knowledge base requires considerable academic diligence.

• Sometimes patients have expectations we cannot meet.

• We don’t offer “cures”; rather PM&R focuses on managing complications from a variety of neurological and muscular conditions and maximizing function based on ability.

3. Why did you choose your specialty?

• For the reasons outlined in question 1.

• In addition, there are many inspiring mentors within Physical Medicine and Rehabilitation, and a highly sociable resident group at the University of Alberta.

4. What types of clinical cases do you commonly see?

• We see patients who have experienced a significant medical event and help guide care while considering prognosis and rehabilitation outcomes.

• There are 3 general categories of clinical cases in PM&R:

  • Neuro rehabilitation cases involve spinal cord injuries, acquired brain injuries (stroke and traumatic brain injury), spasticity, cerebral palsy, spina bifida, post-polio, neuromuscular disorders, multiple sclerosis.

  • Musculoskeletal (MSK) cases involve sports injuries, chronic pain, work related injuries, degenerative joint disease, joint injections, complicated orthopedic cases and amputation.

  • Electrodiagnostic cases involve assessing and performing nerve conduction studies and electromyography to diagnose neuromuscular conditions (peripheral neuropathy, radiculopathy, ALS, myopathy, GBS, Myasthenia gravis, etc.)

5. Briefly describe a typical day

• This depends on the nature of practice, whether it is an inpatient, outpatient or mixed practice, and the Physiatrists interests and involvement in academia.

• A hospital-based practice may involve:

  • Ward rounds on inpatients units and leading team/family conferences.

  • Outpatient clinics based in the hospital.

  • Inpatient consults in acute care hospitals.

  • Administration and paperwork activities.

• Alternatively, an outpatient community-based practice may include clinics, procedures (EMG/NCS or interventional procedures) and team conferences.

• There can be academic teaching and research responsibilities for all types of practice.

• Sub-specializations offer opportunities for various interventional procedures such as fluoroscopic- or ultrasound-guided injections for MSK issues and spasticity.

6. How able is your specialty to accommodate family life?

• It can be very accommodating for family life.

• In an inpatient practice, there are very few acute medical emergencies that would require coming into the hospital immediately while one is on call. Inpatient consults are typically done during normal work hours, with only rare conditions where we give expertise to an emergency department.

• In an outpatient practice, the hours depend on how many patients you book in a day.

7. Range of incomes?

• Variable. In Alberta, the average income is ~ $400,000 annually for a full-time practice; however, there is potential to earn much more if the practice includes procedures (EMG/NCS and image guided injections) or independent medical examinations.

8. How do you see your discipline changing over the next decade?

• There is a movement toward more of an outpatient-based or mixed practice. With regards to an inpatient practice, many rehabilitation hospitals have Physiatrists in a consultant role with internists, family physicians, or nurse practitioners managing the day-to-day inpatient medical issues. This contrasts with the past, where physiatrists were the most responsible physician. There is also the emergence of other rehabilitation subspecialties such as cancer rehab.

1. What are you looking for specifically in an impressive candidate?

• An impressive candidate is a well-rounded, independent learner with patience and compassion. They need a firm grasp of anatomy, and musculoskeletal, and neurological concepts. They need to have leadership qualities while being able to work in an interdisciplinary team setting. Being a strong team player is also highly valued.

2. What can a potential candidate do now in order to be an appealing applicant to your program?

• They should do electives and be sure to know what the specialty is about and involve themselves in activities with a leadership role. Research involvement is also beneficial, no matter how minor a role. The Canadian Association of PM&R offers a medical student essay contest every year at its annual conference. You are encouraged to apply and attend.

3. How is your residency program organized? (i.e., year by year breakdown and schedule of rotations)

Overall, with the implementation of competency based medical education (Competency by Design (CBD)), the program is divided into four stages: Transition to Discipline, Foundations of Discipline, Core of Discipline and Transition to Practice:

• Transition to Discipline (TTD): 2 blocks of PM&R where there is exposure to several PM&R subspecialties

• Foundations of Discipline (FD): Basic clinical training year involving rotations in internal medicine, emergency, psychiatry and surgical rotations as well as rheumatology, orthopedic surgery and neurology.

• Core of Discipline (CD): Rehabilitation rotations in amputation rehabilitation, brain injury rehabilitation, musculoskeletal rehabilitation, neuromuscular medicine and EMG/NCS, spinal cord injury rehabilitation, stroke rehabilitation, and pediatric rehabilitation.

• Transition to Practice (TTP): Variable schedule and highly tailorable based on the resident’s career interests which includes senior resident clinic, inpatient and outpatient rotations, electives, leadership activities and maintenance of certification (MOC) activities.

4. What is your residency program's orientation and focus?

• The UofA PM&R program has a strong academic focus with an emphasis on resident directed learning and resident well-being. We focus on training competent future physiatrists looking to contribute clinically and academically in their future work-place.

• We are also fortunate to have multiple outpatient MSK clinics which offer exposure to interventional procedures (fluoroscopic and ultrasound guided) throughout our residency training.

5. What is the availability of experiences in subspecialty areas during training?

• We provide well rounded exposure to ALL subspecialties in Physical Medicine and Rehabilitation, including pediatrics. There is also access and exposure to emerging subspecialty areas not available in all centres – multidisciplinary spasticity management and fluoroscopic guided injections for back pain. Edmonton is also a leader in ultrasound guided procedures for a wide variety of musculoskeletal issues.

6. Are there sufficient elective opportunities during training to explore your special interests?

• Yes, there is ample time to complete electives during the transition to practice stage of training.

7. What is the on-call schedule during each year of residency?

• During the first year, your call can either be in-house or home call depending on the off-service rotation you are on. Starting in second year, you will do home call for rehabilitation patients admitted to the Glenrose Rehabilitation Hospital. We do an average of 6 week-long home calls per year (call is taken a week at a time). Call is generally quiet with occasional urgent issues requiring going to the hospital to assess patients.

8. What are teaching sessions like in the residency program?

• Formal teaching specific to the rotation occurs in each of the core rehabilitation rotations and is preceptor-based.

• Residents attend weekly academic half-days where core modules incorporate basic science and clinical application sessions followed by problem-based learning (PBL) and application of the material learned. Topics can include clinical management, research, evidence-based medicine, CanMEDS roles, and Indigenous Health.

9. What distinguishes the U of A program from other programs?

• Compared to other PM&R programs, the U of A offers one of the most comprehensive residency training programs in the country, encompassing all the major fields of PM&R. Our MSK specialists are well known in the country, and we train with them quite closely. The Glenrose Rehabilitation Hospital is the largest stand-alone rehabilitation hospital in Canada, and we gain significant exposure to inpatients and multidisciplinary clinics. We also have one of the larger resident groups in the country which is great when it comes to dividing the call schedule, and organizing social events/wellness retreats, etc.

10. How competitive is it to get in, and then to succeed in your field?

• Because PM&R is a relatively small specialty in terms of residency spots across the country, this can be highly variable depending on how many people apply each year. It has certainly become more competitive in the past 10 years and can be competitive to get into one of the more popular programs. Currently the University of Alberta program has CaRMS spots for 3 residents per year.

11. Is there research requirement in your residency program?

• For entry into the program, research experience is helpful, but not required. During residency, it is a requirement to complete a research project. Residents are given 3 blocks of research time throughout their residency. There are many active research projects, as we have several staff physiatrists in the program with a strong interest in research.

12. What role does research play in your career?

• Research is helpful in critically reviewing literature and practicing evidence-based medicine, especially with a number of emerging treatments (e.g. PRP, stem cell therapies) that our specialty is at the forefront of. Being able to stay on top of the latest evidence will be crucial to providing optimal care to patients moving forward.

13. Who can we contact for more information to set up electives?

•  Roxanne (Roxy) Perich (Residency Program Coordinator) - pmrrespr@ualberta.ca

14. Specifically, if there a list of residents whom we can call or email?

• Everett Claridge (Co-lead Resident) - eclaridg@ualberta.ca   

• Matthew Carter (Co-lead Resident) - mjcarte1@ualberta.ca 

15. Where can medical students find additional information on the UofA Physical Medicine and Rehabilitation Residency Program?

▪          https://sites.google.com/ualberta.ca/physmedrehab-carms/home