A new physical medicine and rehabilitation (PM&R) residency program will train future physiatrists at the Yale School of Medicine Department of Orthopaedics & Rehabilitation.
The program, which will accept four medical school graduate trainees annually and requires four-years to complete, will complement the department’s existing orthopaedic surgery residency program.
Jennifer Hankenson, MD is serving as the Residency Program Director and is working alongside PM&R Section Chief, Rummana Aslam, MBBS, to review applicants and welcome the inaugural trainees, who will begin in 2024.
Under the leadership of Chair, Lisa Lattanza, MD, Orthopaedic Surgery Residency Director, Adrienne Socci, MD and now PM&R Residency Director, Jennifer Hankenson, MD, orthopaedic education at Yale is entirely women-led – something rarely found in one of the least diverse specialties in medicine.
Physiatry at a glace
Physiatry is a unique field because it focuses on the whole patient by addressing an individual's physical, emotional, neurological, medical, vocational, and social needs. Physiatry at Yale offers a nonsurgical, holistic, and comprehensive care plan that works in partnership with many specialties both within and beyond orthopaedics to restore function and maximize independence for patients.
Treatment can include managing a range of care options such as inpatient or outpatient rehabilitation, physical therapy, occupational therapy, speech therapy, behavioral therapy, vocational therapy, and neuropsychology. Patients treated by physiatrists range from children to adults and include those with stroke, spinal cord injury, traumatic brain injury, sports related injuries, chronic wounds, and those with musculoskeletal pain or injury.
Physiatrists also prescribe medicine, including anti-inflammatory medicines or muscle relaxants, among other treatments. In some cases, they may treat a problem with an ultrasound-guided or fluoroscopy-guided injection, which is a way to deliver pain medication to an injured or damaged area with accuracy and precision.
Some physiatrists are additionally skilled in using platelet-rich plasma (PRP) to enhance healing. For this treatment, physiatrists take the patient’s own blood products, spin them in a centrifuge to create a highly concentrated growth factor, then inject that into the site of the injury to stimulate healing. They may collaborate with other specialists who can provide various types of surgical regenerative treatments for conditions such as avascular necrosis and more.
A growing need for physiatrists
With approximately 100 physiatry residency programs in the country according to the American Academy of Physical Medicine and Rehabilitation, Yale’s is now the second such program offered in Connecticut
Demand for physiatrists is projected to maintain traction over the next decade. Certain geographic areas in the U.S. suffer because of the disproportionate allocation of where physiatrists train and practice.
“New England has faced a physiatry shortage likely because there is a lack of residency training programs in this region,” Hankenson said. “Due to an aging population, increased disability among patients, and an emergence of new conditions such as long COVID, it is imperative we work to meet the ever-increasing demand for more rehabilitative care.”
PM&R Section Chief, Rummana Aslam, MBBS agrees. “The worldwide the number of people aged 80 and over is estimated to increase threefold by 2050,” Aslam said. “The need for more physiatrists will consistently increase to minimize disability and maximize function of people through the continuum of life so they are independent as they age. With so many programs and leading advancements in technology, regenerative medicine, digital platforms, 3D innovation, and personalized medicine, the residents will have opportunities to access multidimensional training to advance functional possibilities and further advance our field as they become the physiatrists of the future.”
Physiatry, despite being a medical specialty for nearly a century, is not well known in medicine. At times, there is even a lack of knowledge and understanding among surgeons, physicians, and advanced practice providers about what physiatry and PM&R can offer.
“I see starting a PM&R residency at Yale Medicine an opportunity to better educate all healthcare specialties on the broad role physiatry plays in medicine,” Hankenson said. “We are leaders in directing rehabilitation recovery, preventing injury and disease, and can also optimize outcomes by providing early interventional rehabilitative care.”
Another challenge that medicine has faced over the past several years is the COVID-19 pandemic and the ongoing displacement of care that occurred during the pandemic. Physiatry has been a leader in adapting to telemedicine and continues to use this technology to reach more patients, particularly those who are unable to find transportation or who are physically impaired, which makes travel and accessing medical care a clinical setting difficult.
“Telemedicine platforms have allowed us to observe patients in their home environment including looking at domestic set ups, analyzing both their gait and activities of daily living, and other practical considerations that a patient with disability may face in their place of residence,” Hankenson added.
Program details
PM&R residents accepted into this program will benefit from the instruction of world-renowned faculty from multiple subspecialties including orthopaedics, internal medicine, rheumatology, neurology, pain management, and occupational health. Trainees will have the multidisciplinary training and opportunities to grow in unique fields such as rehab traumatology, rehab engineering, and regenerative rehabilitation.
Training encompasses time spent at three sites: Yale New Haven Hospital, which is a Level 1 Trauma center, the nearby Veterans Affairs Medical Center, and Lawrence & Memorial Hospital.
Inpatient rehabilitation units, located in Milford and New London, offer broad exposure to treating stroke, polytrauma, spinal cord injury, and traumatic brain injury. Outpatient sites, located throughout Greater New Haven and New London, will expose residents to general physiatry, sports medicine, pain, pediatrics, traumatic brain injury, spinal cord injury, spasticity and much more.
PM&R residents will participate in an 18-month curriculum cycle that serves as the foundation of didactic education, with rotation specific modules such as musculoskeletal ultrasound, rheumatology, workers compensation, electromyography, and more. Additional educational initiatives include journal clubs, lectures, and opportunities that empower trainees to learn, lead, and innovate through 12-weeks of rotations dedicated to research. Select residents will also have the opportunity to choose a research track, which will include up to six months of research time.
A women-led department rooted in inclusivity
“We collectively believe that a sense of belonging is the natural consequence of diversity, equity, and inclusion,” Hankenson said. “Our department has the honor of training Dr. Claudia Thomas, the first African-American woman in orthopaedic surgery. At the time of her appointment in 2019, Lisa Lattanza was among the first three female department chairs in orthopaedics nationwide. Since joining Yale, she has also worked to create an application process that evaluates all candidates evenly and fairly to find the best possible residents while eliminating as much bias as much as possible.”
“Our longstanding DEI values are reflected in our residents and faculty today,” she continued. “Approximately 20 percent of the department’s orthopaedic surgery residents and full-time faculty are women. Under Dr. Lattanza’s leadership, the residency programs for both PM&R and Orthopaedic Surgery are also led by women, something especially unique in the field of orthopaedics and rehabilitation.”
“Our objective is to build on this legacy and provide PM&R trainees with a nurturing, inclusive environment filled with equitable opportunities that promotes curiosity and critical inquiry for the benefit of all in their care,” Hankenson concluded.