A special agreement exists with the American Board of Physical Medicine and Rehabilitation (ABPMR) whereby an applicant may fulfill the training requirements for certification in pediatrics and physical medicine and rehabilitation by completing five years of combined training. An applicant may take the certifying examination of the ABP in the fifth year of training provided that all pediatric training requirements (except continuity clinics) have been successfully completed.

Approved Training Programs

Preamble

This document is intended to provide guidance to program directors in Pediatrics and Physical Medicine and Rehabilitation (PM&R). All program requirements in both specialties, as described in the Directory of Graduate Medical Education published by the ACGME, apply to combined training residencies unless specifically modified in this document. Because it is unlikely that the RCs in both specialties will write program requirements for these combined training residencies, the training in each new combined residency must be approved by both Boards before residents are recruited.

Objectives of Combined Training

Combined training in pediatrics and PM&R should develop physicians who are fully qualified in both specialties. Physicians completing this training should be competent pediatricians and physiatrists capable of focusing their professional activity in either discipline; however, the goal of the training is to prepare for a career in pediatric physiatry. The strengths of the two residencies should complement each other to provide the optimal educational experience.

General Requirements

The Resident

Residents should enter a combined training residency at the first postgraduate year level. A resident may enter a combined residency at the second postgraduate year level only if the first residency year was served in a categorical residency in pediatrics in the same academic health center. Transitional year training will provide no credit toward the requirements of either Board. Residents may not enter combined residency training and receive credit beyond the first postgraduate year level, nor may a resident transfer to another combined residency without prospective approval by both Boards. A resident transferring from a combined residency to a categorical pediatric or PM&R program should seek specific eligibility information from the appropriate Board.

In the absence of a combined pediatric/PM&R residency, a resident may request permission from the related program directors to seek the development of a personalized training schedule that fulfills the requirements of these guidelines. The program directors of pediatrics and physical medicine and rehabilitation must submit a mutually agreeable assignment schedule for that resident (on a form obtainable from either Board) to the American Board of Pediatrics and to the American Board of Physical Medicine and Rehabilitation for approval. The assignment schedule should cover the full 60 months of combined training and meet the criteria outlined in these guidelines. The proposed individual combined residency must be approved by both Boards before the end of the second year of training.

Vacations, leave, and meeting time will be shared equally by both training categorical programs. Family leave should be prorated and consistent with each Board's individual leave policy.

Characteristics of Eligible Combined Residencies

Both categorical training programs must be accredited by the ACGME. Residents may not be recruited for combined training if either program has provisional or probationary status.

Combined training in pediatrics/PM&R must be based in the same institution or academic health care system. Affiliated programs must be located close enough to facilitate cohesion among the residencies’ house staff, attendance at weekly continuity clinics when scheduled, integrated conferences, and faculty exchanges of curriculum, evaluation, administration, and related matters.

The Training Requirements

The training requirements for credentialing for the certification examination of each Board will be fulfilled by 60 months in the combined residency. A reduction of 12 months of training from that required for two separate residencies is possible by providing appropriate overlap of training requirements. The 36-month pediatric training requirement is met by 30 months of pediatric training plus 6 months credit for training appropriate to pediatrics obtained during the 30 months of PM&R training. Likewise, the 36-month PM&R training requirement is met by 30 months of PM&R training plus 6 months credit for training appropriate to PM&R obtained during the 30 months of pediatric training.

The 12 months of training in the R-1 year should be spent in pediatrics. During the final 48 months, except for one consecutive 12-month period that may be spent in physical medicine and rehabilitation, continuous assignment to one specialty or the other should be not less than 3 or more than 6 months’ duration in any given year.

Training in each discipline must incorporate graded responsibility throughout the training period.

Faculty

The combined residency must be coordinated by a designated full-time director or co-directors who can devote substantial time and effort to the educational program. If a single combined residency director is appointed, an associate director from the other specialty must be designated to ensure both integration of the residency and supervision in each discipline. An exception to this requirement would be a single director who is certified in both specialties and has an academic appointment in each department. The directors from both specialties must document meetings with each other at least quarterly to monitor the success of the residency and the progress of each resident.

Well-established communication must occur between the program directors of each discipline, particularly in those areas where the basic concepts in both specialties overlap, to assure that the training of residents is well coordinated.

As a general principle, the training of residents in pediatrics is the responsibility of the pediatric faculty and the training of residents in PM&R is the responsibility of the PM&R faculty.

There should be an adequate number of faculty members who devote sufficient time to provide leadership to the residency and supervision of the residents. It is recommended that some faculty members have completed a combined pediatrics/PM&R residency.

Pediatric faculty must be certified by the American Board of Pediatrics or have equivalent qualifications in pediatrics.

PM&R faculty must be certified by the American Board of Physical Medicine and Rehabilitation or have equivalent qualifications in PM&R.

Curricular Requirements

A clearly described written curriculum must be available for residents and faculty. The curriculum must assure a cohesive, planned educational experience and not simply comprise a series of rotations between the two specialties. Duplication of clinical experiences between the two specialties should be avoided. Periodic review of the combined residency curriculum must be performed by the program directors of both departments with consultation with residents and faculty from both departments.

Joint educational conferences involving residents from pediatrics and physical medicine and rehabilitation are desirable and should specifically include the participation of all residents in the combined residency.

Pediatric Rehabilitation

There should be a specific curriculum for pediatric rehabilitation with clinical experience of up to 12 but not less than 6 months’ duration.

Periodic Evaluations

Both Boards require the annual tracking evaluations to be completed at the end of each training year.

Periodic evaluation of the educational progress of the resident by the program directors in both specialties is required. Included in the evaluation must be the resident's knowledge, various clinical skills, professional, humanistic and ethical attitudes, and interpersonal relationships. The evaluations should be discussed with the resident at least annually and signed by the resident and must be kept on file and available for review.

Pediatric Requirements

The training should be the same as described in the Program Requirements of the Residency Review Committee for Pediatrics with the following exceptions. Thirty months of training must be in pediatrics; the additional 6 months of credit is recognized through 6 months of PM&R training in pediatric rehabilitation.

Ambulatory Service

In keeping with the commitment to primary and comprehensive care, the 5-year combined residency must provide that 50% of the pediatric experience be ambulatory. This may include all assignments in continuity clinic, acute illness and emergency department, and community-based experiences, as well as the ambulatory portion of the normal newborn, subspecialty, behavior/ development, and adolescent experiences.

Inpatient Experience

General inpatient pediatrics must constitute at least 5 months of a resident’s overall experience, exclusive of intensive care rotations. Intensive care experiences must be a minimum of 4 and a maximum of 6 months and must include at least 3 block-months of neonatal intensive care (Level II or III) and 1 block-month of pediatric intensive care. At least 2 months of supervisory experience must occur on inpatient services.

Emergency and Acute Illness Experience

The experience in emergency and acute illness must constitute a minimum of 4 months. Two of these months should be in emergency medicine; at least 1 of these months must be a block rotation in an emergency department that serves as the receiving point for EMS transport and ambulance traffic and is the access point for seriously injured and acutely ill pediatric patients in the service area.

Subspecialty Experience

Time spent in training in the pediatric subspecialties, excluding adolescent medicine and intensive care experiences, must be a minimum of 6 months. The required and desirable subspecialty experience should conform to the RC Program Requirements for categorical pediatric training.

Adolescent Medicine

There must be a structured educational experience to train residents in the medical and psychosocial problems of the adolescent. This rotation must be for at least 1 month. During this time, experience in adolescent gynecology should be available.

Behavioral/Developmental Pediatrics

At least 1 month of a structured, focused experience in behavioral/developmental pediatrics must be provided. The experience must be supervised by faculty with training and/or experience in the behavioral/developmental aspects of pediatrics.

Normal Newborn Nursery

At least 1 month must be spent in the care of the normal newborn infant.

Continuity Clinic

There must be at least weekly experience in a continuity clinic throughout the pediatric months of training. The patients should include those cared for in the hospital, well children of various ages, and children of various ages with chronic diseases, especially those requiring expertise in PM&R. It is desirable that these experiences continue biweekly during PM&R training.

Supervisory Responsibility

At least 5 months of supervisory responsibility must be provided for each resident during the 30 months of training in pediatrics. The supervisory responsibilities must involve both inpatient and outpatient experience.

Physical Medicine and Rehabilitation Requirements

The training requirements should be the same as described in the current Booklet of Information of the American Board of Physical Medicine and Rehabilitation. During the 36 months in PM&R, the resident must satisfactorily complete 30 months of hospital and outpatient clinical management of patients receiving PM&R services. Within the 30 months of PM&R training, the resident must have a minimum of 6 months of pediatric rehabilitation. The remaining 6 months of training to complete 36 months of training in PM&R may be satisfied by pediatric rotations such as in developmental pediatrics, neonatology, pediatric neurology, pediatric neurosurgery or pediatric orthopedics. Training in PM&R includes basic and advanced knowledge of musculoskeletal and neuromuscular anatomy and physiology as related to kinesiology, exercise, and functional activities as well as immobilization and inactivity. Applications and prescriptions of therapeutic exercise, orthotics, prosthetics, and assistive and supportive devises for ambulation and mobility are essential. The following segments of training in PM&R are also required: adequate training to achieve basic qualifications in electromyography and electrodiagnosis, and opportunities to achieve understanding of special aspects of rehabilitation of patients in geriatric age-groups.

The ABPM&R requirement for 12 months of clinical practice for admissibility to Part II of its Board examination can be met by documented evidence that at least 50% of practice time is devoted to PM&R.

Credentialing

The residents in a combined residency must satisfactorily complete the specific credentialing requirements of each Board to be eligible for the examination of the Board. Clinical competence must be verified by both department chairs/program directors. Lacking this verification, the resident must satisfactorily complete three years of training in either pediatrics or PM&R to qualify for the examination in the respective specialty.

Upon successful completion of all requirements of the combined residency, the candidate is qualified to take either or both the ABP and the ABPM&R certification examinations. A candidate may apply for the certifying examination in general pediatrics in his/her fourth year of combined residency and take the examination in the fall of their fifth year if, by that time, they have successfully completed all pediatric training requirements except for continuity clinic. The candidate will be certified by each Board upon successful completion of its certifying examination. Certification in one specialty will not be contingent upon certification in the other. It is the candidate's responsibility to complete the examination process in each specialty.

7/98
Approved by American Board of Pediatrics 9/96
Approved by American Board of Physical Medicine and Rehabilitation 2/97
12/01