Neuromusculoskeletal medicine residency at LewisGale Hospital Montgomery

There are no specifically required rotations prior to your entry to our program. However, ONMM3 residents benefit from the ability to count MSK rotations performed during their primary residencies towards the required rotations during the ONMM3 year. The more MSK rotations completed during primary residencies, allow significantly more flexibility to customize rotations to personal interests.

Specifically seeking out providers that perform OMT on these rotations, rotating with NMM-OMM certified physicians, and attending AAO convocation along with other local, regional or national OMM workshops will improve your skills, knowledgebase and success at being chosen and completing the ONMM3 program.

ACGME dictates all required rotations and your previous experience contributes to this. So, required selective rotations are chosen after reviewing the incoming resident's rotations completed during their PGY2 and PGY3 years. VCOM’s emphasis is to encourage all ONMM3 residents to do at least one rotation in all musculoskeletal disciplines during the course of their training.

By the end of the ONMM3 year, at a minimum, you must have completed:

1. Selective A (two needed) — Orthopedic surgery, neurosurgery, podiatry, sports medicine, occupational medicine
2. Selective B (two needed) — Physical medicine and rehabilitation (PMR), neurology
3. Selective C (one needed) — Pain management, radiology, MSK radiology
4. Hospital OMM consult service (two needed) — completed longitudinally

• Outpatient Neuromusculoskeletal Medicine (NMM)
• Primary care sports medicine
• Orthopedic surgery
• Neurosurgery
• Podiatry, PMR
• Neurology
• Pain management
• MSK radiology
• Oncology/hospice
• Regenerative medicine
• Medical acupuncture (with certified physician)
• Rehabilitation
• Academics

Pediatrics, family medicine, internal medicine and outpatient obstetric gynecology are also available upon request, but do not count towards the required MSK rotations.

We do not currently have a rheumatology rotation.

The schedule for next year would include the following:

• Five to six half-days per week are on the monthly rotation (required under ACGME; if you have done enough MSK rotations during your primary residency, then six of your 12 rotations are MSK rotations and up to six rotations can be NMM rotations
• Four half-days on OMM resident continuity clinic (one evening at VSOM, one at local VA)
• One evening every 2nd or 3rd week — longitudinal sports medicine/procedural rotation with Dr. Kozar
• One half-day of OMM didactic
• 120+ hours in MSK US training (with 60 percent front-loaded in the first few months)

ONMM is an MSK specialty. VSOM is a primary care-based, osteopathic musculoskeletal specialty clinic. We do not provide primary care, family medicine, internal medicine or pediatric services. However, we expect the resident to approach musculoskeletal pain from all MSK and medical discipline perspectives.

You should know all orthopedic exams, know how to work up and screen rheumatologic issues, know family medicine and internal medicine workups for hormonal issues, understand the growth and development of infants, know the issues associated with obstetrics and develop integrated treatment plans for complex chronic pain patients.

We do not treat patients for OMT care only. Patients should be worked up for their pain complaints from a primary care-based, ONMM specialty perspective. It is most similar to PMR or primary care sports medicine, but with an obvious osteopathic and OPP focus.

We want you to be physicians who deliver holistic care.

We spend a lot of time on research training and development. VCOM fosters and invests a large amount of money in research development within its multi-school system. VCOM has a yearly research day and a yearly research retreat at each campus where ONMM residents participate in. VCOM provides hundreds of thousands of dollars yearly in starter grants for beginning researchers.

There are several half days given for research during the first half of the year, ONMM residents will complete their CITI training either prior to matriculation or upon arrival. The program front loads research training, development and planning so that posters can be presented by the 7th or 8th month of the program for VCOM Research Day and present at the American Academy of Osteopathy (AAO) convocation in March each year.

In our program we require the following:

• Completion of Collaborative Institutional Training Initiative (CITI) training modules, to make the resident eligible for institutional review board (IRB) retrospective and prospective study submission
• Completion of at least one retrospective or prospective clinical study
  • Many of the OMM and SM faculty have ongoing projects that the residents can participate in. Many residents have also chosen to do their own projects. There is the potential to continue and expand prior ONMM resident projects.
• Submission of at least one (OPP)/OMM-related poster to VCOM Research Day and a national convention (usually AAO).
• Submission of a formal written paper (article review, case study, or paper on your research) for possible publication in a journal
  • Residents work with Dr. Kozar to complete this in the second half of the year.

All ONMM residents take home calls for one-week periods, usually every five to eight weeks total for the year (shared by ONMM residents and sports medicine fellows). You might get five to six actual calls all year. You'll need to be available by phone. There is always an OMM or SM attending physician available for backup.

All ONMM residents, during their first half-year, will be on OMM hospital consult service daily, Monday thru Friday. There are no weekends and no major holidays. We average zero to four inpatients per day. These are shared by the residents. Once numbers are good, we may rotate which week you do hospital. We see patients most times over the lunch hour or after afternoon clinics.

Base rotations are all very local:

• VCOM Sports and Osteopathic Medicine (VSOM) — OMM resident clinics, OMM rotations, longitudinal SM rotation, PMR and SM
• LewisGale Hospital Montgomery is in Blacksburg, Virginia and only two miles from the VSOM Clinic

The majority of the rotation sites are within the local area with a 10-20 minute drive. The furthest location is normally Roanoke, Virginia, or Bluefield, West Virginia, (40 minutes) for pain management (usually necessary), and elective rotations in neurosurgery and podiatry.

Credentialing is completed through the VSOM Clinic. Residents are credentialed as residents in training for insurers. For your OMM resident clinic, you are the primary doctor in the electronic (EHR), that is, patients become part of your panel, but billing is thru the attending preceptor.

The school covers malpractice insurance for the residents during the residency and tail coverage afterward up to the required maximum levels by law for Virginia physicians. Providing tail coverage is required under ACGME. Carriers can vary coverage from year to year depending on the cost to the school.