Physical Medicine & Rehabilitation - Part II Oral Exam
What the oral exam rewards
The Part II oral exam assesses clinical reasoning, communication, and safe decision-making under structured questioning. Examiners present a vignette and probe your differential, workup, management, and rehabilitation plan. You are graded on organization, prioritization, and the ability to defend your choices - not on reciting facts.
Core concepts to demonstrate
- Structured presentation: history → focused exam → differential → diagnostic plan → acute management → rehabilitation plan → disposition.
- Rehabilitation reasoning: functional goals, team roles (PT, OT, speech, prosthetist, social work), and realistic timelines.
- Safety and red flags: recognize when to escalate - e.g., cauda equina, spinal cord compression, autonomic dysreflexia, heterotopic ossification, DVT.
- Goal setting: tie interventions to measurable functional outcomes and patient priorities.
Common traps
Candidates lose points by jumping to treatment before completing the differential, ignoring psychosocial and discharge factors, or failing to state priorities when asked "what do you do next?" Examiners also probe complications you did not mention - proactively name the top two or three.
Rule of thumb
Answer in the order: What is it? What confirms it? What do I do now? What does recovery look like? Always name the red flags you are ruling out.
Worked example: A patient with new paraplegia and bowel/bladder dysfunction after back pain. State immediately: "I am concerned about cauda equina syndrome - this is a surgical emergency." Then outline urgent MRI, neurosurgical consult, and monitoring. Naming the emergency first demonstrates safe prioritization.