Harvard/Spaulding

[jessica99]

I just got an interview to spaulding/harvard rehab program. Does anyone have any information on the program- ie what do they look for in an applicant what would increase my chances? Any information would be helpful.
Thanks,
jess

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[Stinky Tofu]

I'm currently a resident in the program. Every year that I've been here, it seems that each group of residents are really different. I think that there are a few characteristics that the program director looks for. He does a ton of research and my inclination is to say that he favors medical students who he thinks will actively participate. My feeling is that medical students who are outgoing and interested in academics would also do well. Starting with this application cycle, we have an Assistant Program Director as well so I think that this may also add a different spin to the way future residents are chosen. I'm not involved with the selection of residents, so these are just my personal impressions. At the AAPM&R website, you'll find the e-mail addresses for the former chief resident (graduated last year) and possibly the next chief. Don't be shy about e-mailing them because they listed their e-mail addresses there to help answer questions from medical students. They would probably give you a better idea as to what the committee is looking for when making a rank list.

http://www.aapmr.org/medstu/resmedment.htm

If you are looking for information about the program itself, I could probably better help you in that regards. Feel free to send me a PM as well. Good luck and let me know how I can help.

 

[tempperson]

Hi Tofu,

I heard from someone that Harvard focuses more on integrating acupunture into pain mgtmnt more so than other PMR programs. Do you know anything about this? Is there a push to use alternative therapies in medical practice. I'm a med student right now, and I seen the baylor dept, and it doesn't seem have a pull towards using acupuncture.

thanks

 

[Stinky Tofu]

I guess the good thing about the Harvard system is the wealth of resources even beyond the Physiatrists in the PM&R department. If you are interested in acupuncture, Dr. Audette would definitely be the attending to rotate with. There are also other attendings who do acupuncture as well, but not as much. On the other hand, we have attendings (both Physiatrists and Anesthesiologists) where you literally do interventional pain procedures all day. In fact, you could spend most of the 4th year doing your own personal fellowship in whatever area of Pain Management you wanted. There are a few residents who did just that and that's probably why they felt they didn't need to do a fellowship after residency. During your PGY-3 year, we do three required Spine rotations that mainly focuses on an intensive spine therapy program and injections.

So basically, if you wanted to, you could spend most of your 4th year being a disc jockey, treating chronic pain, or doing acupuncture. That would be at the extreme of things, but hopefully you'd be motivated to find a good balance. Our program is unique in the number of electives you can do inside the Harvard system or if you wanted to you could fly out to Baylor, Hospital of Special Surgery, Kessler, Stanford, etc. We don't rely on PGY-4s to cover clinics, inpatient rotations, or try to keep them inside the system. A program actually loses money when residents rotate outside the system that's why it is usually kept to a minimum. These are questions that may not seem important now, but when interviewing ask about the number of electives and selectives you can do.

 

[tempperson]

Hi Tofu,

THanks for your response, it was informative. I definitely want to have a program that gives a lot of leeway as to what area of PMR I can focus on 4th year.

Eventually I want to practice in CA, and I haven't checked the laws as to what kind of licensure/training is requisite to practice acupuncture simultaneously in your practice. I know in Texas you have to have licensing at an accredited school of acupuncture, which can take up to 2 years to finish.

 

[rehabdoc]

I also think that the Harvard PM&R program is an excellent teaching program. Agree with Stinky about advantages of electives. Just wanted to make it clear that trying to initiate your practice especially in the area of interventional spine with a few months of electives and observerships is only asking for trouble down the line. There are lots of reason to do a fellowship in an interventional pain/spine program. One being your protection in court of law if something goes bad. Also you are limited in the number of procedures and in sophistication of technique that you could perform, if you have not completed a formal training.

The reason that I am emphasizing on this is that we have med students and junior residents that are learning about our field and I feel responsible to educate them about proper training for more specalized areas of Physiatry.

 

[Loves_Chai]

Any views on these programs? Which program makes the most clinically strong physiatrist? With a choice which would you choice?

Spaulding: Is Harvard's curriculum as unstructured as I hear about? What are the positives of having an entire year for research? How clinically competent are the residents when you have to put out 3 paper during your time there? If you put your time in and work towards it, will you be able to get the fellowship you want?

UCLA: How are their clinical skills? Is this residency as cush as I hear? If you put your time in and work towards it, will you be able to get the fellowship you want?

UMichign: Any thoughts?

 

[axm397]

Of the three programs you listed, I only interviewed at U. Mich. I think a good resource is ligament, as he is a resident there. I thought overall, the program was very strong. I was very impressed by the new out patient facilities for mostly interventional procedures. I guess your choice depends on what you are interested in doing after residency and whether you are planning on pursuing fellowship afterwards. I know that Spaulding just started a pain management fellowship. UMich also has a fellowship in interventional or pain management. (I forgot which). Ann Arbor is a really nice college town and the cost of living is relatively cheap compared to your other two choices. I thought that the residents were very nice and got along well with each other. The PD and associate PD were both very approachable and energetic. And who can beat Alice Cheesman for the best coordinator ever?? (She baked cookies for my interview day although I was the only one interviewing that day). You are also part of the BIGGER Umich resident community, and according to my friend who is doing IM, the residents are treated and paid very well. (She said that she just got a cost of living bonus of about $2500.) Ann Arbor is only 30-45min away from Detroit if you want a city, and Ann Arbor itself has lots of fun energy about it. UMich PM&R also has a sense of history and pride, which I liked. Also, the fact that they are building and moving means that they are invested in the program's future and it's only going to get better.

Honestly, I think it's a toss up. Those programs are all so different - with different pros and cons. You can't really go wrong with any of them. For me, it's about location, quality of the program, the atmosphere/people/PD of the program, and fellowship possibilities. Ideally, my highest ranked programs would possess all of the above. Obviously, CA would have the best weather. Cost of living would be lowest in Ann Arbor. You get the Harvard name for Spaulding. (I think one of the interesting things about PM&R is that programs which would be a "name" in other fields of medicine might not necessarily be a "name" in PM&R.- for ex, I doubt anyone outside of PM&R has heard of Kessler, or RIC, or even TIRR. BUT, the your colleagues, your potential employers, fellowship directors, and many therapists do know "names" in PM&R. It is definitely confusing.)

Anyways, good luck with the ranking process. As a PM&R resident said to me, "If it is that difficult of a decision, then those programs can't be THAT different - so you might as well just rank them and get it over with...". I know, easier said than done.

Let us know in March where you end up!!!

 

[Stinky Tofu]

Originally posted by Loves_Chai
Any views on these programs? Which program makes the most clinically strong physiatrist? With a choice which would you choice?

Spaulding: Is Harvard's curriculum as unstructured as I hear about? What are the positives of having an entire year for research? How clinically competent are the residents when you have to put out 3 paper during your time there? If you put your time in and work towards it, will you be able to get the fellowship you want?

UCLA: How are their clinical skills? Is this residency as cush as I hear? If you put your time in and work towards it, will you be able to get the fellowship you want?

UMichign: Any thoughts?

I'm currently a resident in the Harvard program, but I interviewed at the UCLA program a few years ago. I can't comment on the UMichigan program because I didn't interview there.

We have nearly a full year to do electives/selectives so it's not really a full year for research. Most residents spend at most 1-3 months doing research and I don't really think the PD would let you spend much more than 4-5 months doing research. Our research requirement doesn't have much of an effect on our clinical rotations. I would argue that we have an advantage when compared to most other PM&R programs with regards to fellowship placement. Having so much time for electives really helps when you are trying to get a fellowship. UCLA only has four weeks for electives and there is talk of cutting that down to two weeks. Plus, if you want to do a Pain fellowship, you could do two electives in Pain prior to your audition rotation and really shine on that rotation. Our graduates have gotten really great fellowships at Harvard-affiliated programs and programs outside the system. The Harvard name also helps when securing fellowships that are not PM&R-based such as Anesthesia or Neurology Fellowships.

I didn't think much of the UCLA program when I first interviewed there. I've heard that things have really turned around these last couple of years. I heard that there are 5-6 UCLA students applying to PM&R this year (compared to hardly any the past five years) because of the great rotations they had in the PM&R department. I think the lack of elective time will definitely hurt graduates of their program when they are trying to get a fellowship outside of the UCLA system though.

I can certainly see the appeal of going to UCLA because of the location, but I think the opportunities are better at Spaulding. You have access to some of the top physicians in the country. We get lectures from and rotate with the top Orthopaedic Surgeons, Physiatrists, Neurosurgeons, Neurologists, MSK Radiologists, etc. I have no regrets with regards to ranking this program over the UCLA program. The calls are tougher, we have a research requirement, and the weather sucks, but I feel it will be worth it in the end. If you really want to stay in CA, I would take a closer look at the Stanford and UC Davis programs.

 

[Ligament]

HEY! I CAN POST AGAIN!

Sorry for the delay. My account was FUBAR for a few weeks!

I'll reply in more detail later, but just want to point out fellowship opportunities at the University of Michigan:
1. Two ACGME approved interventional Pain Management spots per year. Run by the PM&R department
2. One non-ACGME approved interventional SPINE fellowship per year. Currently working on some sort of ACGME approval.
3. The ACGME approved Interventional Pain fellowship run by ANESTHESIA saves one or two spots for PM&R docs per year.

Therefore, if you have an interest in Pain or Spine, consider:
1. There are 6 PM&R residents per class at UMich
2. There are 3-4 ACGME approved interventional pain fellowship spots per year at UMich, and 1 non-ACGME approved interventional SPINE fellowship per year. All 4-5 spots are reserved for PM&R docs only.
3. Odds are pretty good you would not have to move for a year if you decide you want an intervential fellowship after residency.

Best, Ligament

 

[Ligament]

I want to add that Spaulding/Harvard's program is kick ass for the 11months of electives. This is really unique and as Stinky says, you can do LOTS of great stuff with this time. Stinky can spend many months of his time doing procedures while I'm stuck doing inpatient rehab consults.

Harvard has so much money that they actually let you go OUT OF SYSTEM for your electives. Wanna go to Florida, California, Europe? No problem.

At UMich we only get 3 months of electives in our Senior year and those must be done IN the UMich system, unless it is something not available within UMich (and there is almost nothing that is unavailable here).

Respect to Stinky!

 

[Finally M3]

I would have added something about UMich, but Ligament has reappeared, and he is the resident guru of all things Michigan

IMHO, I thought UMich was an extremely well-rounded program, lots of great resources available since you're at a huge quaternary medical center. Not so much SportsMed, but then again, I don't really want to go into that so it's not a problem for me

One more night shift in the ER....one day more!

 

[Loves_Chai]

The Spauling program sounds great but:

With those 11 months of electives in the 4th year, you don't feel as if you will need more time to do the core clinical requirements and are missng additional learning. How is it that this program can get all of the core stuff done in 2 years where as other programs do it in 3 or so years with 2 months of electives? What gets short shifted in your learning? Do you get the required EMG time?

Also with 3 months of research, how time consuming is this over the course of the residency?

And yes I'd really like to stay in Cali, which is why I have the tough decision.

 

[Stinky Tofu]

I can't say I have recently compared our core rotations to Kessler, Baylor, UMichigan, Mayo, or other top programs. In terms of what we are forced to do, I'm sure we do lack in some areas. Some programs may have you do inpatient cosults, three months of SCI, etc. Our requirements are listed on the SRH website so you can compare it with other programs. There have been a couple of changes with regards to electives and EMG time, but that's pretty much what our core rotations look like.

If you want to use your electives to do an inpatient SCI month at Kessler, you are free to do so. So, if you really feel like you are missing out on something, there's no one stopping you from doing another inpatient month. One of our PGY-4s just got hired to be an Assistant Professor at Baylor. She wanted to be in Houston and I'm sure the fact that she did several electives there probably helped. The fact is that most of our residents do stay in the Harvard system and few opt to do more inpatient months. Our average graduate is probably not as well-rounded as a Kessler or RIC grad, but they tend to be really good in the area they chose to focus on.

With regards to research, you are not forced to use any of your electives to do research. You have to submit one paper for publication and present two posters at a conference. I really don't think it's that hard to meet the research requirements. There are always a ton of studies going on and an attending would love it if you wanted to help out.

We have three months of required EMG rotations. We do two months at MGH and one month at BWH. Once again, you can do more if you want. I think we will also now have more opportunities to do them at SRH because of the new attendings we've hired. Previously, it was mainly Dr. Krivickas doing them at SRH and on the days she wasn't there, you did something else.

I want to also clarify that some of the electives are selectives and that means you need to do them within the Harvard system. The drawbacks to all these electives are small, but it is there. For example, we have a rotation in Hawaii doing Occ Med. Most people do not do this rotation for the awesome learning experience. What people learn the most on this rotation is how to surf/windsurf, how to get a tan while minimizing sunburns, and where the best sushi places are on each of the islands. If you decided to do three months is Hawaii, you'd obviously miss out on potential opportunities. The other drawback is mainly fo the department. If you do three months at Baylor, Baylor gets paid for you being there instead of SRH. This is the main reason why most programs limit your elective opportunities.

Personally, I don't think you need much more inpatient months than we have. I'm sure I am biased because I don't want to do inpatient rehabilitation, but other residents/graduates have not expressed that they felt our program was lacking. I just don't see myself learning that much more if I did do 1-2 months more on a certain floor. If I did a certain rotation at Kessler or Michigan, I might possibly learn more on that particular rotation there because they might have better teachers, but doing more doesn't necessarily mean that it is better. I think you have to also look at the quality of the attendings at each program in addition to comparing the number of months on each service.

I am confident that either UMichigan or SRH will provide you with a great overall education. While SoCal itself is great, I can't confidently say that you wouldn't be lacking in certain areas if you went to the UCLA program. While support for the program from UCLA is improving, it is nowhere near the level you will receive from UMichigan or Harvard. Don't get me wrong, I struggled with the decision of whether or not to rank a CA program at the top of my list too. I certainly know it isn't an easy decision and I know at least one person on SDN who ranked the UCLA program above SRH.

 

[Ligament]

I agree with Stinky.

I also want to chime in that I personally feel it is *OK* to choose a residency based on whether you will get to do lots of procedures, or lots of brain injury, or whatever floats your boat, as opposed to choosing the best "well rounded" residency.

WE ARE SPECIALISTS, ITS OK TO SPECIALIZE!

I think med school and internship is the time to be "well rounded." Residency is the time to SPECIALIZE in what you WANT to do, not what you COULD do for the rest of your career.

Granted, being at a "well rounded" program will help you with PM&R boards, or help you be an excellent generalist physiatrist, or give you time to decide what you want to do within PM&R (it is a HUGE field after all, with many roads to follow). I certainly realize the above scenario is the one many people prefer and that is just fine and makes sense to me.

But if you are SURE you HATE EMGs but love brain injury rehab, choose a program in which you wont have to suffer six months of EMGs, but get to spend six months on TBI! It makes perfect sense, and is a perfectly valid thing to do! Knowing what you want is vital in this case.

Bottom line: if you dont know what you want, definately do a "well rounded" program. If you DO know what you want, then select programs based on that.

Best, Ligament

 

[TripleH]

How come noone here talks about the Spaulding program much? I have a friend apply this year and I've been trying to find current info on this program, but nothing... I didn't interview here but waht stats to you need? Board Scores Step 1 & 2? Research? Do they fill with top applicants only? Do they fill? How's the program itself? What are its weaknesses? Are they a No-DO or IMG place? How does the place compare to other programs. It seems noone here on this board goes here or interviews here, so not much info is out there. Where is the best place (besides visiting AND doing a rotation there) can my friend get more info? Another message board perhaps? just kidding

sorta

 

[Finally M3]

Stinky is the only SDN PM&R contributor (that we know of) that is at Spaulding...that's why noone is talking about the place