PM&R Specific Residency questions

[ZigPig]

I am an MS4 looking trying research residency programs for this upcoming interview season. I have read through the mother of all stickies, interview threads, and residency tips, but I hope you can help me out with some questions. I had recently changed my speciality choice to PM&R (after not knowing much of this career, and just doing my first PM&R elective), so I have not developed a deep interest in a particular aspect of physiatry (like TBI or SCI), so I am trying to figure out what would be a well rounded program. I have worked with 3 private practice physiatrists (also following them in non-residency rehab hospital) - so I know my perception is someone skewed, and there is a lot that I have have not seen.

What are some things that I should be looking for in PM&R residency programs? I am not talking location, work hours, benefits, specific fit, or things that are generic to figuring out any speciality.

For example, for PM&R, what is a good split between inpatient and outpatient time?
How much time with expsoure to EMG/injections/ultrasound/pediatrics/pain/TBI/SCI/sports/p&o is considered "average/"lacking"/"good exposure" ?
What are important things to look for that I have not listed?

Also, if anyone has any programs in particular they reccomend that is well rounded that fits my profile, let me know! (Step 1 228, no problems with passing classes but no honors, adequate but not glowing LOR, not much research experience)

Thank you, I appreciate your opinions

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[Lanvin]

Things I looked for:
1) Minimum required months in inpatient PM&R (12 months).
2) Good EMG exposure. You should specifically ask programs what their number of EMG/NCSs are by the time residents graduate. There are some people that argue that observing an EMG/NCS is as good as performing one. I'm not going to make that decision for you. Just make sure you know their #'s and exactly what their #'s mean (to be well-informed when you rank programs).
3) Enough time during inpatient rotations to observe/participate in your patient's therapy sessions. You need to have a good understanding of what the therapists do as a team leader (plus it's more enjoyable participating in patient care). Some places I visited had no census caps and routinely averaged 20-24 patients per resident. There is no way you can have any idea what is going on with your patients with this heavy of a census. I thought an average of 12-14 was reasonable.
4) Exposure to procedures, ultrasound, etc...
5) Elective months. Most places have 1-2 months. I was shooting for at least 4 elective/selective months so I could afford to wait a little longer in my residency training to decide my long-term PM&R focus and tailor my education around it.
6) Anatomy/biomechanics/gait education/training
7) Which programs have curriculum designed in a way that will best fit my learning style?

 

[PhysiatristDoc]

PM&R is very diverse. If there was a particular aspect of PM&R you liked best, make sure the program will expose you to that.

For example, if you loved TBI or Peds, there are some programs that will leave you a star in these areas when you are done, and many that will not leave you confident in these areas without a fellowship.

If you loved outpatient and procedures, ask the residents for actual numbers and hands on time. Minimize the inpatient stuff. There are programs where you will come out proficient in basic fluoro guided procedures and ultrasound injections/diagnosis.

Lanvin mentioned places where residents are rounding on 20-24 patients and I will say that if there really is such a place, run the other way. Inpatient load should cap around 12 for a resident, there is no way to learn otherwise. You can round with the team on more than that, but writing daily notes and managing 20-24 patients sounds more like a busy private practice than a training program.

weekend rounds are entirely different - it's just divide and conquer on the weekends.

 

[ZigPig]

Thanks Lanvin and PhysiatristDoc, I appreciate the advice.

 

[MedBronc23]

Great question. I can only speak for the three programs I rotated at as an M4 and my current program.

I rotated at a Midwest, mountain west, and east coast program. The east coast program was very strong stand alone rehab, emg exposure, and reputation. Also had all fellowships I was interested in Pain and Sports. The location (away from my home in mountain west and wife's in Upper Midwest put it lower on our list but not deal breaker. It was definitely a highly academic program with strong research emphasis. Lots of big academic physiatrists who publish alot. The biggest drawback to me was the fellows got all the interventional and US hands on experience. I wanted to be prepared and have hands on procedure experience before fellowship. IMHO fellowship is not to learn but to perfect ones chosen craft.

The mountain west program was very balanced with good exposure to everything. It was extremely close to both our families in location. Nice staff but no major big names save a few. I was treated awesome by one of the inpatient attendings and really built great relationship (even got a letter). However the PD was new, and his vision for the residency program was not my ideal experience. Also I only had a good experience with 1/2 attendings in the subspecialty areas I was interested in, and I wanted close mentors for research and clinical learning in both sports/MSK and pain/interventional spine. So it went lower on my list. I also felt the fellows got most of hands on exposure there and that the rotations being spread out all over town with small class size put you on an island with only your attending for support/ resources. Which could be great or bad. However, i would have been happy there because of location but not as happy knowing other places were stronger in my areas of interest.

I rotated at my current program really knowing nothing about it except the overall renowned reputation of the institution as a whole. However, I knew after the first week I was at home. Here are the factors that made it my obvious #1.

1.It was the right size: 7-8 residents/ year (21-24 total)= great opportunity for upperclassmen mentors/resources and opportunity to work as a team on inpatient.
2. Appropriate level of autonomy on inpatient and outpatient:

on inpatient service is two seniors (pgy4) and two junior residents (PGY-2 usually) with one attending. The patients are places under one of the PGY-2 schedule who is responsible for daily rounds, interdisciplinary rounds, and gym rounds. Seniors help with sit down conferences admissions ect. And resource to keep flow going.

On outpatient you rotate on various days with each attending of that subspecialty (amputee sports pain ect. You usually work with staff and fellow. You get to see pts on your own and then staff. Lots of one on one teaching and education.

3. Home call. I was not ranking somewhere without home call on my top ten. I wanted to learn and have a life. Being someone's admission and dismissal workhorse was not my idea of learning. Plus at my program everything is so electronically connected and close that home call works (orders and emr on ipad iphone via apps) We have excellent medicine and surgery resources at are disposal 24/7. Also I do not believe you have to have home call to train good inpatient rehab docs...we train enough and they are just as good if they were in house or not.

4. Procedures: not just seeing but doing. I chose my program because it is IMHO the best for diagnostic and interventional MSK US training in the nation. It also has a strong pain department where PM&R Neuro and Anesthesia work in collaboration to prepare all three areas residents to do axial spine and peripheral interventions on Fluoro and US.

I have over done over 100 MSK ultrasound procedures and I'm only in the beginning of PGY 3 year. I have observed over 200 more. I also have logged over 100 pain procedures and observed 50 more. I will have opportunity to do both again as senior elective to get even more exposure before fellowship.

I bet you would be hard pressed to find those numbers at other programs for their PGY2 residents.

One thing I will say is we only get Botox on peds and SCI rotations. But we get plenty of Baclofen pump fills and refills and reprogramming. We also assist in placing these on our pain rotation as pain places these at my institution.

5. EMG: I wanted to be able to do EMG procedures after residency without fellowship. We have arguably one of the best emg labs in the world at my institution. Neuro and PM&R staff provide training with graduated education modules leading to you doing these solo after 6 months of only EMG during pgy3. We typically perform >300 solo during that time and observe much more. Can do emg refresher as senior as well.

6. Atmosphere: my program is extremely collegial. We hang out. We bike run marathons grill ski boat watch sporting events golf and even have a fantasy football league with 20 residents and their significant others participating. We are a team made up of people from all over country and world. Our diversity makes us strong and the fact that we are in a smaller city with world renowned medical clever just attracts the best type of people.

7. conferences/ team coverage:

We have great resident benefits besides the standards. Here if you get a poster or research presentation accepted the program pays for you to attend no matter how many you have in one year. Also gives you one national trip during residency which most use for board review and a local educational conference paid for each year in an area of your interest.

We also have ample opportunities to cover hockey football marathons wrestling you name it on the high school collegiate levels as residents. I am team doc for a few local high school teams.

8. Last but not least. Think of your family kids and significant other. It needs to be a joint decision and a place where your spouse can find a job.

That being said I moved far away from family and friends for a great program that fit me and had an amazing national reputation in PM&R and international in medicine. I knew I could go anywhere and that I would have limitless possibilities training at my program.

So choose wisely and what's the most important for you for life.

 

[ZigPig]

Thanks MedBronc for really elaborating on why you chose your program. It is great to hear you found such a great match. I am crossing my fingers, hoping I am as lucky as you.

I just found out I've got a baby on the way, so that has changed my preferences quite a bit, without even interviewing!