Average board scores at the top 10 PMnR programs?

[rehab_sports_dr]

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ampaphb, I appreciate your kind words.

The point about Spaulding is fair. I wouldn't group them in the historical big 5, because they became great more recently, but I don't dispute their quality

All of the items I listed are inadequate and with flaws, but I still think aggregate is useful.

Are there great teachers who are not researchers? Of course. Most of the great teachers are not researchers (just because true researchers are pretty rare. I am not one).

Still, if a residency program has 0% funded research, it suggests that it is a program without balance or leadership. One thing residents want to know is the ratio of education/service. If the department cannot protect time for the faculty (whether it is for research, leadership, or education), there is a very good chance that they cannot protect time for the educational needs of their residents. This is why the departments treatment of faculty matters so much for residents- it is very hard to directly measure how programs treat residents (since their are RRC requirements that all residency programs have to either comply with or lie to pretend they comply with), so the metrics are obscured. But you can indirectly look at how the department treats the faculty, and it will give you a sense of the culture of the organization.

> 3) Programs with in house fellowships is a plus/minus IMHO. While good fellows are also good teachers, they tend to limit the resident opportunities to gain as much hands on exposure.

Fair point. It's not a pure plus. One of the reasons in-house fellowships are useful, though, is that it means that the department has secured a funding mechanism for the fellows. Which means the department has its act together financially


- I guess my list of characteristics of a good residency program is really a list of secondary signs that you are looking at a well run organization. That doesn't guarantee a good experience or a good fit for any one particular resident. But it is A LOT easier to succeed in a well run organization that has a track record of promoting success than in a poorly run organization

And this is more important in PMR than some other fields, because the difference between top programs and not-top programs is striking. ALL of the programs have some serious flaws, but the really good ones have far less of them

 

[Disciple]

While I appreciate the comments about how residency choice doesn't matter that much, it still matters...

Of course it matters. No one wants to be poorly trained, but alumni networks, etc. aside, I think you overestimate the importance of PM&R rep on PM&R private practice success, circa 2009.

It’s been brought up many times before that until recently, the vast majority of musculoskeletal Physiatrists had to wait until PGY-5 to attain expertise in their desired skill-set.

So, looking forward, you could argue that a higher % of graduates from a particular program pursuing fellowship training suggests that that particular program is not providing the training that its residents desire (I think I remember Axm posting that only 3-4 of her class pursued fellowship training).

You tend to name drop quite a bit in your posts, and I just don’t think that has that much of an impact in this particular specialty in a community setting.

For example, my group gets referrals from a surgeon across the street who invented a procedure (and started the associated company) that is widely performed by spine surgeons and to a lesser degree, interventional pain physicians, in both private practice and academic centers.

I had no idea until it popped up on google when I was looking for his office phone number. I’m sure a lot of the PCPs who refer to him have no idea, and probably don’t care.

I had been wondering why he was retiring early.

Stars, in PM&R? I didn’t know that anyone practiced Physiatry in front of 50,000 screaming fans.

I understand your point about PM&R residents developing confidence issues. If a resident needs the reputation of their PM&R residency to help them overcome their insecurities when dealing with surgeons and IM subspecialists, then I guess you’re right in that regard, though I don’t think that this includes most Physiatrists. I think it depends on the individual. If it doesn’t, and the problem is widespread, then it suggests that there is something wrong with PM&R training in general. In my opinion (as was previously posted) the most important factor, is finding a program that is best "for you".

I think we can agree to disagree. Your perspective is academic PM&R, mine is private practice, with neither of us having crossed over yet.

 

[rehab_sports_dr]

> You tend to name drop quite a bit in your posts

I don't remember name dropping unless specifically asked for a name. I've mentioned specific programs, however, since that is what was asked

> I understand your point about PM&R residents developing confidence issues. If a resident needs the reputation of their PM&R residency to help them overcome their insecurities when dealing with surgeons and IM subspecialists, then I guess you’re right in that regard, though I don’t think that this includes most Physiatrists.

I guess we can respectfully disagree on this issue as well.

It is my impression that the biggest transition for residents when they leave residency is not improving their knowledge level or developing technical skills, but having the confidence to act independently. I don't think this is particular to PMR, incidently- speaking with educators from other specialties and the nurses who work with other specialists, there is a big concern that residents are coming out of residency as well trained physician extenders, but not comfortable making decisions on their own.

I think this is the fault of the way we educate residents. For the most part residents ARE treated as physician extenders, and not asked to make independent decisions. This tends to be particularly glaring on inpatient rotations, in my opinion.

> In my opinion (as was previously posted) the most important factor, is finding a program that is best "for you".

I agree with that, although I would add the caveat to be really careful to avoid bad programs.

> I think we can agree to disagree. Your perspective is academic PM&R, mine is private practice, with neither of us having crossed over yet.[/QUOTE]

Fair enough. I think the multitude of perspectives is what makes a message board helpful. I know I have learned a lot from your posts in the past, so I am glad to hear your opinion.

 

[PMR 4 MSK]

I think this is the fault of the way we educate residents. For the most part residents ARE treated as physician extenders, and not asked to make independent decisions. This tends to be particularly glaring on inpatient rotations, in my opinion.

This is as close as one can get to a perfect Truth in medicine.

It wasn't until after residency, when I had to make my own decisions, that my education truely began. Residency prepared me for that education.

My PD told us my first year that she did not intend to release us with all the knowledge we would ever need to practice on our own. She intended to release us with the knowledge that we were safe to practice on our own. It was so true.

 

[PMR2008]

What about a stellar resident at an average program who ends up going to a top notch fellowship. Would the residency program or fellowship matter more?

 

[Ludicolo]

Thank you gentlemen, for discussing metrics other than reputation. I'm digging this thread.

I will agree w/ rehab_sports_dr that a financially secure, well-organized program is better positioned to impart success towards its residents. Leadership at the chair and PD level is key. The prominence of research is important as well. Research advances our field forward, and it’s exciting to train/work at a cutting edge place. And I will grudgingly agree that program reputation carries far more weight than it should if one chooses to pursue a career in academics - at least it does in my neck of the woods. Even within my current institution, I’m still referred to as “that guy from ____”.

What about a stellar resident at an average program who ends up going to a top notch fellowship. Would the residency program or fellowship matter more?

It is the stellar resident that matters the most. Residency/fellowship is what you make of it. Reputation can get your foot in the door, and it’s a nice marketing tool, but it can only carry you so far.

Thinking back to my residency training, the people who were my best teachers were not necessarily the best researchers. People who put time and effort into teaching are a different breed. They remember what it was like when they were residents. They are not looking to establish a national reputation for themselves. They were, instead, the kinds of docs you would want to treat your mom - kind, caring, patient, and yet challenging, with a wealth of knowledge to impart. Many of the best teachers I have had were the least impressed with themselves, and had to ultimately be recognized by those around them for what they had accomplished over the years.

👍👍👍👍👍

 

[Saladin MD]

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[normalforce]

1) I think consensus would indicate that any list of top programs that leaves off Spaulding is incomplete.

2) Thinking back to my residency training, the people who were my best teachers were not necessarily the best researchers. People who put time and effort into teaching are a different breed. They remember what it was like when they were residents. They are not looking to establish a national reputation for themselves. They were, instead, the kinds of docs you would want to treat your mom - kind, caring, patient, and yet challenging, with a wealth of knowledge to impart. Many of the best teachers I have had were the least impressed with themselves, and had to ultimately be recognized by those around them for what they had accomplished over the years.

3) Programs with in house fellowships is a plus/minus IMHO. While good fellows are also good teachers, they tend to limit the resident opportunities to gain as much hands on exposure.

4) % of residents pursuing post-residency fellowships can also be an indicator of what is lacking in the residency.

I am incredibly impressed by people like Rehab_Sports_Dr who lecture nationally, are well-published, and are able to obtain grant money for their departments. I would contend, however, that what makes him such a terrific colleague is none of those things, but rather that he really loves to teach, and I just don't think there is an adequate metric to quantify that kind of passion.

Having personal experience being around the guy, Rehab_Sports_Dr is easily, hands-down, the best teacher I have ever had the privilege of learning from. (attending, fellow, resident, student) And I have had the opportunity to be around a lot of great teachers.