how are things looking for a D.O or FMG trying to get into PM&R

[HussainGQ]

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As you all know, the big "stigma" of being a D.O or a FMG is that you would not have much too much difficulty getting a residency in "primary care", but need a miracle to get matched into a residency like Dermatology, or Orthepedics. Well, were does PM&R stand in this mix?? I guess the question I am asking is if it is AS competiive as a plastic surgery, or Ortho residency is. So if you are a Carrib. or other international grad, how competitive would you be in getting a good spot in PM&R.

What about D.Os?would their knowledge of the musculo-skeletal system give them an advantage in this field of medicine?

 

[Finally M3]

Lots of DOs in PM&R. Lots of DO applicants in PM&R. Last year there were ~300+ USMGs, ~200 DOs, ~1K FMG/IMG.

There were a scattering of FMG/IMGs at the places I applied to, so it isn't out of the question. However, the two best programs I went to had 2 FMG/IMGs, I think. Half of next year's PGY2s at UMich are gonna be DOs.

Hope this helps.

 

[novacek88]

PMR loves DO's That's all i'm saying

 

[normalforce]

PMR loves DO's That's all i'm saying

Novacek88 are you going into PM&R or are you interested in it. If not, please do not post on these boards.

NF

 

[rehabmd]

I think posts like novicek88 are the reason this forum exists. There are many excellent med students who pursue PMR because they are wooed by program directors who talk humanistically and they don't realize how different the mentality in what is considered academic rehab is from other specialties. It is very difficult for some people to train in a specialty in which their role in the hospital is perceived to be less valuable than the therapists and social workers-the reason most inpatient beds are filled is not for the services that the physiatrist will provide but for the services that social workers and therapists will provide-ask any honest orthopedist, neurosurgeon or internist. Most other departments hire nurse pracatitiones and PA's to provide such services so their residents receive an education in the specialty they will be called to be expert consultants in. Patients can get better advice about rehab for musculoskeletal and neurological injuriesfrom the internet than what rehab residency prepared me to give. I have trained and worked in the four large hospitals in NYC and my experience at every single one of them has been the same: rehab resident education in expert musculoskeltal/orthopedic and neurological care is sacrificed for the purpose of filling inpatient beds so rehab residents eventually become attendings who function at the level of medical interns for the rest of their career. I know I was rewarded as a resident for doing hundreds of consults that were never read by anyone except for the last sentence which stated whether the patient was an inpatient rehab candidate or not. I would have preferred using that time being trained by neurologists and orthopedic surgeons in their clinics. I have spent considerable time and money after residency learning from orthopedists and neurologists so I can continue to function as the physician that my med school had trained me and I had envisioned I would become when I was initially drawn to rehab.

 

[novacek88]

Novacek88 are you going into PM&R or are you interested in it. If not, please do not post on these boards.

NF

I saw you on the plastics forum doing the same. I suggest you follow your own advice or keep quiet. Asking other to do something that you regularly do is being a hypocrite. I attend a DO school and I know several DO's who have successfully matched in PM&R from my school. Just because I'm not entering PM&R, I can certainly offer anectodal evidence. Look at the AZCOM matchlist if you want proof.

http://mwunet.midwestern.edu/academic/AZCOM/azcomDean.htm

 

[HussainGQ]

so I go through the Carrib. route for med school, would I have as difficult time matching in PM&R as I might have, tryingto get into Plastic Surgery, or Dermatology.......or the other "competitive" residencies? On the subject of competitiveness, just how competitive is it to get into this field of medicine, compared to others?

Generally speaking, FMGs do not have a difficult time in matching into a family practice, IM, OB GYN res. (from what I have heard from others), but what about PM&R? Is it also within thereach of FMGs?

 

[Gauss]

Is it also within thereach of FMGs?

not the programs at major academic institutions
and not the west coast programs either
I know a lot of middle tier porgrams are no longer interviewing FMG's

 

[Disciple]

I know I was rewarded as a resident for doing hundreds of consults that were never read by anyone except for the last sentence which stated whether the patient was an inpatient rehab candidate or not. I would have preferred using that time being trained by neurologists and orthopedic surgeons in their clinics.

Ain't that the truth?


Thank god my program director is a practical guy and made the proper adjustments to the program.

 

[Phil Anthropist]

As you all know, the big "stigma" of being a D.O or a FMG is that you would not have much too much difficulty getting a residency in "primary care", but need a miracle to get matched into a residency like Dermatology, or Orthepedics. Well, were does PM&R stand in this mix?? I guess the question I am asking is if it is AS competiive as a plastic surgery, or Ortho residency is. So if you are a Carrib. or other international grad, how competitive would you be in getting a good spot in PM&R.

What about D.Os?would their knowledge of the musculo-skeletal system give them an advantage in this field of medicine?

DOs have no trouble matching PM&R. Check out the match list of just about any osteopathic school and you'll see they match extremely well. I recently looked at TCOM, NYCOM, UNECOM, and Kirksville's match lists and they're very impressive. The president of the AAPM&R in my state went to DMU! 😀

It's nowhere close to as competitive as plastics or ortho. I think the NRMP revealed about a 93% success rate for matches. Someone correct me if I'm wrong.
http://www.nrmp.org/res_match/tables/table10ab_04.pdf

Regarding Caribbean schools...Ross and AUC don't seem to have that many matches. That may be personal preference, I don't know. SGU had 10 matches this year, Ross had 3, AUC had one. I heard some of the FMG matches were prematches too. This year SGU even had one match at Thomas Jefferson University Hospital--a hospital that is ranked by US News as one of the best rehab hospitals in the nation. In past years, SGU has had matches at UCLA and U Washington too--also highly regarded programs, especially the latter.

So I don't think you're at that much of a disadvantage going the FMG route and as an osteopathic student I don't think you'd have any problems whatsoever. 👍

And in case you're wondering, I'm a premed student, I just happen to be very interested in pm&r. 🙂

 

[Gauss]

past years mean little now for FMG's
some will match of course
but I know for a fact there are MANY programs no longer interviewing FMG's
too many qualified US students are applying now
the rise in US apps has been susbstantial just in the past 2 years

 

[rehab_sports_dr]

My impression is the DOs do very well in the match- on a par with similarly qualified MDs. The skills they develop as osteopaths are an asset to the field

As for FMGs, they don't do as well in the match. Unlike the DOs, there is no special skill set associated with being an FMG.

 

[HussainGQ]

If I were to do a research fellowhip at the American Sports medicine institute in Birmingham Alabama or at Tulane University's Sports Medicine program, before going to school in the Carribean, would that significantly increase my chances of getting into a PM&R residency upon completion of med school?

What about if I did an internship year after med. school, would I then be able to seek a residency in PM&R without too much difficulty?

 

[prominence]

As for FMGs, they don't do as well in the match. Unlike the DOs, there is no special skill set associated with being an FMG.

wtf? how come these SDN moderators censor MD vs. DO "flame wars", but they NEVER step in when ppl p*ss on FMGs?

by the way dude, when do DOs use their "special skill set" in radiology and pathology residencies?

lay off FMGs, u dolt.

 

[Finally M3]

by the way dude, when do DOs use their "special skill set" in radiology and pathology residencies?

lay off FMGs, u dolt.

Yikes. Ease up on the hostility. What Rehabsportsdr said is true; osteos, through their training of osteop. manip., do bring a different skill set to the table that benefits them in PM&R. Likewise, FMGs, like AMGs, don't have that.

 

[drusso]

wtf? how come these SDN moderators censor MD vs. DO "flame wars", but they NEVER step in when ppl p*ss on FMGs?

by the way dude, when do DOs use their "special skill set" in radiology and pathology residencies?

lay off FMGs, u dolt.

http://www.healthsciences.okstate.edu/college/dept/basic/pathology/sloka_cv.html

http://www.uicomp.uic.edu/radres/docs/cmitchell.htm

 

[Disciple]

If I were to do a research fellowhip at the American Sports medicine institute in Birmingham Alabama or at Tulane University's Sports Medicine program, before going to school in the Carribean, would that significantly increase my chances of getting into a PM&R residency upon completion of med school?

What about if I did an internship year after med. school, would I then be able to seek a residency in PM&R without too much difficulty?

The sports research might help somewhat.

Everyone does an intership year before starting PM&R residency, so this will not increase your chances in any way.

IMO, your best bet is to publish or participate in some PM&R research and to do a few clinical rotations at well respected PM&R programs during medical school. Obviously, try to obtain good LORs from these.

 

[Disciple]

Yikes. Ease up on the hostility. What Rehabsportsdr said is true; osteos, through their training of osteop. manip., do bring a different skill set to the table that benefits them in PM&R. Likewise, FMGs, like AMGs, don't have that.

I think it goes a little bit beyond having a different skill set in regards to DOs and PM&R.

The core philosophies of Osteopathic Medicine have much in common with those of PM&R.

1. That thing about treating the whole pt? If you've done any rehab consults yet you know all about the importance of the Social/Functional History and functional prognosis/outcome.

2. The interelatedness of structure and function/the OMM structural exam.
Many of these components and concepts are also part of the physiatric physical medicine exam. The Thomas Test, Gilette's Test, FABER Test, myofascial pain syndrome, the kinetic chain, muscular imbalances, overuse syndromes, trigger/tender points, somatic dysfunction and chronic pain syndromes, etc? These are all things that DOs are exposed to in their first two years of medical school.

I guess you could say that DOs almost receive a certain amount pre-training in PM&R during medical school.

My 2-cents.

 

[HussainGQ]

The sports research might help somewhat.

Everyone does an intership year before starting PM&R residency, so this will not increase your chances in any way.

IMO, your best bet is to publish or participate in some PM&R research and to do a few clinical rotations at well respected PM&R programs during medical school. Obviously, try to obtain good LORs from these.

Thanks for the advice Disciple, does everybody else agree with him/her?

 

[paz5559]

The interelatedness of structure and function/the OMM structural exam.
Many of these components and concepts are also part of the physiatric physical medicine exam. The Thomas Test, Gilette's Test, FABER Test, myofascial pain syndrome, the kinetic chain, muscular imbalances, overuse syndromes, trigger/tender points, somatic dysfunction and chronic pain syndromes, etc? These are all things that DOs are exposed to in their first two years of medical school.

I guess you could say that DOs almost receive a certain amount pre-training in PM&R during medical school.

My 2-cents.

It is my impression, and I definitely need someone to correct me if I am mistaken, that there is very little evidentiary basis for what OMM does. (Yes, I recognize this is a controversial statement, and am asking to be educated, not flamed)

All of PM&R is being subjected to the rigours of peer reviewed scientific methodology. While much of what Disciple refers to is, indeed, part of what we are taught, we are taught it with the caveat that there is no scientific basis for most of those particular entities (ie. Gilette & FABER tests do not haver anything close to good correlation with response to diagnostic SI blocks, which are the gold standard, myofacial trigger points have very poor inter-observer reliability)

Hypotheses alone are fine, and ones that are logical, or should work are even better. Anectotal experience is great, but does't prove a particular treatment is any better than placebo. Until OMM is subjected to the same evaluation criteria that medicine, in general, is insisiting on for all aspects of our field, I for one, will view it with a healthy dose of skepticism.

 

[drusso]

It is my impression, and I definitely need someone to correct me if I am mistaken, that there is very little evidentiary basis for what OMM does. (Yes, I recognize this is a controversial statement, and am asking to be educated, not flamed)

All of PM&R is being subjected to the rigours of peer reviewed scientific methodology. While much of what Disciple refers to is, indeed, part of what we are taught, we are taught it with the caveat that there is no scientific basis for most of those particular entities (ie. Gilette & FABER tests do not haver anything close to good correlation with response to diagnostic SI blocks, which are the gold standard, myofacial trigger points ahve very poor interobserver reliability)

Hypotheses alone are fine, and ones that are logical, or should work are even better. Anectotal experience is great, but does't prove a particular treatment is any better than placebo. But until they are subjected to the same evaluation criteria that medicine, in general, is insisiting on for all aspects of our field, I for one, will view it with a healthy dose of skepticism.

Depends. If you look at OMM as a process of health care distinct from "allopathic medicine" then the evidence for the effectiveness of OMM is rather weak. If you look at spinal manipulation as a treatment modality, then the picture is mixed. Here is the latest pragmatic effectiveness studies of spinal manipulation combined with exercise for back pain...

AMA News Article Comparing MD and DO styles


BMJ. 2004 Nov 29


United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

[No authors listed]

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months

BMJ. 2004 Nov 29


United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.



OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were pound195 ($360; 279 euro; 95% credibility interval pound85 to pound308) for manipulation, pound140 ( pound3 to pound278) for exercise, and pound125 ( pound21 to pound228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost pound3800; in economic terms it had an "incremental cost effectiveness ratio" of pound3800. Manipulation alone had a ratio of pound8700 relative to combined treatment. If the NHS was prepared to pay at least pound10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of pound8300 relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

 

[HussainGQ]

Dr. Russo
So do you think if I did the research fellowship at ASMI or at Tulane I would significantly increase my chances of getting into PM&R, if I went to med school in the Carribean (Granted I do extremelly well on my boards).

 

[paz5559]

Depends. If you look at OMM as a process of health care distinct from "allopathic medicine" then the evidence for the effectiveness of OMM is rather weak. If you look at spinal manipulation as a treatment modality, then the picture is mixed. Here is the latest pragmatic effectiveness studies of spinal manipulation combined with exercise for back pain...

AMA News Article Comparing MD and DO styles


BMJ. 2004 Nov 29


United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

[No authors listed]

OBJECTIVE: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain. DESIGN: Pragmatic randomised trial with factorial design. SETTING: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. PARTICIPANTS: 1334 patients consulting their general practices about low back pain. MAIN OUTCOME MEASURES: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. RESULTS: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No significant differences in outcome occurred between manipulation in NHS premises and in private premises. No serious adverse events occurred. CONCLUSIONS: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months

BMJ. 2004 Nov 29


United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.



OBJECTIVE: To assess the cost effectiveness of adding spinal manipulation, exercise classes, or manipulation followed by exercise ("combined treatment") to "best care" in general practice for patients consulting with low back pain. DESIGN: Stochastic cost utility analysis alongside pragmatic randomised trial with factorial design. SETTING: 181 general practices and 63 community settings for physical treatments around 14 centres across the United Kingdom. PARTICIPANTS: 1287 (96%) of 1334 trial participants. MAIN OUTCOME MEASURES: Healthcare costs, quality adjusted life years (QALYs), and cost per QALY over 12 months. RESULTS: Over one year, mean treatment costs relative to "best care" were pound195 ($360; 279 euro; 95% credibility interval pound85 to pound308) for manipulation, pound140 ( pound3 to pound278) for exercise, and pound125 ( pound21 to pound228) for combined treatment. All three active treatments increased participants' average QALYs compared with best care alone. Each extra QALY that combined treatment yielded relative to best care cost pound3800; in economic terms it had an "incremental cost effectiveness ratio" of pound3800. Manipulation alone had a ratio of pound8700 relative to combined treatment. If the NHS was prepared to pay at least pound10 000 for each extra QALY (lower than previous recommendations in the United Kingdom), manipulation alone would probably be the best strategy. If manipulation was not available, exercise would have an incremental cost effectiveness ratio of pound8300 relative to best care. CONCLUSIONS: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

I recognize drusso is more than likely cognizant of the issues I list below regarding the literature he cites, which is why he characterizes it as weak or mixed depending on one's viewpoint.

1) None of the above quoted studies are double blind, placebo-controlled, prospective studies, as one would hope for (although I readily admit such a protocol would be exceedingly hard to design). None the less, as THAT is the standard we hold all new methodologies to (ie. IDET, nucleoplasty), I am certain the Osteopathic community would want to be evaluated with and held to the same rigorous criteria we hold allopathic "modalities" and procedures to. That way, if proven to be efficacious, there is no wiggle room for skeptics like me to cast aspersions on the legitimacy of the study findings.

2) Nick Bogduk suggests that any study that evaluates a modality, process, or procedure for "low back pain" without first breaking out the likely pain generators (ie discogenic, neuroforaminal narrowing, spinal stenosis, SI joint or Z-joint etiology) is like looking at treatments for all chest pain without first ruling out pain of non-cardiac origin (ie. costochondritis or GERD). He characterizes any such study's results as "pure rubbish" (typically blunt Aussie that he is).

Unless I am mistaken, both of the above quoted studies fall into just that category.

 

[HussainGQ]

This is beginning to turn into an MD vs. DO all out battle royal (I am having trouble distinguishing between who are the fans and who are the Indiana Pacers in here) which is not the reason why I started this thread!

Please DO NOT post in here unless you are writing to give me (and others in my situation) some useful information about the things that I have mentioned above.

 

[paz5559]

This is beginning to turn into an MD vs. DO all out battle royal (I am having trouble distinguishing between who are the fans and who are the Indiana Pacers in here) which is not the reason why I started this thread!

Please DO NOT post in here unless you are writing to give me (and others in my situation) some useful information about the things that I have mentioned above.

Forgive me, Hussain, but unless you have suddenly morphed into drusso, I don't believe you are the moderator, and thus empowered to tell any of us what to or not to do in this forum. This is a public forum, and as such, we can each go off on our own little tangent, within the parameters of the board. Don't like it? I guess you have three choices: 1) complain to drusso (the moderator, but you may have noticed, he is a participant in the discussion you are deriding, so perhaps that might not be the most productive tract); 2) bring the topic back to what it is you want to discuss, and see if anyone else out there wants to follow your lead, or 3) start a new thread altogether.

Also, if it advice from an individual you seek, have you noticed that nifty PM option the board makes available?

 

[drusso]

I recognize drusso is more than likely cognizant of the issues I list below regarding the literature he cites, which is why he characterizes it as weak or mixed depending on one's viewpoint.

1) None of the above quoted studies are double blind, placebo-controlled, prospective studies, as one would hope for (although I readily admit such a protocol would be exceedingly hard to design). None the less, as THAT is the standard we hold all new methodologies to (ie. IDET, nucleoplasty), I am certain the Osteopathic community would want to be evaluated with and held to the same rigorous criteria we hold allopathic "modalities" and procedures to. That way, if proven to be efficacious, there is no wiggle room for skeptics like me to cast aspersions on the legitimacy of the study findings.

2) Nick Bogduk suggests that any study that evaluates a modality, process, or procedure for "low back pain" without first breaking out the likely pain generators (ie discogenic, neuroforaminal narrowing, spinal stenosis, SI joint or Z-joint etiology) is like looking at treatments for all chest pain without first ruling out pain of non-cardiac origin (ie. costochondritis or GERD). He characterizes any such study's results as "pure rubbish" (typically blunt Aussie that he is).

Unless I am mistaken, both of the above quoted studies fall into just that category.

Well, I think "rubbish" is a little extreme, but any science is limited by the "garbage in/garbage out" principle. Pazz's points are all well-taken and readily acknowledged by those manual medicine researchers attempting to be scientific about the process. I've been involved in studying spinal manipulation as a treatment modality for a number of years and have published in the field and I can tell you that it the hardest kind of research to do because everything is so "soft."

Consequently, many proponents and practitioners of spinal manipulation argue that the placebo-controlled paradigm is methodologically wrong for answering patient oriented questions about spinal manipulation. They argue that the patient experience of manual medicine is more like undergoing psychotherapy (somatherapy?) than it is like taking a Vioxx pill for a backache. Thus, manual medicine practitioners are less interested in knowing if patients who undergo a course of treatment with spinal manipulation separate from placebo than they are in knowing if those patients ultimately do better than those who receive what passes for "standard of care" in the primary care setting. On the other hand, questions about the underlying physiology of manipulation, how to best select patients for this treatment modality, what are the "generators" of back pain that is responsive to spinal manipulation, or how to characterize the "manipulatable lesion" in a rigorous way are difficult to ignore...The NIH, however, has recently funded a series of mechanistically oriented studies to begin to systematically explore these issues.


Abstract: The Graduate School of Biomedical Sciences (GSBS) is collaborating with the Texas College of Osteopathic Medicine (TCOM) at UNTHSC, and the Arizona College of Osteopathic Medicine (AZCOM) to propose a Developmental Center for Research on Osteopathic Manipulative Medicine (DCR-OMM). OMM is a body-based therapy as defined by the NCCAM definitions of complementary and alternative medicine (CAM). The varied principles and practices of OMM are unique among other body-based therapies primarily because they are applied by fully licensed physicians and therefore can be applied to alleviate both musculoskeletal and visceral disease processes and readily integrated with conventional health care. Four key elements of osteopathic principles and practices will be investigated in this DCR-OMM:

Study #1) Effects of direct biomechanical strain on the fascial tissues of the musculoskeletal system;
Study #2) Effects of OMM (lymphatic pump) on the lymphatic duct lymph flow and the resultant potential beneficial effects on edema and immune function subsequent to an improvement in lymphatic circulation;
Study #3) Effects of OMM on sympathetic neural activity either by affecting the sympathetic nervous system directly or by affecting the sympathetic nervous system indirectly by reduction of somatic dysfunction induced pain;
Study #4) Combined synergistic clinical outcome effects that result from applying OMM in patients post -CABG who have a complex combination of fascial restrictions, pathologic fluid shifts, somatic pain and hypersympathotonia.

What constitutes a manipulation "placebo?" (this question is actually my most recent area of interest!"). How do patient perceptions of placebo versus real spinal manipulation affect treatment outcomes in clinical trials? Anyone who has actually performed manual medicine and worked with patients in this manner know that there are a lot of "non-specific" effects in the mix...I recently presented the following abstract at an osteopathic conference:

Treatment Credibility Abstract

The jury is still out.

 

[Disciple]

It is my impression, and I definitely need someone to correct me if I am mistaken, that there is very little evidentiary basis for what OMM does. (Yes, I recognize this is a controversial statement, and am asking to be educated, not flamed)

All of PM&R is being subjected to the rigours of peer reviewed scientific methodology. While much of what Disciple refers to is, indeed, part of what we are taught, we are taught it with the caveat that there is no scientific basis for most of those particular entities (ie. Gilette & FABER tests do not haver anything close to good correlation with response to diagnostic SI blocks, which are the gold standard, myofacial trigger points have very poor inter-observer reliability)

Hypotheses alone are fine, and ones that are logical, or should work are even better. Anectotal experience is great, but does't prove a particular treatment is any better than placebo. Until OMM is subjected to the same evaluation criteria that medicine, in general, is insisiting on for all aspects of our field, I for one, will view it with a healthy dose of skepticism.

Unfortunately, PM&R as a whole still lags behind other more research oriented medical specialties. The field is still relatively small and as it grows, so to will the amount of quality research performed.

Until then, however, we have only our training and our current standard of care. True, SI blocks are the gold standard for diagnosing sacroiliitis, but how many practicioners do you know that would jump to that step before making a clinical diagnosis and attempting a course of conservative therapy?

How long ago was it believed that the SI joint was not a legitimate cause of low back pain? Historically speaking, before the advancement of nonoperative spine care how many pts underwent discectomies only to wind up with failed back syndromes?

Our understanding of chronic pain? Superficial at best.

The point I'm trying to make is that we have had and continue to have a limited understanding of the neuromusculoskeletal system. That being said, until we catch up, we should continue to take care of our pts the best we can with the skills and training that we're given.

 

[nvrsumr]

PMR is one of the less competitive specialties. As a well qualified FMG you will have an excellent chance matching at a good program. Please search for Dr. Cuts post on maximizing the match for FMGs. Invaluable information is within the thread for all FMGs.

I had 50+ interview invites as an FMG 2 years ago, several at arguably top 5 programs. Match day was a great day for me and I wish you the same good fortune.

 

[prominence]

PMR is one of the less competitive specialties. As a well qualified FMG you will have an excellent chance matching at a good program. Please search for Dr. Cuts post on maximizing the match for FMGs. Invaluable information is within the thread for all FMGs.

I had 50+ interview invites as an FMG 2 years ago, several at arguably top 5 programs. Match day was a great day for me and I wish you the same good fortune.

that advice holds less weight now because interest in pm&r has gone up tremendously in the last 2 years. the word is out about pm&r. AMGs are especially familiar with the pm&r lifestyle. the field is small, and residency directors have more than enough qualified AMGs. a qualified FMG can still get a decent pm&r spot, but the elite programs will be out of reach (in my opinion).

 

[HussainGQ]

As I mentioned before, if I was to do a research internship at the American Sports Medicine Institute, or in the Sports med. department at Tulane before going to medical school (in the Carribean that is), would that significantly increase my chances of getting into one of the better residency programs with that extra experience under my belt?

 

[novacek88]

It is my impression, and I definitely need someone to correct me if I am mistaken, that there is very little evidentiary basis for what OMM does. (Yes, I recognize this is a controversial statement, and am asking to be educated, not flamed)

All of PM&R is being subjected to the rigours of peer reviewed scientific methodology. While much of what Disciple refers to is, indeed, part of what we are taught, we are taught it with the caveat that there is no scientific basis for most of those particular entities (ie. Gilette & FABER tests do not haver anything close to good correlation with response to diagnostic SI blocks, which are the gold standard, myofacial trigger points have very poor inter-observer reliability)

Hypotheses alone are fine, and ones that are logical, or should work are even better. Anectotal experience is great, but does't prove a particular treatment is any better than placebo. Until OMM is subjected to the same evaluation criteria that medicine, in general, is insisiting on for all aspects of our field, I for one, will view it with a healthy dose of skepticism.

I understand your point of view because prior to DO school, my impression of OMM was the same. I will acknowledge there are plenty of my classmates who respect it yet do not believe in it or wish to practice it. However, even these classmates would admit they learned more about anatomy and became more intimate with human physiology as a result of taking OMM for 2 years. The treatments in OMM may see weak in your opinion and that is fine. But if you took the course, I think even you would acknowledge that OMM is at least theoretically based on anatomy and human physiology even if you thought the treatments were unsound. And to learn these theories and treatments, you have to become an expert on anatomy and physiology.

And for the record, I do think some cranio-sacral aspects of OMM is pure bunk but from a theoretical perspective, OMM is based on principles of anatomy. So I do think DO's have an adavantage because they take Anatomy like everyone else and then "Applied Anatomy" or OMM for two whole years. Even if you don't believe OMM treatments are valid, you spend so much additional time learning about anatomy and the body in general that I can see a DO having an edge in this area.

 

[paz5559]

I understand your point of view because prior to DO school, my impression of OMM was the same. I will acknowledge there are plenty of my classmates who respect it yet do not believe in it or wish to practice it. However, even these classmates would admit they learned more about anatomy and became more intimate with human physiology as a result of taking OMM for 2 years. The treatments in OMM may see weak in your opinion and that is fine. But if you took the course, I think even you would acknowledge that OMM is at least theoretically based on anatomy and human physiology even if you thought the treatments were unsound. And to learn these theories and treatments, you have to become an expert on anatomy and physiology.

And for the record, I do think some cranio-sacral aspects of OMM is pure bunk but from a theoretical perspective, OMM is based on principles of anatomy. So I do think DO's have an adavantage because they take Anatomy like everyone else and then "Applied Anatomy" or OMM for two whole years. Even if you don't believe OMM treatments are valid, you spend so much additional time learning about anatomy and the body in general that I can see a DO having an edge in this area.

I am not sure you followed the basic point I was trying to make: OMM sounds good in THEORY. So did Vioxx. So do lots of things. None of it is valid until it is subjected to peer reviewed, placebo controlled, double blinded studies validating said theories. Until then, it is just blowing smoke.

After all, "In my experience" = one case
"In my series" = two cases
and "case after case" = three cases