How to make myself competitive for a pain fellowship?

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Hello all,
As the match is a week away, I was wondering how can I make myself a competitive applicant for a pain fellowship. I have applied to PM&R for residency. Prior to returning to medical school I knew I wanted to do pain and eventually chose PMR as I enjoy the MSK and neuropharm aspects of the residency.

I was wondering what can I do to make myself a more competitive applicant one fellowship application time rolls around.
* I am hoping to contact the anesthesiology department and see what pain research projects they have going and see if I can help out or start one of my own.
* I will hopefully do a couple of case studies on some type of pain or MSK.
* And try to get as many procedures as I can in residency.
* How important are USMLE step 3 scores in the application process? ( I am a DO student and took the USMLE 1 and 2, and was wondering if taking USMLE 3 also is recommended?)

Just wondering, but suppose I have a post call day or something during residency or take a day or two off for vacation. Is it feasible to ask the pain department if I can rotate with them for that day or is that overkill?

Also, how competitive are anesthesiology based pain fellowships for a PM&R applicant. Im sure they want to give positions to their own specialty if possible.

As I am doing a pain rotation currently as my last rotation in 4th year medical school. I have been exposed to many areas that I find very fun and interesting such as cancer pain and the acute pain service. All the fellows I am working with are anesthesiologists. If a physiatrist did an anesthesiology based pain fellowship, do they get exposure to the acute pain and cancer pain services and how likely is it that a physiatrist ( or neurologist or psychiatrist) would do acute, cancer pain service, or SCS/intrathecal pumps after a pain fellowship, or do they tend to do more outpatient pain services?

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- Yes, try to get involved with pain projects, case studies, whatever. The more pain research you have, the better. It will also help you get to know attendings who could potentially write you LORs.
- I don't think step 3 matters a whole lot. Just take it when you're supposed to (typically done before PGY2 year)
- Try to do as many electives in pain as you can so you are comfortable with the procedures and clinical diagnostic stuff. If the dept is cool with you coming on a post-call day, I'd do that too. Trying to forge a good relationship with your pain dept is always a good idea.
- From what I've heard, it's a little more competitive from PM&R but by no means impossible. Many, many anesthesia-pain programs have PM&R residents in them.

You already sound ahead of the game since you're thinking about all this pretty early, so you should be good to go. Good luck!
 
The most important thing is to make yourself known to your local Pain faculty. Research is a good idea. Don't worry about procedure numbers during residency. I don't think you would need to take USMLE Step 3 but don't take my word for it, ask a few fellowship programs if COMLEX is sufficient when the time comes. In-training exam scores are more important.

Isn't pain a required component of PM&R residency? If your residency doesn't include a rotation in pain, arrange one as an elective. A few days here and there aren't going to make much of an impression.

Exposure to acute pain and cancer pain are required components of ACGME-accredited pain fellowships. Post-fellowship, most are not doing this sort of work outside of academia (regardless of base specialty). SCS and pumps, yes.
 
Of all the things you've mentioned, procedures are the least important. You will learn how to properly guide a needle during fellowship and no one wants to break you of bad habits. Your major selling point as a PM&R resident is your understanding of functional anatomy. Our procedures only work if you correctly diagnose the problem. The other part where you may be weaker is understanding of pharmacology for pain medications.

I really think fellowship programs choose the applicants they think will make their life easier. The more teachable and knowledgeable you appear the better. Anesthesiologists also tend to think PM&R guys can't handle early mornings/long hours.
 
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