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WaveFunction

5+ Year Member
Oct 26, 2012
12
1
Status
Pre-Medical
I'm a 3rd year medical student doing electives over the next few months in order to decide what to apply in this August.

I have a longstanding interest in the nervous system, and have been involved in clinical neuro research for a long time. While I think epilepsy, movement disorders, MS, acute stroke, and ICU medicine are cool, I am finding myself increasingly drawn toward neurorehabilitation; I find the process of recovery inspiring and at times miraculous. I'm intrigued by how little we know about how this recovery takes place, and hopeful that we will soon develop new ways to enhance it. I know I want a career in which I can do clinical research, and right now I'm a little obsessed with the potential for tDCS and TMS to improve rehab outcomes in stroke, TBI and neurosurg patients.

As far as clinical work, I love seeing patients and think I am best-suited for the outpatient setting, and think it would be awesome to have some outpatient procedures to do (maybe tDCS and TMS protocols? pipe dream? maybe...). I have been planning to match into a neurology program (and have also been considering IM, since I really value the general medicine skills I'm starting to develop and don't want to lose them), but my PM&R rotation was very cool and so now I'm more conflicted.

QUESTIONS:
- What are the pros and cons of PM&R vs neuro as far as research opportunities?
- Is it accurate to say that I will get more general medicine experience in neurology vs PM&R?
- Would it make sense to do neuro and then a neurorehabilitation fellowship vs. just doing PM&R?
- if noninvasive stimulation protocols ever become a thing, will neurologists or physiatrist do them?

I know there are already a number of threads on this topic, but I wanted to ask more specifically about how this decision will affect my ability to pursue research opportunities in the future. I'll be posting this in the PM&R forum too.

Thank you all for your input!
 

curiousneuro

2+ Year Member
Oct 1, 2015
101
108
Status
Resident [Any Field]
I'm a 3rd year medical student doing electives over the next few months in order to decide what to apply in this August.

I have a longstanding interest in the nervous system, and have been involved in clinical neuro research for a long time. While I think epilepsy, movement disorders, MS, acute stroke, and ICU medicine are cool, I am finding myself increasingly drawn toward neurorehabilitation; I find the process of recovery inspiring and at times miraculous. I'm intrigued by how little we know about how this recovery takes place, and hopeful that we will soon develop new ways to enhance it. I know I want a career in which I can do clinical research, and right now I'm a little obsessed with the potential for tDCS and TMS to improve rehab outcomes in stroke, TBI and neurosurg patients.

As far as clinical work, I love seeing patients and think I am best-suited for the outpatient setting, and think it would be awesome to have some outpatient procedures to do (maybe tDCS and TMS protocols? pipe dream? maybe...). I have been planning to match into a neurology program (and have also been considering IM, since I really value the general medicine skills I'm starting to develop and don't want to lose them), but my PM&R rotation was very cool and so now I'm more conflicted.

QUESTIONS:
- What are the pros and cons of PM&R vs neuro as far as research opportunities?
- Is it accurate to say that I will get more general medicine experience in neurology vs PM&R?
- Would it make sense to do neuro and then a neurorehabilitation fellowship vs. just doing PM&R?
- if noninvasive stimulation protocols ever become a thing, will neurologists or physiatrist do them?

I know there are already a number of threads on this topic, but I wanted to ask more specifically about how this decision will affect my ability to pursue research opportunities in the future. I'll be posting this in the PM&R forum too.

Thank you all for your input!
1) I don't know much about research opportunities in PM&R, but obviously they are quite broad in neurology. I can't imagine PM&R having anywhere near the variability in research opportunities as compared to neurology.
2) Again, I'm a bit biased, but as neurology residents, we get a tremendous amount of exposure to general medicine as well (especially on the inpatient side). Because PM&R is primarily an outpatient specialty, I would imagine your general medicine exposure would be less. Remember - the focus of PM&R is primarily recovery from an illness...if they are medically unstable, they likely won't be seeing much of you in PM&R.
3) It depends on what you want. Do you want to be a neurologist who's trained in rehabilitation, or a rehabilitation specialist primarily? That answer is up to you.
4) I would say yes, and would imagine both would/could be able to do them.
 

kchan99

15+ Year Member
Apr 21, 2004
320
89
Maryland
Status
Attending Physician
There is an interest in TMS and tDCS in neurorehab. Neurorehab fellowships can be approached from neurology or PM&R.

If you're highly interested in doing EMG's and joint injections, then go into PM&R.
 
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Dr. Bruce Banner

5+ Year Member
Oct 19, 2014
50
32
both fields are ripe for research. Neuro gets the most money right now because of all the new drugs. PM&R is starting to focus on regenerative therapy on neuroregeneration and msk regeneration, which I personally think is cool and may / may not be the net big thing. Predicting one day PM&R will be become PRM - physical regenerative medicine
 

Hank Rearden

7+ Year Member
May 1, 2012
101
37
Status
Attending Physician
I can speak from the perspective of a neurologist who does rehabilitation research. For reasons that are still not clear to me, PM&R docs that do a significant amount of research are extremely rare. I think many select PM&R due to an easier lifestyle, and for that reason research is not high on their priority list. There are a few outstanding rehab researchers from PM&R, but for whatever reason there is a much larger population of neurologists and PT/PhDs in this field.

I'm curious as to why you're so interested in TMS/tDCS. I personally feel that our field is saturated with people conducting this type of research and that it holds little promise to truly improve outcomes. There was a large industry sponsored RCT of TMS in stroke recently that was negative. A large RCT of tDCS for stroke was recently accepted through StrokeNet, but hasn't started enrolling yet. With TMS you are stimulating a cubic centimeter of tissue only on the cortical surface (~1 billion neurons). tDCS is even less specific. There are some newer technologies that allow more localized stimulation - I feel these are more promising avenues for the rehab field to explore moving forward.
 
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