Non-PM&R Fourth Year Clinical Rotations for PM&R Career

[jleebo]

I am a third-year medical student who is interested in pursuing a career in Physical Medicine & Rehabilitation. I was wondering if anyone had any advice for non-PM&R fourth year clinical rotations that would be beneficial to an individual like myself that will be hoping to match in PM&R next spring? If I remember correctly some individuals in the past has suggested going a neurology clinical rotation, but I cannot recall the others that people have listed in the past that would beneficial before a transitional year and PM&R career. Any input would be greatly appreciated!!

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[Taus]

last year at the national conference one of the speakers rec'd Neurosurg, Rheum, Ortho and I think Urology (lots of bowel/bladder management in inpatient rehab)

 

[drusso]

If you can set up a good neuro-radiology rotation where you learn to read basic brain and spine MRI's--that would be very helpful.

Otherwise: Rheum always good. Trauma surgery or Neuro ICU (or neuro stroke service) is very good too.

 

[Taus]

I would put wayyy more stock into what the previous poster said vs. my advice....so basically....what he said..

 

[rehab_sports_dr]

Orthopaedics (especially outpatient ortho), Rheumatology, Neuro, Neurosurgery, Radiology (both MSK and Neuro)

 

[caedmon]

I want to reemphasize something Drusso touched on above.

A neuro rotation will be great if it is heavy on stroke. Sometimes consult services or general neurology services will be dealing a lot with meningitis, epilepsy, altered mental status etc. While this is all good to learn this stuff, it's not particularly useful in rehab. If your school has a dedicated stroke service you will see acute strokes, SAH, subdurals etc. At our institution every patient admitted to the stroke service gets a PM&R consult.

 

[drvlad2004]

Definitely do a neurology rotation. It is very important in how to do a good neurological exam. Having done a good Ortho rotation helped me a lot. You get to see how the surgeries are done. Also you get to learn how to do musculoskeletal exam with outpatient ortho. Surprisingly, Urology is very useful, you will run into countless of cases that have bowel/bladder dysfunction secondary to conditions such as SCI, TBI, stroke, MS, etc. Understanding bladder/bowel management is important. There are so many other rotations that would useful in PM&R but I think Neurology, Ortho, Urology, and perhaps Rheum would probably be the most useful.

 

[kaizen]

Before I started 4th year, I was all into doing "useful" and "interesting" electives. I can tell you that half of that changes because of : applications, interviews (traveling), Step2 CK & CS, a desire to enjoy life.

Useful Endeavors:
Radiology (easy elective, but being able to read a Chest XR well is priceless)
Cardiology/CCU (basically, you need to be able read an ECG at least for intern year - and for an inpatient endeavor)
Neuroradiology
Urology
Neurosurg ICU
Outpatient Ortho
Derm (Mostly for strange rashes and ulcers)

Better Endeavors:
Alternative medicine and/or pain management in Hawaii - my friend did this. I'm jealous.
Psychiatry of Chronic illness - useful and easy, not available everywhere
"Research" - Do a case report, add to your resume, get a months credit for two weeks of actual work

Because you need to interview/take your boards/sleep, etc.:
Pathology (Autopsy may be helpful)

 

[axm397]

Before I started 4th year, I was all into doing "useful" and "interesting" electives. I can tell you that half of that changes because of : applications, interviews (traveling), Step2 CK & CS, a desire to enjoy life.

Useful Endeavors:
Radiology (easy elective, but being able to read a Chest XR well is priceless)
Cardiology/CCU (basically, you need to be able read an ECG at least for intern year - and for an inpatient endeavor)
Neuroradiology
Urology
Neurosurg ICU
Outpatient Ortho
Derm (Mostly for strange rashes and ulcers)

Better Endeavors:
Alternative medicine and/or pain management in Hawaii - my friend did this. I'm jealous.
Psychiatry of Chronic illness - useful and easy, not available everywhere
"Research" - Do a case report, add to your resume, get a months credit for two weeks of actual work

Because you need to interview/take your boards/sleep, etc.:
Pathology (Autopsy may be helpful)

I think my 4th year, I took 2 vacation months, 1 research month, 1 month writing a case for case based learning, 1 month teaching case based learning, 2 away PM&R electives, 1 home PM&R elective which counted as Surgery subI although I never set foot in an OR, and I can't remember the rest...

 

[Finally M3]

Before I started 4th year, I was all into doing "useful" and "interesting" electives. I can tell you that half of that changes because of : applications, interviews (traveling), Step2 CK & CS, a desire to enjoy life.

Useful Endeavors:
Radiology (easy elective, but being able to read a Chest XR well is priceless)
Cardiology/CCU (basically, you need to be able read an ECG at least for intern year - and for an inpatient endeavor)
Neuroradiology
Urology
Neurosurg ICU
Outpatient Ortho
Derm (Mostly for strange rashes and ulcers)

Better Endeavors:
Alternative medicine and/or pain management in Hawaii - my friend did this. I'm jealous.
Psychiatry of Chronic illness - useful and easy, not available everywhere
"Research" - Do a case report, add to your resume, get a months credit for two weeks of actual work

Rads: Focus; Neurorads, MSK. You'll get all the CXR/AAS experience you nee during internship. Plus, it helps that most rads rotations are half days

Ortho: I would recommend clinic more than OR time, but OR time (just a little) wouldn't hurt. Get an idea of what the surgeons feel requires operative management v. conservative therapy. Enjoy seeing all the composite metals and 5-figure carpentry tools used in the OR.

Neurosurg: As above

Rheum: Clinic only; inpatient rheum will have less application (do you want to do vasculitis/SLE consults all day? I don't!)

ICU? CCU? Elective as an M4? This was the reaction of my academic advisor while setting up my M4 schedule. BTW, she was a PM&R attending. You will get your fill during internship.

Enjoy your M4 year; learn what interests you. We had a medicine and the law elective, clinical pathology (the CSI/Crossing Jordan elective) that were very popular. Besides, M4 after match is the longest, best vacation you'll have!

PS: I think ICU/CCU experience is crucial if you are planning to goto some of the larger academic PM&R programs; I just don't think you need to gain said experience during the M4 year

 

[Karaoke]

If you're not dead-set on PM&R, I would recommend doing related rotations that might be similar to rehab but a better fit for you. You might find that there's another field out there that you like better than rehab. I'd look at:

Ortho clinic
Neurology
Rheumatology
Family Medicine

If you *are* dead-set on PM&R, personally, I would recommend doing rotations in things you will never see again. If you go to a decent program, you will learn all the diseases and the proper physical exam techniques in your rehab residency.

Instead, do some of the following:

1. Spend time in the OR with ortho and neurosurg and see what your patients are really going through before they arrive in your office or on your hospital floor.

2. Go to a strong medicine program for internship so you don't turn into one of those useless "specialists" who panics whenever a patient gets chest pain / fever and calls consults at the drop of a hat.

3. Do a rotation in radiology and actually pay attention instead of goofing off like most people do on their radiology elective. There's sooooo much to learn about how to read those studies. Watch some barium swallow studies, too.

4. Psychiatry - increase your comfort level for interacting with patients with psychiatric comorbidities. Inpatient psych is better for this, because in the clinic you mostly just spend time adjusting medication doses, not necessarily that useful for your future in rehab. Okay, maybe a little useful.

5. GI/GU - I'm not sure how useful doing rotations in these would actually be, but in theory it's a great idea. So much bowel / bladder management involved in rehab medicine. More than I realized.

Hope this helps, and please feel free to disagree with what I said above. I'm still learning.

 

[melancholy]

Agree with all the above.. lots of great suggestions depending on what approach you want to take towards arranging 4th year rotations. Personally, I had the mentality of picking complimentary rotations to boost my knowledge base and skill level which would be reflecting during my PM&R experiences as a medical student. However, I realize that just as important are the grittier rotations that will help you build up foundation and breadth of knowledge which will hopefully allow for a better internship experience (which is arguably one of the most important periods for learning your fundamentals of medical management). In retrospect, you can and will learn tons during PM&R residency, but having that comfort level with general medicine and other very important areas (i.e. cards, pulm, GI/GU, etc.) seems like it would make the PM&R learning experience that much smoother.

 

[joseppi]

roations i did - the obvious neuro/ortho
but a slant on that is to do the above within the peds dept/childrens hospital even if not interested in ped you see alot more, I felt anyhow. With a strong peds ortho dept, you will see alot of the genetic / congenital d/o , dystrphoes, CP, dytrophies, marfans, CA, scoliosis mgmt etc... a little more than the jt replacements and overuse syndroms in adult ortho.


The hospital I did neuro at used the pmr service well. I got to also follow pts in rehab so it was useful. Alot of stroke but plenty of other stuff too, tremors, nph, devics dz, transverse myelitis etc...

May want to do nuero icu if its a good rotation at your hospital or neurosurgery. Will probably learn about baclofen pump refills, tumors, spine surgery. Wanted to but didn't have time.
Other things you may want to do neuro-optho; ocular d/o common in our field. Many ppl with field cuts. Another if interested in pain, anesthesia, getting experience with line placements, intubation etc...

I also did derm, thought a good idea the add the recognition and treatment of simple rashes etc... to your arsenal

Definately do radiology- can learn alot. And its very useful. Often depending on who reads to films you get varied reports, nice to be able to look art it yourself.

I also did rheum- very usefull.

I did 2 away pmr rotations.