Other Electives

[the prodogy]

As an MSIII, I have a choice of 2 electives. I decided to do one in PM&R, what other specialty should I look into doing that may be similar/helpful to PM&R aside from another PM&R rotation? Thanks

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[shantster]

Just finishing up fourth year so not sure exactly how useful it will be for residency, but I had asked a few different PM&R attendings for their recommendations on rotations before third year started. Electives I took over the last two years:

Neurosurgery
Rheumatology consults
Pain medicine (half with Anesthesia-trained attendings and really a injection clinic, half with Neurology-trained attending that was a pain rehab clinic)
Non-operative sports medicine
Radiology - lecture-based course with opportunity to go to reading rooms

Of those, I found the Radiology to be most helpful for all aspects of medicine and should be a required portion of our curriculum. If you have one that is a lecture-based course, take it at some point before you graduate. Next most helpful was Neurosurgery. Even though the hours sucked, when I got to my PM&R rotation I knew exactly what procedures the patients had gone through. I rounded with the trauma service so I got to see a lot of the acute management of the spinal cord injuries and traumatic brain injuries and followed their hospital course before being sent to rehab. I also did it right away in third year when I was debating surgical subspecialty vs PM&R and it confirmed PM&R for me.

I would recommend that if you do Rheumatology, to try to do at least half clinics. Consults is not a great learning experience since most people that are Rheum consults are not in the hospital for a primary Rheum disease (at least by me). The consult just comes in because they had a less common one (like Wegener's or dermatomyositis) and the Medicine service did not know how to manage their meds or wanted to make sure the disease was not active. Or you get old men out of surgery with gout flares. The clinic would be better for learning, especially if you get to see new patients, since they are coming in for management of their primary Rheum disease.

 

[Phillyborn]

I think during third year, you should be looking to get as many broad experiences as possible. Even if you don't think they will be applicable, having some rudimentary understanding of what other specialties do is going to be beneficial.

That being said, I think Shantster has some good suggestions. Others which I took and really enjoyed were Ortho surgery (for similar reasons the those made for neuro surgery) and emergency medicine (knowing how to manage acute problems on the floors and recognize when you need help- plus, in my rotation at least, tons of exposure to people seeking pain meds and all that comes with sorting that out).

I also really enjoyed my rotations in plastic surgery and palliative care.

In plastics, after I had told the attendings I was interested in going into PM&R, they made sure the residents included me on all of the evaluations for pressure ulcers and their evaluation and that I scrubbed in on all of the flap surgeries. This was far from glamorous, but I gained a firm grasp of what to know before I call a plastics consult (and then speak with some level of intelligence and give them just the information they are looking for).

For palliative care, besides learning some pain management, you also get to sit in on a lot of family meetings. The attending I worked with was fantastic at breaking bad news and giving a measured dose of perspective/hope/resolution so that even though this was going to be a major life event for everyone involved, it could be as positive as possible. In PM&R there are many such situations (stroke, TBI, SCI, amputation), and having that skill in your arsenal is going to really help a lot of patients.

 

[Jitter Bug]

Agree a well rounded education is first.

Electives I found helpful for PM&R: Neurosurgery: because SCI and TBI all start in the trauma bay with them. Neurology: because all the strokes, transverse myelitis, Guillain Barre, MS start with them, and the PM&R exam and the Neuro exam have a ton of crossover so you should be good at it. Ortho: to get an idea when joints and tendon problems need surgery and when they don't (and then become PM&R territory). Also oddly enough critical care is relevant because you will see anoxia after cardiac arrest, ARDS, CABD, and medical debility after kidney failure, CHF, and all of the aforementioned ICU stuff.

General PM&R is a very broad field and I found tidbits from almost every rotation helpful to me in my practice. I did a transitional internship which worked out great for me because of the variety.

 

[PMR 4 MSK]

Just finishing up fourth year so not sure exactly how useful it will be for residency, but I had asked a few different PM&R attendings for their recommendations on rotations before third year started. Electives I took over the last two years:

Neurosurgery
Rheumatology consults
Pain medicine (half with Anesthesia-trained attendings and really a injection clinic, half with Neurology-trained attending that was a pain rehab clinic)
Non-operative sports medicine
Radiology - lecture-based course with opportunity to go to reading rooms

Of those, I found the Radiology to be most helpful for all aspects of medicine and should be a required portion of our curriculum. If you have one that is a lecture-based course, take it at some point before you graduate. Next most helpful was Neurosurgery. Even though the hours sucked, when I got to my PM&R rotation I knew exactly what procedures the patients had gone through. I rounded with the trauma service so I got to see a lot of the acute management of the spinal cord injuries and traumatic brain injuries and followed their hospital course before being sent to rehab. I also did it right away in third year when I was debating surgical subspecialty vs PM&R and it confirmed PM&R for me.

I would recommend that if you do Rheumatology, to try to do at least half clinics. Consults is not a great learning experience since most people that are Rheum consults are not in the hospital for a primary Rheum disease (at least by me). The consult just comes in because they had a less common one (like Wegener's or dermatomyositis) and the Medicine service did not know how to manage their meds or wanted to make sure the disease was not active. Or you get old men out of surgery with gout flares. The clinic would be better for learning, especially if you get to see new patients, since they are coming in for management of their primary Rheum disease.

I don't know about the consults in house being less educational. I sometimes cover our rheumatologists when they all go out of town at once, or similar, and they see some sick patients in the hospital. Septic joint w/u, scleroderma, SLE flares (my favorite was SLE + sickle cell crisis) and similar. There are almost no inpatients that you cannot learn something from.

I did electives as an MS4 in PM&R (x2), neuro, ortho, sports med, and as an intern did rheum, radiology (radi-holiday), ortho, urology (uro-no-way-in-hell-was-it-a-holiday), podiatry and sports med. All were very valuable.

 

[shantster]

I don't know about the consults in house being less educational. I sometimes cover our rheumatologists when they all go out of town at once, or similar, and they see some sick patients in the hospital. Septic joint w/u, scleroderma, SLE flares (my favorite was SLE + sickle cell crisis) and similar. There are almost no inpatients that you cannot learn something from.

I think it depends on what you see on consults. As a student I found ours not helpful. 50-60% was an old man with gout flare in our hospital and the Medicine team requested a steroid injection or someone else to recommend the colchicine since they decided not to give it themselves. Since on a team with a fellow + 2-3 residents + 1 intern, I obviously did not get the injections. The rest were patients that come in for some other reason completely unrelated to their condition and was a BS "this patient has RA or SLE or whatever and is well-controlled on their meds but we want you to see them to tell us to keep giving them their meds" consult. Very unuseful as a student since these patients did not need any workup. Just had to bless the use of the meds that were keeping their disease under good control. The only interesting one was a woman who the primary team had no idea what was wrong so they pan-consulted. It ended up not being a Rheum condition, but still interesting to see what other services thought and what to do for the work-up in that situation.

I would have liked to do at least 2 weeks of outpatient because that's where people really go through the workup and management of the disease.