PM&R to Neurocritical Care

[JaxJax17]

I’ve noticed over the past few years there has been a handful of Physiatry residents that have pursued Neurocritical Care fellowships- as a PM&R resident who is becoming increasingly interested in being more heavily involved in the acute care of the TBI/Stroke population, is NCC a realistic option? I know PM&R residents have been accepted into these programs but can they officially sit for the NCC boards or practice after graduating from the fellowship?

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[DrMetal]

I’ve noticed over the past few years there has been a handful of Physiatry residents that have pursued Neurocritical Care fellowships-

Wow. Who's not getting their hands into the cookie jar of critical care these days? PM&R? If you can find a way to do physiotherapy on an intubated patient with an EF of 15% while on CRRT . . . more power to you, bless you!

 

[CCM-MD]

I've never heard of this. I think you're misinformed.

You might be thinking of brain injury medicine fellowships, which deal with sequelae of brain injury and rehab aspects.

 

[JaxJax17]

I've never heard of this. I think you're misinformed.

You might be thinking of brain injury medicine fellowships, which deal with sequelae of brain injury and rehab aspects.

There is currently a NCC fellow at Uwashington and a fellow at Northwell that are PM&R trained.

 

[CCM-MD]

There is currently a NCC fellow at Uwashington and a fellow at Northwell that are PM&R trained.

Fellows | Department of Neurology

Where?

PM&R to NCC is absurd. Even for SDN.

 

[JaxJax17]

Fellows | Department of Neurology

Where?

PM&R to NCC is absurd. Even for SDN.

Dr Alex Brahmsteadt- bio is wrong, he is Umich PM&R trained

 

[DrMetal]

Dr Alex Brahmsteadt- bio is wrong, he is Umich PM&R trained

Well then, the janitor in your avatar (from Scrubs) should also get in on critical care. Janitorial services are after all very important in the ICU. He should bill for 'critical care time'.

 

[gro2001]

I’ve noticed over the past few years there has been a handful of Physiatry residents that have pursued Neurocritical Care fellowships- as a PM&R resident who is becoming increasingly interested in being more heavily involved in the acute care of the TBI/Stroke population, is NCC a realistic option? I know PM&R residents have been accepted into these programs but can they officially sit for the NCC boards or practice after graduating from the fellowship?

I am a non-neurologist myself (EM), so I am obviously sympathetic to the idea of non-neurology trained neurointensivists. And I know some super successful folks in the field who are non-neurologists. I was in fellowship when I heard that we had a PM&R resident applying and was excited to hear it. I think if they could pull it off they would be a tremendous benefit to the field and provide a unique perspective.

However, neurocrit has some unique training challenges. You both have to learn a lot of neurocrit as well as a lot of general critical care (often, with a twist; eg not just get proficient at central lines, but learn to put them in the other way round for a jug bulb). It's challenging enough for neurology trained folks, because they often will have had very little procedural experience in residency (or, frankly, general medical experience, depending on their specific residency program), but at least they have a head start on a lot of the neuro side of things (though obviously there is still a lot of specialty specific knowledge). It's also challenging for the EM folks, since they will have had very little recent neuroanatomy learning, relatively little neuroradiology knowledge, and other major neuro gaps. But at least they will have a solid foundation of most of the procedures, resus, and general medicine. I have seen a couple of trainees go straight from IM (without doing CCM first), and all of those people have struggled tremendously. I don't have as good a sense of what PM&R trainees know and what kind of gaps they have, but I am afraid they could have the hardest time because they will probably have very little acute/general medicine, very little neurology, and very little of the ICU procedural skill set.

I would love for them to succeed, and I think they would bring a lot to the field. But I think that all else being equal, it would be the hardest pathway through neurocrit.

I hope to run into one of these folks at NCS and pick their brain (no pun intended).

 

[sloh]

This has got to be a joke. I’m PM&R and in acute inpatient rehab (internist-lite), PM&R docs are already trigger happy with placing consults for anything medically related that they are remotely uncomfortable with outside of simple UTI’s, DVT’s, etc. To think PM&R can just complete a fellowship and practice critical care competently and safely is a slap in the face to all the NCC docs out there with EM, IM, Neuro background.

 

[Dantes]

According to UCNS, the pathways to neurocrit are through neurology, neurosurgery, IM, anesthesiology, gen surg, EM, or pediatrics.

Despite that, I actually have met a PM&R trained neurocrit fellow. I'm unclear about exceptions to board eligibility or practice restrictions, so you may want to reach out to programs who have accepted one to ask. But it does seem like a lot to learn in two years coming from a different skillset in PM&R.