Prioritizing Sub-Specialty Electives During Intern Year

[armonia]

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I'm putting together an elective wish list for intern year and was wondering if those of you who have either finished or are in PM&R residency have thoughts on prioritizing the following electives:

• Neurology
• Infectious Disease
• Emergency Medicine
• Cardiology
• GI
• Renal
• Heme-Onc
• Pulmonary

I would appreciate any and all input (reasons particularly appreciated).🙂

 

[rehab_sports_dr]

I think it depends on your long term goals.

I knew I was going to be an outpatient MSK doc, so my intern electives were:
- rheumatology
- neurology
- outpatient orthopedics
- radiology
- emergency medicine

If I were to do primarily inpatient, I would recommend-
- neurology
- urology
- emergency medicine
- radiology
- endocrinology

 

[MSKalltheway]

Might you guys please elaborate on how emergency med might be helpful in outpatient PM&R? Forgive my ignorance if this is apparent! I find this intriguing as a suggestion for an elective and had to know...

 

[rehab_sports_dr]

When you are on inpatient services, the most important question when on call is "does this patient look toxic."

The specifics of the management of medical conditions changes all the time, and when you are 5-10 years out of your internship, you are not likely to be as up on the literature as you need to be manage complex medical issues. But you still want to hone your sixth sense of "This patient is toxic, and something needs to be done before some bad stuff happens." And there is no better place to hone that instinct than in the ER

 

[armonia]

I initially was leaning heavily towards inpatient, but am now sitting on the fence between inpatient and outpatient.

rehab_sports_dr, what was your experience as an intern on radiology? Did you have a chance to read studies some, or did you largely watch? Were you in a program where there were radiology residents?

I'm curious as to why endocrinology for inpatient rehab (this may be a very naive question).

 

[rehab_sports_dr]

> rehab_sports_dr, what was your experience as an intern on radiology? Did you have a chance to read studies some, or did you largely watch? Were you in a program where there were radiology residents?

I did my internship at Bassett Hospital in Cooperstown, which was a fantastic experience.

On my radiology month, I sat 1-on-1 with a radiologist and read whatever films they happened to be reading. It was mostly plain films, but certainly some CT, MRI, ultrasound. In retrospect, I wish I read more MSK stuff, but it was still a slam-dunk great experience.

> I'm curious as to why endocrinology for inpatient rehab (this may be a very naive question).

Great question. Let me expand

There is an emerging field of endocrine rehabilitation. TBI researchers, including Ross Zafonte at Pittsburgh and Elie Elovic at Kessler, amongst others, who have been investigating endocrine abnormalities in TBI patients, and how this can impact clinical outcomes. Not surprisingly, it looks like TBI can disrupt the entire pituitaty-hypothalamic-adrenal axis. They have looked at how alterations in HGH or TRH or other aspects of the axis can affect clinical outcomes, and whether there may be a protective benefit for use of hormones like progesterone.

I think this is one of the most exciting frontiers in rehab medicine, and if I could do things over again, one thing I wish I had spent more time doing was endocrinology rotations.

One particularly exciting area of endocrine research is hypotestosteronism in rehabilitation diagnoses. For example, here is a partial list of diagnoses where hyoptestosteronism has been implicated as a possible causative factor:
- chronic pain
- pressure ulcers
- sarcopenia
- burns
- critical illness neuropathy and myopathy
- TBI
- AIDS
- depression
- fatigue

Hmmmm..... if only there were a specialty that was focused on the functional restoration of patients with such conditions.

I obviously think that PM+R should be on the forefront of exploring the management of endocrine disruption in these diagnoses, including the appropriate and judicious supplementation of patients with established endocrine deficiencies that may be contributing to their functional deficits

One of the reasons I took a position in Arkansas is that they have arguably the world's top research center for the aging. In particular, they have top active researchers including Bill Evans, Arny Ferrando, and Bob Wolff who are looking at the what factors contribute to the aging process, and sarcopenia (muscle breakdown) in particular. It looks like, yet again, that the endocrine axis probably plays an important role. Hopefully PM+R will be on the forefront on monitoring and treating endocrine abnormalities associated with rehabilitation diagnoses.

 

[lucyz02]

]Might you guys please elaborate on how emergency med might be helpful in outpatient PM&R? Forgive my ignorance if this is apparent! I find this intriguing as a suggestion for an elective and had to know...[/QUOTE]

They say more than 1/3 of ER visits are msk complaints. You get a good opportunity to see alot of acute orth cases as well. Some ED have fast track, less life threatening injuries, sort of occ med type injuries, minor lacs getting a chance to keep up on suturing skill in case you want to moonlight.... Part of ED is reading films too, you probably will get a chance to brush up on your radiology incase you can't get that rotation. Acute CVAs, ICH, SAH... other rehab stuff.

 

[Disciple]

I'm putting together an elective wish list for intern year and was wondering if those of you who have either finished or are in PM&R residency have thoughts on prioritizing the following electives:

• Neurology
• Infectious Disease
• Emergency Medicine
• Cardiology
• GI
• Renal
• Heme-Onc
• Pulmonary

I would appreciate any and all input (reasons particularly appreciated).🙂

Neurology and maybe ER are the only ones that I could see helping you out that much.

You may want to consider a Neurosurg/Ortho/Ortho Spine clinic/OR rotation. During my inpt rehab months there was usually a full load of post-op fusions, THA/TKAs, S/P VP shunt, aneurysm coiling, paraplegia after dural tumor resection and then of course your TBIs/SCIs after gunshot wounds/blunt trauma, etc. on the county rotations. Plus these types of electives would naturally translate to your MSK/Spine training later on.

 

[Finally M3]

I would also add that you should be looking at outpatient Rheum, not inpatient. I'm not sure that evaluation for Wegner's/vasculitis/whatever would provide that much benefit (although familiarity will provide some). I think your time would be better spent on the outpatient side looking at the rheum arth, fibro, etc.

I would second rotation with ortho more than ED, especially if your ED will immobilize and send out to the community orthopods. Also, you will become more familiar with the different replacements, as well as the restrictions postop.

Finally, I loved my rads rotation; specifically, I stuck around the neuro and MSK reading rooms. And OTD by 2PM

 

[Hemisphere]

I don't think there is a set plan of electives that will create the ultimate pgy-2. it seems pm&r touches upon so much ... case in point evolving research in TBI endocrinology... thanks for that rehabsportsdoc, had no idea about that fascinating area of research. If you are in an inpatient rehab any internal medicine general and electives are useful. Neurology i think would be one of the core electives not to miss there is considerable overlap. Ultimately, there is the question of what you see yourself interested in. And then there is the theory of not taking PM&R electives as a TY because you will have plenty of chance for that later and not wasting your chance to work with other fields. one thing that might be helpful would be to discuss the pgy-1 schedule with your pm&r program director as well as asking on here. good luck.

 

[armonia]

Thanks so much for all of this input! This discussion has been very helpful in both in coming up with a list of elective requests for PGY-1 and in thinking about long term goals.