Programs with an orthopedics focus

[rs2006]

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Hi all,

I am a fourth year med student considering PM&R and have heard that many PM&R residency programs are focused more on the "medical" ortho aspect of the field rather than the spinal cord/neuro aspect of the field (The school which I attend tends to emphasize the neuro aspect of the field). Anyone have any opinions about this issue? Also, since I am new to this forum, does anyone know which programs are good to look at? Thanks for any input.

 

[axm397]

I think most of the better programs in the country are good at both. Some of the more recent emphasis on the musculoskeletal part of PM&R may be because of a recent surge in applicants interested in musculoskeletal PM&R.

I've never heard of it phrased that way (medical ortho vs spinal cord neuro). usually it's out patient vs inpatient, or physical medicine vs rehabilitation medicine... 🙂

 

[rehabmd]

It is impossible to separate the two aspects of neuro vs ortho rehab. For example, a child with cerebral palsy requires a thorough neurodevelopmental exm of gross and fine motor skills, and adaptive/cognitive/communication skills, tone and spastcity, as well as orthopedic issues such as scoliosis, hip dysplasia, fractures, as well as overuse syndromes, which are also cmmon in chronic spinal cord injury. Overall, at least in the NYC area, training and quality care of these outpatient rehab issues is marginalized during rehab residency, since most rehab training programs invest their resources into inpatient rehab and recently interventional pain management. Even EMG trainign time is being cut in many prgrams. Mostly pediatricians, orthopedists and neurologists manage outpatient rehab issues in disabled populations, so it is best for physiatrists who are interested to offer their services to pediatrics, neurology and orthopedics depts for jobs that allow them to care for chronically disabled patients.

 

[Disciple]

I would have to agree with the above.

Sports blends into general MSK, which blends into Spine/Pain/EMG, which blends into spinal cord injury.

I can handle inpt/SCI/TBI. I can handle sports, spine, EMG, interventional pain.

Outpt f/u of MS, Parkinson's, CP, etc. I'm not so hot, and I still don't feel comfortable Botoxing spastic limbs. I may have to use some elective time before graduation to address these deficits.

As for EMG time being cut at some programs, that is just a shame. Electrodiagnosis is a valuable skill unique to Physiatrists and Neurologists. To cut EMG training time is to do a disservice to your residents.

 

[drusso]

The key is "balance." You want to select a PM&R residency that offers you balanced exposure to all aspects of the field--neuro, MSK, pain, amputee, outpatient, EMG, sports, peds, spine, etc. PM&R is maturing as a field and subspecialty training is becoming more the norm than the exception. The ABPM&R is evaluating applications for several new ACGME-accredited fellowships such as Acquired Brain Injury, Sports Medicine, and even Spinal Intervention. These subspecialties will join Pain, Pediatrics, Neuromuscular Medicine, Spinal Cord Injury as bona-fide PM&R fellowships. Stay away from program too slanted toward inpatient (the board only requires 12 months of inpatient training yet some programs make residents do more than twice that much) and too heavy on consult months (which count for nothing toward ACGME training requirements). In fact, familiarize yourself with the ACGME training requirements in PM&R (link below) and measure programs by how well they meet or exceed these requirements.

ACGME PM&R Training Program Requirements

 

[paz5559]

The key is "balance." You want to select a PM&R residency that offers you balanced exposure to all aspects of the field--neuro, MSK, pain, amputee, outpatient, EMG, sports, peds, spine, etc. PM&R is maturing as a field and subspecialty training is becoming more the norm than the exception. The ABPM&R is evaluating applications for several new ACGME-accredited fellowships such as Acquired Brain Injury, Sports Medicine, and even Spinal Intervention. These subspecialties will join Pain, Pediatrics, Neuromuscular Medicine, Spinal Cord Injury as bona-fide PM&R fellowships. Stay away from program too slanted toward inpatient (the board only requires 12 months of inpatient training yet some programs make residents do more than twice that much) and too heavy on consult months (which count for nothing toward ACGME training requirements). In fact, familiarize yourself with the ACGME training requirements in PM&R (link below) and measure programs by how well they meet or exceed these requirements.

ACGME PM&R Training Program Requirements

I have a slightly different viewoint from the esteemed drusso (gee, me disagreeing? shocking!)

I knew from the getgo I wanted to be an interventionist when I grew up. The most highly regarded programs in the nation are amost all (ie with the exception of Mayo and maybe Spaulding) heavily weighted toward inpatient, with very little quality interventional exposure.

Whereas drusso stresses balance, let me suggest that an applicant's focus should be on the quality of the individual staffmembers' teaching, rather than the overall reputation of the program. I say this cause it is great to get 3-4 months of whatever odd area ytou want to focus on later in life, but if the particular doc teaching in that area either isn't a good teacher, isn't terribly good at what he or she does, or just isn't well liked by the resdents, then the program can be viewed as balanced, but your exposure to that aspect of the field will be tainted by the experience.

So how do you ferret out the very info most programs don't want you to learn? Wel, certainly not from the staff you are interviewing with, and quite honestly, not from the current residents either. Instead, I would ask the program coordinator for the contact informaton of some recent graduates (over whom the program has no power, and thus can say good, bad, or indifferent about their experiences).

Just my two cents

 

[drusso]

I think that Pazz's approach is reasonable too. It depends upon how certain you are about what you want to be when you "grow up." My advice has less to do with the aspiring applicant than it does the program itself. Too many programs are too slanted toward either end of the spectrum...probably a vestige from when our specialty was two separate fields "physical medicine" and "rehabilitation medicine."

Remember, at the end of a 36 month PM&R residency you have to pass a board examination. It helpful if you've trained in a program that exposed you to the full breadth of clinical experiences...or at least be a very motivated "independent learner."