Residency Training Program Questions

[jleebo]

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I am currently a fourth-year medical student that is in the process of finalizing which physical medicine & rehabilitation residency training programs that I will be applying to for the match this year. I have researched the various programs that I will be applying to through frieda, scutwork, program's webpage, etc. There are a few programs that I was thinking about applying to, but I have been unable to find much information about them. I was hoping that someone might be able to give me some input about the following programs below if they have any information that would be worthwhile to an individual like myself that is interested in applying to their program:

Jackson Memorial Hospital - Miami
University of Kentucky - Lexington
Michigan State University - East Lansing
Wayne State University - Detroit
William Beaumont Hospital - Royal Oak
University of Buffalo - Buffalo
Baylor University - Dallas
UT Southwestern - Dallas

Thanks in advance!

 

[dc2md]

Jackson Memorial: i think this is an up-and-coming excellent program. it's only 3or4 years old so def no rep yet. program director was really nice. i would've ranked them higher but miami def wasn't for me (high cost of living, horrible traffic, crime, and i don't speak spanish)...so i picked new orleans with even worse crime (hahaha; actually the bad crime is in the bad part of nola so just stay out).

UTSW: good program with the best coordinator ever (terri). not much interventional experience though, but i hear they're bringing in a pain guy. advanced (pgy2-4) program. get about $1,000 in books when you start. can pay other residents to take your call (handy if you have moonlighting that pays a ton more).

yeah i know, not much info but at least it's a start. i didn't apply or interview at the other ones so sorry.

 

[ampaphb]

Jackson Memorial: i think this is an up-and-coming excellent program. it's only 3or4 years old so def no rep yet. program director was really nice. i would've ranked them higher but miami def wasn't for me (high cost of living, horrible traffic, crime, and i don't speak spanish)...so i picked new orleans with even worse crime (hahaha; actually the bad crime is in the bad part of nola so just stay out).

UTSW: good program with the best coordinator ever (terri). not much interventional experience though, but i hear they're bringing in a pain guy. advanced (pgy2-4) program. get about $1,000 in books when you start. can pay other residents to take your call (handy if you have moonlighting that pays a ton more).

yeah i know, not much info but at least it's a start. i didn't apply or interview at the other ones so sorry.

The pain "guy" is actually a girl, who trained with Dr. Aprill, and is moving from Mobile, AL.

 

[dc2md]

The pain "guy" is actually a girl, who trained with Dr. Aprill, and is moving from Mobile, AL.

good for them. dr. aprill is amazing so she's gonna be a great asset for the UTSW program.

 

[axm397]

there's also a pain "guy" who trained at MD Anderson who just started at UTSW - dual apptmt Anesthesia and PM&R.

 

[lobelsteve]

The pain "guy" is actually a girl, who trained with Dr. Aprill, and is moving from Mobile, AL.

Are you that pain girl?
Call you later.

 

[normalforce]

I rotated at William Beaumont in Royal Oak in 2004. The attendings were great, nice and approachable. It is a small program. Little inpatient. Residents do not work too hard. Average day was 8a-3p. A lot of downtime on occasion. Didactics were hit/miss. Overall, this is an average program, private practice based. Great people. Nice area. Probably one of the most hours friendly programs (residents worked 30-40 hours/week).

 

[Disciple]

The pain "guy" is actually a girl, who trained with Dr. Aprill, and is moving from Mobile, AL.

Amy Phelan?

 

[rehab_sports_dr]

> Jackson Memorial Hospital - Miami

They have a new chair, Diana Cardenas, who was one of the main SCI physicians at UW-Seattle for many years. Very nice woman, and IMO she has a strong vision for the program.

Andy Sherman has been the program director since the onset, and he is excellent- one of my favorite people in rehab. He is a very hard worker, a gentleman in every sense, and a strong resident advocate.

So they have good people in the 2 main positions. They are expanding their faculty- they hired a multiple sclerosis fellow from Seattle 2 years ago, and they just hired the sports Fellow from Malanga in NJ.

It's a good group, and has potential to be one of the best programs in the Southeast, if it not already.

> Michigan State University - East Lansing

I don't know much about the program overall. Mike Andary is there, and he is pretty universally regarded as one of the most likable and supportive people in PM+R. He is outstanding in electrodiagnostics, and is a strong resident advocate.

Other than that, it is a smaller program, and has a strong DO influence, even for the MD trained physicians. They also are tied closely to the Big 10 athletic teams, which is a definite positive there.

> William Beaumont Hospital - Royal Oak

I know almost nothing about them. I believe (about 80% sure) that they are second only to Kessler in terms of the # of Elkins award winners. I have no idea what that says about their program, but it is one peripheral measure of quality.

 

[bbbmd]

there's also a pain "guy" who trained at MD Anderson who just started at UTSW - dual apptmt Anesthesia and PM&R.

Thanks AXM for letting me know about recent posts....

The MD Anderson "guy" that just joined UTSW is me... We are also hoping that a very well respected musculoskeletal/spine physician will join soon... I will not reveal "her" name until things are confirmed.

I just started, but from my few weeks as faculty I can confirm that the PM&R residents will get ample amount of injection experience. Currently, I do them as well as another physician. Once the new faculty member joins, there will be 3 PM&R interventional faculty members. The brand new UTSW Spine Center will be opening Nov. 1. The PM&R residents have an "injection rotation" and get hands on training with both PM&R and Anesthesia.

I implanted a baclofen pump a couple weeks ago with the help of a PMR resident and a Pain fellow. I am not sure many (if any) PMR programs out there will provide implant experience.

I am also faculty for the pain program through Anesthesia... The other pain faculty are outstanding... The fellows will have experience in ALL procedures with the combined strength and skills of the new and seasoned pain faculty... Fellows will be trained in: Pumps, Stims, Discs, Vertebral Augmentation (vertebro, kypho), facial procedures and all spine injections... The current faculty are dedicated to education, teaching and training well rounded, competent pain physicians. PM&R and Anesthesiology have an outstanding relationship.

You can contact Terri Isbell for more info about the PM&R residency program. She will be very helpful.

B

 

[drusso]

Wow, B

Way to step up!

--DR

 

[Finally M3]

This is a dated review (copied from my review on the interview trail, way back in 2003-4) re: Beaumont. Take it FWIW

Only interviewee of the day, apparently this is their MO to make sure the applicant gets individual attention. Interview day started at 8:30 AM, which was much too early. I was supposed to have a formal meet & greet of the residents and then a tour of the hospital before my 11:00 AM interview with the program director. However, since I had done a PM&R rotation AND my subI at this hospital, the residents felt there wasn't anything else for them to show me at the hospital.

Very laid back program PGY1 only, happy residents (3 per class). Call is from home. 26 bed inpatient covered by 2 residents. You see SCI, TBI, stroke (lots) and some ortho/disability. 8 months inpt. PGY2, 4 mo consults working with a PGY3. 4 months of EMGs in PGY3 with 4 months inpt. 4 months of elective PGY4, with 4 months of essentially independence at Troy Beaumont rehab. Call averages out to around q6-7, 1 weekend a month. PGY2s cover one of Thanksgiving/Xmas/New Years, PGY3s cover Memorial Day/Labor Day/4th of July. Didactics include 3-4 lectures in the morning and evenings, weekly friday morning EMG lectures, journal club, etc. PGY2s and 3s tag-team prosecting cadavers.

Different attendings have sports med affiliations (local high schools, some minor pro), plenty of injection experience, interventional procedure experience available via PGY4 elective time, with residents with a stated interest in this also sent to a training seminar somewhere. Residents feel that they have enough experience in epidurals to utilize this following graduation. Rare for graduates to pursue fellowships, partly explained by the fact that residents feel they do not need further training. Mandatory requirement to perform some sort of research, churn out an abstract for submission to a conference (AAPMR preferably).

Overall impressions; smaller program, residents happy with education, cohesive classes, feel prepared for careers. This is a residency that emphasizes the physical medicine side of PM&R. Although you will see a lot on the inpatient side, you may not see as many or as complex a patient population on an inpatient side than you would see at larger academic facilities. The PGY4 year is VERY flexible; allows for a lot of freedom to pursue what interests you and what experience you need to gain prior to graduation.

 

[ShrikeMD]

I am happy for the UTSW residents. It appears that their musculoskeletal/pain injection experience will compare favorably to those of most physiatry programs.

I am curious, however, whether bbbmd believes that synchromed pump implant experience (aside from seeing a few of them) is particularly helpful to most physiatry residents. We "manage" the patients/pumps, not implant them.

 

[bbbmd]

I am happy for the UTSW residents. It appears that their musculoskeletal/pain injection experience will compare favorably to those of most physiatry programs.

I am curious, however, whether bbbmd believes that synchromed pump implant experience (aside from seeing a few of them) is particularly helpful to most physiatry residents. We "manage" the patients/pumps, not implant them.

I agree that most PM&R residents will not be implanting these pumps in their lifetime, nor would they want to. Getting hands on experience with implant technology and advanced pain management techniques during residency will give them 1.) First hand exposure to treatment options for their patients; 2.) the opportunity to learn what an "interventional physiatrist" can provide; 3.) and enable them to make educated and informed decisions with regards to pursuing fellowship training.

Many of today's general physiatrist manage pumps, but not many programs teach their residents the basics of intrathecal therapy... I hope that with the experience that my residents obtain, they will be comfortable managing baclofen and opioid pumps (if they choose to do so) when they graduate. I will not advocate for residents to perform implants and advanced procedures without a lot more training, but I want to make sure they are well versed in these valuable treatment options.

No one on this forum can deny that Physiatry is evolving... There are many of us NEW PM&R attendings with very invasive skill sets (DRUSSO, LIGAMENT, DISCIPLE, GECKO- to name a few). Since I am in academics, I am in the perfect position to ensure that the field of PM&R acknowledges our presence and that we are here to stay... UTSW is open to this and has a dynamic chairman who is supportive and a FORWARD-THINKER!

 

[drusso]

No one on this forum can deny that Physiatry is evolving... There are many of us NEW PM&R attendings with very invasive skill sets (DRUSSO, LIGAMENT, DISCIPLE, GECKO- to name a few). Since I am in academics, I am in the perfect position to ensure that the field of PM&R acknowledges our presence and that we are here to stay... UTSW is open to this and has a dynamic chairman who is supportive and a FORWARD-THINKER!

B,

You're definitely on the right track. I hope that you can carry this argument to the AAP-crowd who seems, to my view, very opposed to modifying PM&R core ACGME training requirements in order to incorporate language regarding "basic competencies" in interventional procedures for physiatrists. Again, the usual argument goes, "Oh, our smaller programs will suffer! There are too many turf issues at our institution. We don't have the faculty, the money, or the resources...these things are best reserved for fellowship level training." These arguments may indeed correctly identify the symptoms of the problem, but don't address the underlying causes.

Thus, we end up with a hodge-podge of non-university affiliated fellowship training programs (some of which are very good; others not so good) and remedial post-graduate courses in interventional procedures masquerading as CME. Maybe part of the effort to re-incorporate PASSOR back into the Academy should also involve incorporating the spinal procedure workshops and other CME training back into the core PM&R residency training curriculum.

 

[ShrikeMD]

I endorse bbbmd's objectives for the hands-on experience with implant technology, and his/her desire to make sure that the residents are well-versed in this treatment option. While I have no intention of ever implanting a pump myself, having observed an implant is very helpful in describing the procedure to a potential patient.

I don't think that most of today's physiatrists manage pumps, and fewer manage them well. Perhaps many physicians believe that they can manage a pump, but there really is a lot more to it than turning the dose up or down. The education provided for troubleshooting (from Medtronic) is limited at best, and most people with extensive (ITB) pump experience can share horror stories of poor/catastrophic outcomes of patients that were poorly selected or poorly managed. For those of us who practice on the neurorehabilitation "side" of our specialty, ITB pumps generate both favorable and unfavorable outcomes; the proportion of each can be influenced by the experience/knowledge base of the clinicians involved.

I agree with the observation regarding the evolution of Physiatry. Whether one is addressing very invasive skill sets, or broadening our exposure to different patient populations, the specialty moves forward with the sustained efforts of its clinicians, educators, investigators, and even administrators (it helps to be reimbursed for our efforts). I wouldn't worry too much about whether your presence is acknowledged by others; if you stick around long enough to persevere, you will be in a position to call the shots. Besides, there are few forces on earth as powerful as an idea whose time has come. (or words to that effect)

 

[SG1]

Smaller program--3 residents per year but with plans to expand. 12 months of inpatient--40 inpatient beds at this time (note that this is an increase from Finally M3s review). Inpatients are a good mix of neuro & ortho, and you see some TBI & SCI but not as much as you'd see at WSU or U of M. OUTSTANDING outpatient experience. Attendings are wonderful teachers. Consult rotation is varied--not just the typical placement consults. Lots of ortho, neuro, ob/gyn--actual consults for diagnosis & management of problems. Great relationships with ortho, neuro & anesthesia. No turf battles over injections or EMGs. Home call as PYG-2 & PGY-3. No PGY-4 call except for July to help the PGY-2 class get settled. Ancillary staff is excellent, as well. WONDERFUL nurses. Residents work hard but education is outstanding. Residents are generally happy & enjoy spending time together in & outside of work.

 

[Disciple]

B,

You're definitely on the right track. I hope that you can carry this argument to the AAP-crowd who seems, to my view, very opposed to modifying PM&R core ACGME training requirements in order to incorporate language regarding "basic competencies" in interventional procedures for physiatrists. Again, the usual argument goes, "Oh, our smaller programs will suffer! There are too many turf issues at our institution. We don't have the faculty, the money, or the resources...these things are best reserved for fellowship level training." These arguments may indeed correctly identify the symptoms of the problem, but don't address the underlying causes.

Thus, we end up with a hodge-podge of non-university affiliated fellowship training programs (some of which are very good; others not so good) and remedial post-graduate courses in interventional procedures masquerading as CME. Maybe part of the effort to re-incorporate PASSOR back into the Academy should also involve incorporating the spinal procedure workshops and other CME training back into the core PM&R residency training curriculum.

Love the excuses.

And they wonder why nobody wants to keep AAP membership after finishing residency.

For those currently in residency looking to push for procedural experience in their programs, an idea that never quite came to fruition during my residency:

Each year we would have a functional anatomy course with associated lab time in the affiliated med school's cadaver lab.

The year I graduated, Smith and Nephew held a high quality training workshop in the same cadaver lab on RF, IDET and Discography.

I see no reason why PM&R departments in institutions with affiliated medical schools couldn't purchase a couple of cadavers once a year as a primer to those beginning procedural oriented rotations. Too expensive? Costs could be shared amongst several programs within the same city.

Make it some kind of a bonus if residents hit x number of inpt admissions over a given time period.

Lots o' ways to skin a cat.

 

[bbbmd]

I think that there are a few programs slowly realizing the importance of procedural training, but the field still has a long way to go. Even the residency I completed, with a reputation of inpatient-heavy training, provided a pretty high quality cadaver interventional workshop when I was there. If a program has progressive program directors and chairmen, I think that the young interventional staff could make a difference that may later translate into significant change at the national level... I know I am an optimist, but I still have hope!

 

[axm397]

Love the excuses.

And they wonder why nobody wants to keep AAP membership after finishing residency.

For those currently in residency looking to push for procedural experience in their programs, an idea that never quite came to fruition during my residency:

Each year we would have a functional anatomy course with associated lab time in the affiliated med school's cadaver lab.

The year I graduated, Smith and Nephew held a high quality training workshop in the same cadaver lab on RF, IDET and Discography.

I see no reason why PM&R departments in institutions with affiliated medical schools couldn't purchase a couple of cadavers once a year as a primer to those beginning procedural oriented rotations. Too expensive? Costs could be shared amongst several programs within the same city.

Make it some kind of a bonus if residents hit x number of inpt admissions over a given time period.

Lots o' ways to skin a cat.

We actually get two cadavers for use during our anatomy course (August - October) I don't know if we can arrange for some procedural training with the cadavers... good idea, disciple!!

We also have plastic models that we can practice on - had an interventional spine weekend workshop at RIC last spring - got to practice with the models and fluoro - but those models were so perfect with the most crisp spinal anatomy that am not sure how much it truly approximated the real thing.

I do agree that it is hard to convince PDs of the importance of getting interventional exposure - their favorite reason for not doing it is that interventional procedures are not required by the ACGME to be performed/taught during residency. Some have told me they do not feel comfortable writing that they feel that a resident is "competent" in performing injections.

I think the young faculty members are certainly pushing for more MSK/interventional curriculum - and we residents always push as well - but it's really hard to have a truly united front of residents - because some people are always going to be too scared to speak up - some just don't care about getting exposure because they don't plan on performing those procedures after residency - and still others don't care about getting the exposure during residency because they plan on doing fellowships anyways.

 

[lucyz02]

I thought having an anatomy / cadavers course was an acgme requirement. We do it every year-

We actually get two cadavers for use during our anatomy course (August - October) I don't know if we can arrange for some procedural training with the cadavers... good idea, disciple!!

 

[Disciple]

I do agree that it is hard to convince PDs of the importance of getting interventional exposure - their favorite reason for not doing it is that interventional procedures are not required by the ACGME to be performed/taught during residency. Some have told me they do not feel comfortable writing that they feel that a resident is "competent" in performing injections.

I don't think you really need a statement saying you are "competent". I don't remember getting any kind of letter saying I was competent in EMG. What you want is some kind of letter accompanying procedure logs stating "Dr. So and so performed the following procedures under the supervision of Dr. X (credentialed at this university hospital) using X guidelines or X standard technique.

Academic Physiatry needs to start taking some responsibility for what Physiatrists do out in the community, including the wide variability in procedural skill sets of Physiatrists. The only way to eliminate criticism from the rest of the medical community would be for

1. Physiatrists not to do any procedures
2. Providing training so that some level of standards are met

Option #1 is unrealistic so that leaves #2. Turning a blind eye to it and pretending it doesn't happen or that the problem will just go away doesn't help anybody.