Rounding in pm+r

[epic110]

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I'm just starting 4th year and trying to decide what to do with my life. My school does not have a pm+r residency but several people have mentioned looking into the field. I was hoping to like surgery 3rd year so i could do ortho, but im not sure its for me. Im interested in msk, but absolutely hate rounding.

So i guess my question is how much rounding do you guys have to do during residency and after?

 

[Taus]

The amount of rounding in PM&R residency and practice depends on if you are taking care of inpatients or outpatients, as well as if you are in an academic setting or not. Inpatient services (ie brain injury, spinal cord injury, stroke, etc) will have rounding, whereas outpatient services (msk, sports, spine, pain, emg, etc) will not. The duration of rounding while on inpatient services depends on how much the attending wants to teach, the complexity of patient issues and the efficiency of the residents/attendings (just as in any other field). Inpatient rounds with a full census, ie 15-20 patients, can vary between 30 mins to several hours. The number of inpatient months varies widely between each residency program as well.... from 12 at a minimum all the way up to mid-20's.

I would highly recommmend that you do an elective rotation in PM&R that exposes you to a variety of inpatient services in addition to outpatient MSK. If you think you want to go into the field and clearly do not like inpatient rehab/rounding, then make sure you can at least tolerate it duriing residency and choose your program wisely.

 

[fozzy40]

What exactly do you dislike about rounding?

 

[PMR 4 MSK]

Most PM&R residencies are about 50% inpt, 50% outpt. Interships vary, but many are heavily inpt. Inpt = daily rounding, sometimes 2x/day.

There are not many specialties that don't do inpt work, at least through training.

Maybe you should consider radiology, and then looking into Interventional Radiology.

 

[eljefe]

but then the OP might have to make inpatient rounds on all those clogged PICC lines...

 

[epic110]

I guess rounding just doesn't fit my learning or working style. I go from anxiety presenting my own patients to boredom as I space out while other people present their patients. I liked out-patient more because i could present directly to the attending and then move on to the next patient when we were done.

I tried radiology and while I liked it in the mornings, the dark room became difficult to handle in the afternoons.

 

[topwise]

Rounds in something like medicine in an academic center are only one style of rounding. I dislike that style as well.

When I was an intern at a county hospital, often each of the interns would round individually with the attending on our patients, and there was none of that scary pimping. As a PM&R resident, there was only one resident per attending, and I'd usually do discovery rounds with my attending, where we'd both see the patient at the same time, so there was really no "presenting" per se. Other times we'd see the patients separately and just discuss them while sitting down together later. It was pretty low stress.

 

[PMR 4 MSK]

I guess rounding just doesn't fit my learning or working style. I go from anxiety presenting my own patients to boredom as I space out while other people present their patients. I liked out-patient more because i could present directly to the attending and then move on to the next patient when we were done.

I tried radiology and while I liked it in the mornings, the dark room became difficult to handle in the afternoons.

OK, I see where you are coming from. I was the same in med school. I even had a couple attendings ask me if I was not happy due to my constant spacing out while other people presented to the attending. I was often bored silly.

When it is just you and your patients, no one to present to, no large teams, you will likely like it much more. Ask yourself how much you enjoy the patient interaction when it is just you and the patient. See yourself doing your own rounds, doing your own charting, etc. Try to keep that in mind.

 

[Mattchiavelli]

I will say this- rounds in an acute rehab hospital were more tolerable because the patients were less sick in order to participate in their therapy requirements. This made the patients more interactive and made rounding more tolerable for me. Rounding on my medicine Sub-I was better in a different way b/c our rounds group was attending, senior resident and myself which made everything run quicker and more efficient. The anxiety will lessen the more you get accustomed to clinical medicine.

Rounding as a 3rd year clerk is honestly one of the worst medical experiences in terms of time:education IMO. It goes on forever and is the most likely to be run by people with little/no presentation skills.

Anyway the ortho component is significant, it's what made me decide to get to neurorehab via neurology and not PM&R (for me movement and neurodegeneration are more interesting than bones). Patients are going to need docs with MSK training to deal with their orthopedic surgical issues long after the orthopedic surgeons have lost interest and in cases where patients can't tolerate surgery.