**WHAT DO YOU WISH YOU KNEW ABOUT PM&R**

[drusso]

Readers,

I need your help. I've been asked to help develop a workshop for medical students at the next AAPM&R meeting in Philadelphia in October 2005. The purpose of the workshop is to introduce medical students to the field of physiatry, have residency recruiters from nearby programs on hand to answer questions, and provide an opportunity for networking. What do you think would be most helpful for medical students to learn in this setting about the field of PM&R? What information do you wish you had in mind when you're considering specialties--beyond the usual salary, procedures, lifestyle considerations...

--David

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[Disciple]

I think the bulk of the discussion should involve scope of practice.

The origins of PM&R, what it was going into the 80's-90's, what it is today and where it's going.

When I was medical student, most of my PM&R experience was sports/spine/worker's comp, etc. I knew nothing about inpt. rehab, SCI, TBI. Imagine my surprise on interviews being pimped on autonomic dysreflexia, DVT prophyllaxis, etc.
WTF?

 

[staydin]

Agreed with the above, however, you also want to make sure that the inpatient side of PMR is shown. I have so many classmates who are going into PMR, who have never been in a Rehab unit, or consult service in the hospital.

And finally, PMR is not medicine free. It is so discouraging to hear people say I don't want to do surgery, I hate medicine, so I am doing PMR. Medicne is a big part of the training, and that needs to be put out into the open.

Good luck.

 

[DOctorJay]

I think it would be important to let students know that this area tends to be more of a specialty geared towards people who enjoy working as a team. Let them know the members of the team they will be working with and how that team fits together (PT, OT, ST, psych, of course nursing, etc.) These other health professionals tend to be very compassionate and lots of fun to be around. Also the extreme range of practice options should be mentioned from acute in patients all the way to professional athletes.

-J

 

[Disciple]

you also want to make sure that the inpatient side of PMR is shown. PMR is not medicine free. It is so discouraging to hear people say I don't want to do surgery, I hate medicine, so I am doing PMR. Medicne is a big part of the training, and that needs to be put out into the open.

Agree.

Many residency directors will stress to med students, however, the huge amount of IM involved in inpt. rehab. In actuality, the medicine performed by a physiatrist on the rehab unit is relatively tame. Basically, it consists of checking INRs, watching blood sugars/BPs, preventing PEs, etc. Should a pt start to crash, they are transferred off the rehab unit immediately. Not that a physiatrist would have difficulty handling the situation, but in general, hospitals do not have monitored beds on the rehab unit nor will they allow any drips to be hung, e.g. Heparin, Cardizem, Dopamine.

 

[lilnix]

i might be repeating what others have said, but it would be helpful to discuss all the different practice options for someone doing pm&r. in doing this, you could detail all the different things the practice entails.

 

[theD.O.C.]

Agree.

Many residency directors will stress to med students, however, the huge amount of IM involved in inpt. rehab. In actuality, the medicine performed by a physiatrist on the rehab unit is relatively tame. Basically, it consists of checking INRs, watching blood sugars/BPs, preventing PEs, etc. Should a pt start to crash, they are transferred off the rehab unit immediately. Not that a physiatrist would have difficulty handling the situation, but in general, hospitals do not have monitored beds on the rehab unit nor will they allow any drips to be hung, e.g. Heparin, Cardizem, Dopamine.

I would have second the need for a good solid basis in internal medicine for two reasons. 1. to help manage your patients 2. to be able to communicate with your consults/referring physicians.

There is understanding the pathology (with a focus on neuro deficits) of your patient and what interventions (ie surgery)were done in the acute care setting. These two issues have a direct impact on the patient's ability and potential for benefit from an acute comprehensive inpatient rehab stay.

 

[Disciple]

In regards to the upcoming medical student workshop, I think it best to inform medical students how broad the field is. Specifically, there is a place for those who like the IM aspect of rehab medicine and those who don't.

During my 17 months of training I've had the good fortune to work with a variety of different attendings including those who are very involved in the day to day medical management of inpts and those who let the referring internist handle it. On occasion I've been involved in making the primary diagnosis for a pt during their acute rehab course. Ideally, this shouldn't happen too often as it implies that the previous primary service dumped the pt without initiating or completing the workup.

I guess my point is that the field can accomodate a wide variety of interests and physicians. If you're purely a musculoskeletal type, you can be. If you like medicine you can do that. If you want to do a little bit of everything, there's still a place for you in PM&R.

 

[pmrunner]

Another idea would be to discuss some of the research avenues that PM&R docs take during and after residency. The whole gait lab stuff in addition to rehab modalities, etc. I think the unlimited topics that are covered by various people show just how many things they could get involved in is pretty exciting.

I also think going through and discussing some of the "old wives tales" related to PM&R would be helpful. Posting a slide with commonly asked questions/misperceptions and then negating/answering them would be helpful. Eg- Are PM&R docs PTs? (I get that one all the time), Are you just a sports med doctor? Do you just work in a nursing home? Just a few ideas...