Which SubI should I do if I'm looking at PM&R?

[zeppelinpage4]

Hi everyone. I've never posted in the resident forums before, so apologies if this is the wrong place to ask this.

I'm making my 4th year schedule and we have room to schedule 1 or 2 SubIs. When I started the scheduling, thought I might want to do peds, so I'm set up to do a Pediatrics SubI in June. But PM&R is something I really want to explore 4th year, and if I find I like it, I want to know if doing a pediatrics SubI would be detrimental since it's a whole different field.

More so, what Sub Internships and electives should a student interested in PM&R have done? I don't think my school has a specific SubI in PM&R, we can do either OB/gyn, Peds, IM, surgery, or EM.

Thanks!

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[j4pac]

If you are considering Peds...I would suggest doing a Peds Sub-I.

If you had a 2nd sub-I to burn...I personally would go with IM. IM is the basis of all medicine and it's a subject that you just can't get too much experience with. When you are on the rehab wards...you are expected to know bread and butter IM...and the mass majority of prelims/internships are IM heavy.

As a third choice I would pick Neuro. The ability to perform a quality exam is priceless...especially entering PM&R.

 

[RangerBob]

If you think you might apply for PM&R, you definitely need to do a PM&R rotation. If your school doesn't offer a rotation, do an away. I don't think you'd be able to match into PM&R without a PM&R rotation--it's a specialty where programs will really want to see you prove an interest in it. I believe it's essentially a requirement now. (And it's a great rotation to do!)

You could also always do a peds rehab elective--that way you could do something that will absolutely help you if you do peds, and will help you get an idea if you like PM&R. And depending on how the rotation is structured, if you're really interested faculty will often let you spend a couple half days in other clinics, in case you want to see some EMGs, MSK clinics, round on SCI for the day, etc.

Remember, you can do a peds prelim year for PM&R. I know someone doing that right now. And there are a few peds-PM&R programs out there (I think it saves you a year vs doing PM&R and then a peds fellowship)

I agree with j4pac--if you're really thinking about peds, do a peds sub-I. Doing a peds sub-I will definitely not hurt you. If you plan to do adult rehab and end up doing a prelim-IM year then certainly a medicine sub-I would help more, but a big part of what you learn on sub-I's is how to act more independent, gain confidence, etc. I don't think there's any sub-I that could actually hurt you (maybe derm?). Still, I wish I knew more derm--it's actually a pretty helpful field...

Medicine is the best alternative if you think you're going to go into adult PM&R. Neuro is nice too, but I'd definitely do medicine over neuro. If you haven't done a neuro elective already, then you should make sure to do one if you do plan to go into PM&R.

ICU is a good experience to have--it won't be quite as scary when you're an intern if you've already spent a month in the ICU as a medical student.

 

[zeppelinpage4]

If you are considering Peds...I would suggest doing a Peds Sub-I.

If you had a 2nd sub-I to burn...I personally would go with IM. IM is the basis of all medicine and it's a subject that you just can't get too much experience with. When you are on the rehab wards...you are expected to know bread and butter IM...and the mass majority of prelims/internships are IM heavy.

As a third choice I would pick Neuro. The ability to perform a quality exam is priceless...especially entering PM&R.

Thanks j4pac, I am seriously considering peds still, so I'll keep that SubI. Even though IM might be applicable to a wider range of specialties, it would close the peds door, which I want to keep open for now.
And that's really helpful to know, perhaps I can do some electives in neuro to see how I like it. I'm gathering that neuro is a large part of PM&R. To be honest, neuro was never one of my favorite subject, should that be a warning sign I may not like PM&R?

If you think you might apply for PM&R, you definitely need to do a PM&R rotation. If your school doesn't offer a rotation, do an away. I don't think you'd be able to match into PM&R without a PM&R rotation--it's a specialty where programs will really want to see you prove an interest in it. I believe it's essentially a requirement now. (And it's a great rotation to do!)

You could also always do a peds rehab elective--that way you could do something that will absolutely help you if you do peds, and will help you get an idea if you like PM&R. And depending on how the rotation is structured, if you're really interested faculty will often let you spend a couple half days in other clinics, in case you want to see some EMGs, MSK clinics, round on SCI for the day, etc.

Remember, you can do a peds prelim year for PM&R. I know someone doing that right now. And there are a few peds-PM&R programs out there (I think it saves you a year vs doing PM&R and then a peds fellowship)

I agree with j4pac--if you're really thinking about peds, do a peds sub-I. Doing a peds sub-I will definitely not hurt you. If you plan to do adult rehab and end up doing a prelim-IM year then certainly a medicine sub-I would help more, but a big part of what you learn on sub-I's is how to act more independent, gain confidence, etc. I don't think there's any sub-I that could actually hurt you (maybe derm?). Still, I wish I knew more derm--it's actually a pretty helpful field...

Medicine is the best alternative if you think you're going to go into adult PM&R. Neuro is nice too, but I'd definitely do medicine over neuro. If you haven't done a neuro elective already, then you should make sure to do one if you do plan to go into PM&R.

ICU is a good experience to have--it won't be quite as scary when you're an intern if you've already spent a month in the ICU as a medical student.

Thanks RangerBob! I'll look into an away rotation. And that's a brilliant idea! I'll need to see if there's a peds rehab elective at my program or one nearby. It would be a good way to get a taste of rehabilitation without diverting too much from my current schedule which has a lot of peds stuff. Actually PM&R with peds patients might be a cool avenue to explore if I find I like both specialties. Will definitely keep this in mind, thank you for the idea.

And thank you for clarifying that for me, I was afraid the Peds SubI might rule me out of adult PM&R, but it's good to know that door is still open even if I only get the Peds SubI in. And haha, maybe I'll keep an eye out for a derm elective.
Appreciate the suggestion on ICU too, I know Peds ICU is definitely an option for SubI's. It wasn't the best experience for me in third year, but maybe I'll consider giving it another chance if the experience helps.

Thanks again for all the awesome advice guys. Really, I got a lot of ideas and avenues to look into now. And I'm glad to know I can still explore and consider PM&R with the Peds SubI.

 

[j4pac]

Thanks j4pac, I am seriously considering peds still, so I'll keep that SubI. Even though IM might be applicable to a wider range of specialties, it would close the peds door, which I want to keep open for now.
And that's really helpful to know, perhaps I can do some electives in neuro to see how I like it. I'm gathering that neuro is a large part of PM&R. To be honest, neuro was never one of my favorite subject, should that be a warning sign I may not like PM&R?



Thanks RangerBob! I'll look into an away rotation. And that's a brilliant idea! I'll need to see if there's a peds rehab elective at my program or one nearby. It would be a good way to get a taste of rehabilitation without diverting too much from my current schedule which has a lot of peds stuff. Actually PM&R with peds patients might be a cool avenue to explore if I find I like both specialties. Will definitely keep this in mind, thank you for the idea.

And thank you for clarifying that for me, I was afraid the Peds SubI might rule me out of adult PM&R, but it's good to know that door is still open even if I only get the Peds SubI in. And haha, maybe I'll keep an eye out for a derm elective.
Appreciate the suggestion on ICU too, I know Peds ICU is definitely an option for SubI's. It wasn't the best experience for me in third year, but maybe I'll consider giving it another chance if the experience helps.

Thanks again for all the awesome advice guys. Really, I got a lot of ideas and avenues to look into now. And I'm glad to know I can still explore and consider PM&R with the Peds SubI.

As a warning...there is only one Peds-PM&R duel program in the country. You could do a Peds fellowship on top of PM&R...but not the opposite way around. You could do Sports on top of Peds, but it would be difficult to land a FP or PM&R Sports program...leaving only a handful of Peds Sports Med fellowships which are very competitive. My wife is a 3rd year Peds resident who looked into Sports...so that's how I know about the track.

If you hate Neuro, you should question what you like about PM&R. PM&R is largely applied Neuro and non-surgical Orthopedics. You really need to get a taste of inpatient and outpatient PM&R to figure out if it's for you.

 

[RangerBob]

Just for clarification, there are three combined programs (Cincinnati, Colorado, and Thomas Jefferson/duPont):
https://www.abp.org/content/pediatrics-physical-medicine-and-rehabilitation

As J4Pac mentions, PM&R is by and large applied neuro and non-surgical orthopedics. I loved my neuroscience course, but I didn't love my neuro rotation (I thought it was ok). If you really didn't like either, then it signal that a good fit with PM&R might be less likely. However, it's really all about where you fit in and what you enjoy--you don't necessarily have to love the science of your field to love what you do. A good example is the well-child exam, sort of the bread and butter of peds. It's not the most fascinating thing to memorize milestones--but it sure is fascinating to see those kids again and again and watch them grow!

It's similar with PM&R--maybe you're not as excited about localizing the stroke (the neuro service does that for you anyway...), but watching your patient get stronger, improve their gait, and rebuild their life and social ties is really fulfilling, and even more so when you're working with such a great team--I really enjoy working with my nurses, PT's, OT's, SLP's, case managers, social workers, pharmacists, etc. The people you work with has a huge impact on your happiness--and that isn't something medical students think about too often.

Medical students (including me when I was one) often think about "what sounds the most interesting/fascinating." But that really translates into "what seems the most interesting to me at this moment in time." (And even more often, it translates into "what rotation did I enjoy the most and which attendings did I like the most"). We're quite a bit more biased by the luck-of-the-draw of what attendings we work with in medical school than we realize.

It's hard, but think about what you would find meaning in and what you would enjoy doing on a daily basis. Often, it's the specialty where you have a gut reaction of "this is where I belong."

 

[RUOkie]

It's similar with PM&R--maybe you're not as excited about localizing the stroke (the neuro service does that for you anyway...), but watching your patient get stronger, improve their gait, and rebuild their life and social ties is really fulfilling, and even more so when you're working with such a great team--I really enjoy working with my nurses, PT's, OT's, SLP's, case managers, social workers, pharmacists, etc. The people you work with has a huge impact on your happiness--and that isn't something medical students think about too often.

Off topic: this kind of thinking is dangerous (the highlighted portion). Out in the non-academic world, the physiatrist is thought of as the expert in stroke. I've found many neurologists to be too busy to really localize, and end up making recommendations on medical treatment (revascularization vs. antiplatelets vs anticoagulation) and then disappear. The functional deficits are what determine prognosis, and usually that is the bailiwick of the physiatrist.

A physiatrist who does not do a good neurological examination on every patient is a bad physiatrist.

 

[j4pac]

As a warning...there is only one Peds-PM&R duel program in the country. QUOTE]

Good catch...I only knew of the one in Denver/Aurora.

 

[RangerBob]

Off topic: this kind of thinking is dangerous (the highlighted portion). Out in the non-academic world, the physiatrist is thought of as the expert in stroke. I've found many neurologists to be too busy to really localize, and end up making recommendations on medical treatment (revascularization vs. antiplatelets vs anticoagulation) and then disappear. The functional deficits are what determine prognosis, and usually that is the bailiwick of the physiatrist.

A physiatrist who does not do a good neurological examination on every patient is a bad physiatrist.

True--I was trying to emphasize that the OP doesn't have to be super excited about localization to find PM&R meaningful and enjoyable. Our neuro service does a pretty good job of making the diagnosis over here. But they do typically disapear after they make their recommendations... But by and large in inpatient rehab we are not diagnosing patients as they've usually been diagnosed by that point--though there are often undiagnosed MSK conditions that can/do affect their rehab that we diagnose.

I agree about performing a good neuro exam. In fact, we should be (and usually are) much better at it than the neuro service.