Key Take Aways:
- Changing from one rotation to another can be challenging in a broad field like PM&R.
- Apply the medical student clerkship mindset: Open minded, treat each rotation like you were going into that subspecialty, and get the most out of each experience
- For those with specific subspecialty aspirations, some rotations may *seem* unrelated
- Look for overlap and opportunities to develop essential skills on all rotations
- Physiatrists are team leaders, cultivating multidisciplinary leadership skills in training is essential
Medical training starts broad and narrows with each successive phase. As medical students, we studied an expansive curriculum to build foundational knowledge. We then spent a few weeks or months at a time training in different corners of the medical field to develop clinical skills and find our future specialties. The classic clerkship advice was to remain open minded, treat each rotation like you were going into that specialty, and get the most out of each experience. After all the dust settled, we felt that PM&R was the specialty for us. Moreover, many of us may not have even known about PM&R going into medical school, a testament to the open-minded mentality of residents entering our field.
While many other specialties narrow their scope of practice on day one of residency, PM&R remains broad. This can be challenging, even for the physiatrist who is undecided on their future practice or wants to be a generalist, but especially for those pursuing specific fellowships. Jumping from inpatient rehab to pediatric clinic to interventional pain to EMGs is no easy feat. From a bird’s eye view, the day-to-day experience, workflow, and clinical practice of each subdiscipline appears as disparate as medicine and surgery. For trainees working towards specific career goals, some rotations may even seem low yield. A word of caution: this outlook can contribute to feelings of burnout, limit growth, and lead to missed opportunities.
As residents, how do we take on this challenge and get the most out of our relatively brief time as trainees? As trite as it may sound, it takes the clerkship mentality but kicked up a notch. In addition to open-mindedness and getting the most out of every experience, there are general- and subspecialty-specific skills that can be honed on every rotation. Some of those general skills, like note writing and efficiency, are more obvious. Others take creativity to see. As an aspiring interventional pain medicine physiatrist, I will use pain medicine as an example.
On the surface, inpatient rehab (IPR) seems the most different from interventional pain practice. However, pain is one of the most common complaints encountered in inpatient rehab. Whether the source of pain is acutely related to the admission diagnosis, or the patient had chronic pain before the incident, pain management skills are developed on the unit and can be applied to the pain management clinic. Considering how interventional pain positions frequently include pain consult coverage, our inpatient pain management experience is invaluable. IPR also presents opportunities for peripheral joint injections that can enhance a patient’s rehab experience and outcomes. One could even obtain an ultrasound machine to aid in making the diagnosis and further develop their proficiency in ultrasound guided injections.
The most fundamental IPR-developed skill comes into play in the outpatient setting. Patients with complex and refractory chronic pain often require a multimodal comprehensive treatment plan with coordination between physical therapy, occupational therapy, mental health services, and other specialties. There is no better place to cultivate the skills necessary to lead a multidisciplinary treatment team than the inpatient rehab setting where multidisciplinary team meetings occur on a weekly basis.
Similar opportunities for growth can be found on every rotation and this same mindset can be applied to other subspecialties as the PM&R overlap is more extensive than it first appears. Regardless of career aspirations, physiatrists can master anatomy and improve their needle dexterity in EMG clinic. Spasticity management and botulinum toxin injection skills are developed in a variety of clinical settings from neurorehab to pediatric rehab. The list of opportunities goes on and on. At the center of everything is the special role a physiatrist plays on the multidisciplinary team leveraging stakeholders and coordinating care to maximize outcomes.