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PM&R Resident E-Newsletter

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August 2017

From Your Physiatrist in Training Council (PHiT)


Comparing PM&R and Family Medicine Sports Medicine Fellowships

Aditya Raghunandan, MD
PGY3, Icahn School of Medicine at Mount Sinai
AAPM&R RPC Ambassador for Mount Sinai

 

 

Gerardo Miranda-Comas, MD, RMSK, FAAPMR
Assistant Professor of Rehabilitation Medicine
Associate Program Director of Sports Medicine Fellowship
Icahn School of Medicine at Mount Sinai

 

 

 

Siobhan M Statuta, MD, CAQSM
Director, Primary Care Sports Medicine Fellowship
Assistant Professor, Family Medicine and Physical Medicine & Rehabilitation
Team Physician, UVA Sports Medicine
University of Virginia Health System

PM&R-trained physicians can become an accredited sports medicine physician through fellowships under 4 core specialties: emergency medicine, pediatrics, family medicine (FM), and physical medicine and rehabilitation (PM&R). PM&R and FM-based sports fellowship programs tend to be the most popular routes for PM&R residents.

Dr. Raghunandan: What are the differences between PM&R sports fellowships and FM sports fellowships?
Dr. Miranda: There are no significant differences in terms of accreditation. The main difference is the focus of the core specialty that the fellowship is under. In our fellowship, about 10% of a fellow's time is spent in general PM&R clinical responsibilities. Additionally, there tends to be a higher number of faculty from the core specialty in the program.

Dr. Statuta: I don't have first-hand exposure to PM&R sports fellowships, however, I can speak to the overall approach of FM sports fellowships. In general, a specialty-specific fellowship tends to focus on the skills taught throughout residency. As such, our focus in the FM fellowship is to continue the global approach to each athlete and treat all body systems, including and beyond the MSK concerns (i.e., nutrition, development, psychiatric, gynecological, etc.). The primary focus is to further develop all primary care skills and secondary focus on procedures such as learning EMG or fluoro-guided injections. That said, at UVA, we heavily emphasize MSK ultrasound-guided injections as we believe this is an imperative skill each and every graduating sports medicine fellow must be comfortable with.

Dr. Raghunandan: What are the pros and cons of a PM&R fellowship compared to FM sports fellowship?
Dr. Miranda: There is a strong influence of PM&R in your daily practice, which allows PM&R-trained residents to continue the skills that they learned. PM&R fellowships tend to have a higher interventional focus compared to the FM counterparts. Furthermore, there has been a push to incorporate ultrasound MSK into both fellowship types, so that's a positive for both. The one downside to a PM&R-based fellowship is that the sports medicine board includes all sports medicine topics with some added emphasis in primary care issues. Although these topics are covered during the fellowship’s curriculum, it is a lesser experience than the FM counterpart. That being said, the pass rate for PM&R fellows on the boards is still close to 100%.

Dr. Statuta: In FM sports fellowships, the fellows get a wide breadth of primary care, which in my mind is a pro. They increase their differential diagnoses and become better overall physicians, having seen, diagnosed, and managed more conditions. The cons are that PM&R applicants will likely end up spending time focusing on strengthening primary skills that they haven’t focused on much since medical school or internship. As this takes time, less time is devoted to maintaining the procedural skills that are often emphasized during their PM&R residency.

Dr. Raghunandan: What is the curriculum structure?
Dr. Miranda: We cover the ACGME sports medicine topics via didactics and journal clubs. In addition, the fellows get plenty of clinical exposure, hands-on time with interventions, and MSK ultrasound diagnostics/procedure time.

Dr. Statuta: We start off broad and get more specialized. For example, a fellow begins with rotations in general sports, orthopedics, and primary care clinic. At mid-year, the learners’ experiences become more focused such as having time in the hand clinic, foot clinic, and MSK radiology. Additionally, we create our curriculum to meet the needs and goals of each specific new fellow. If there is a certain area of interest for that fellow, we change the structure of the schedule to permit more time to develop in those areas.

Dr. Raghunandan: What attributes do you look for in an applicant?
Dr. Miranda: We look for applicants who have had sports exposure covering multiple events and have been involved with pre-participation physicals. Our program also values residents with a strong academic background, have good scores on the boards, and have participated in research, preferably in MSK and sports-associated topics.

Dr. Statuta: We look for applicants who are driven, passionate, have good social skills (works well with specialists from different departments), and are team players. We want to make sure that the applicant's goals fit with what the program can offer.

Dr. Raghunandan: Where do alumni practice?
Dr. Miranda: We recently sent out a survey to our former fellows. Preliminary responses show that most of our graduates are practicing in multi-specialty practices as non-surgical physiatrists specializing in musculoskeletal medicine.

Dr. Statuta: Most have stayed on as faculty here at UVA or remain in the local area. Others have entered private practice and work in multi-specialty practices as primary care sports medicine experts.

Dr. Raghunandan: In your opinion, what are some specific traits of your sports fellowship that are unique compared to other PM&R or FM-based sports fellowships?
Dr. Miranda: We are one of the few, if not the only program, with 2 fellows who are both PM&R residency trained. Other programs usually have a split between other specialties. We also pride ourselves on having a strong collaboration with our core PM&R residency program. Finally, our fellows receive significant exposure to interventions as well as provide care to a very diverse demographic here in Manhattan.

Dr. Statuta: We take 1 fellow per year and UVA is the only program I’m aware of that individualizes the curriculum for each specific matched fellow. Shortly after The Match in January, I ask the fellow for his/her list of dreams, experiences, knowledge, and skills they want to gain over the year. It’s their “Sports Fellowship Bucket-List” of sorts. The curriculum is modified so there is no wasted time and we address as many experiences from this list as we’re able to provide. I personally meet with the fellow monthly for feedback and constantly modify the curriculum to fit the fellow's needs. We also boast a 100% pass rate on the sports medicine boards.

Dr. Raghunandan: Do you have any other general advice for PM&R residents interested in applying to sports fellowships?
Dr. Miranda: I encourage residents to obtain hands-on exposure at programs that they are interested in by doing 2-4 week rotations to get exposure to FM-based sports programs as well to understand the differences. In addition, it is important to get involved with sports coverage, maintain a strong academic background, and attend national meetings. Attending these meetings allows for networking opportunities, and the fees are relatively nominal for residents.

Dr. Statuta: I want applicants to think about what it means to be a physician in the trenches of sports. Since fellows spend about 80-90% of their clinical time in primary care clinics, I encourage all to start thinking about the athlete as an entity and the entirety of their primary care needs. This will, inadvertently, make them into the ideal sports medicine provider and ultimate team player.



Fellowship Spotlight on Sports Fellowships: A Fellow’s Perspective

Sara Raiser, MD
PGY4, University of Virginia



 

Lindsay Ramey, MD
Sports Fellow, Shirley Ryan AbilityLab (formerly the Rehabilitation Institute of Chicago)

The Primary Care Sports Medicine (PCSM) fellowship is a competitive program that matched 81.1% of applicants in 2017. PCSM is a 1-year fellowship that can be completed by residents from 5 different specialties (physical medicine and rehabilitation (PM&R), emergency medicine, family medicine, internal medicine, and pediatrics). Most PM&R residents will apply to both PM&R and non-PM&R affiliated programs.

I spoke with Lindsay Ramey, MD, a sports fellow at the Shirley Ryan AbilityLab (formerly the Rehabilitation Institute of Chicago), regarding her PCSM fellowship experience. Dr. Ramey attended the University of Virginia for her medical education and completed her PM&R residency at Spaulding Rehabilitation Hospital/Harvard Medical School.

Dr. Raiser: What initially developed your interest in sports?
Dr. Ramey: I’ve always been interested in anatomy and body movement. I grew up dancing, and I think that’s probably where it started. Even in high school and college, I took some anatomy courses, and I thought it was really interesting how one small change in your anatomy or alignment can cause such big downstream effects. And, the more I started spending time with sports medicine physicians and patients, the more I fell in love with it. I think the patients are very motivated for the most part, and they want to learn and take an active role in their treatment, which was really important to me. I also had some really great mentors throughout my training and if you’re working with someone who comes to work every day and is happy with what they do, you can see yourself being happy doing that, too. So I think it’s a combination of interests, liking the patient population, and then having some really great mentors.

Dr. Raiser: Why did you choose a fellowship?
Dr. Ramey: My major was in education; so, I actually thought I was going to be a teacher, but then I fell in love with medicine. As soon as I realized I could still focus on teaching in medicine, I was 100% committed. Once I found sports medicine, I knew I wanted to go into sports medicine academics. I set my goals on becoming a part of a fellowship training program for sports medicine. I chose to pursue fellowship because I needed more training to improve my clinical knowledge and procedural skills to be the doctor and the mentor that I want to be. With my academic interests, I also want to be board-certified in sports. So, I wanted to go to an ACGME-accredited sports fellowship program for that reason too.

Dr. Raiser: Do you have any recommendations regarding how to choose between PM&R and non-PM&R affiliated programs?
Dr. Ramey: I really don’t think there is a right or a wrong answer to this. The advice that I would give to anyone who is planning to apply to sports fellowship is… sit down and literally write out your career goals and try to prioritize them. There are so many options of what you can do. Do you want to be a professional or a collegiate-level team physician? Procedurally, do you want to do spinal procedures? Do you want to do ultrasound-guided procedures? Do you want to do EMG? Do you want to do regenerative medicine, and if so, to what extent? Do you want to do PRP or stem cells? There are just so many possibilities there. Do you want to do primary research? Or do you want to focus more on, maybe, a clinician educator track? So, I think when you can sit down and say where you fall on the spectrum of all of these things, a fellowship program will kind of pick you. Once you have your priorities, you can read about programs online, and talk to colleagues and mentors at various programs to see if the goals of a program are in line with your personal career goals. For example, I am very interested in women’s health and bone health. And, I wanted to find a program that would allow me to focus on these areas. So, tailoring what I want to do in my career path and defining that before I even stepped into the interview allowed me to find a program that fits my needs.

So, that is a very broad comment that I would make to anyone. But once you can define those things, there are some generalizations about PM&R vs. primary care that might help. I think that PM&R fellowships probably offer a little bit more robust training in spinal procedures, ultrasound, and regenerative medicine. I know there are some primary care programs that offer that, but it is not quite as common in that setting. Primary care programs, on the other hand, offer incredibly broad team coverage opportunities and broader exposure to some of the medical issues, the dermatologic conditions, the cardiovascular issues, et cetera, that you want to know if you plan on being a team physician one day. I think that both categories have their strengths, so once you define what you want to get out of a program, that might help you pick between PM&R and primary care. I would just caveat that there are definitely exceptions to those rules. I know some primary care places that do spine a half day each week and their trainees come out feeling really confident in it. If there is a particular program that you’re looking into, I would send them an email, and see if there is a physiatrist on staff that you could talk to.

Dr. Raiser: Have there been any surprises along your path of fellowship applications to where you are now, midway through your fellowship year?
Dr. Ramey: Every day is a surprise… my co-fellow probably said it best, “The first week of fellowship is like trying to drink from a fire hydrant.” You learn so much, so quickly. It’s such a steep learning curve at the beginning. I kept thinking that the learning curve was going to flatten out. But I am constantly surprised at how much I continue to learn every single day, even after 8 months. And then the more that I learn, the more questions I have. It’s like the world of sports medicine just keeps getting bigger and bigger to me, which isn’t necessarily a bad thing. But I’ve been surprised at how much growth can happen every single day.

Dr. Raiser: What has been the most challenging aspect of your sports fellowship?
Dr. Ramey: I’m the type of person that likes to be involved in everything. So, I would say for me, trying to stay focused on a few key areas throughout the year has probably been the hardest thing. You’ll get so many opportunities throughout the year. You’ll have opportunities to cover 10 different sports. You’ll have opportunities to do adaptive sports, research, QI projects, book chapters, and case reports. You’re in an academic program that offers you support, and you want to do it all but you can’t. It’s 1 year, and there’s literally not enough time or coffee in the world to do everything that you might want to do. I found that I go back to that career list that I talked about earlier. I think, “What am I going to do tonight? Am I going to cover the wrestling match? Am I going to go to training room? Am I going to work on my research project? Or, am I going to spend time with my fiancé?” I look at my professional and personal goals, and I think, “which will get me there?” That’s helpful. Granted, a lot of times, events are mandatory, but when you have the option, that can be helpful. But I think that the more you can weed out extras that are not mandatory or useful to you or your program, the happier you will be during your fellowship year, and probably the better you will come out for it, because you will come out with a few key areas that you will feel well-versed in.

Dr. Raiser: How has your fellowship been helpful in developing your career goals and finding your first job?
Dr. Ramey: I came in with “these are my career goals” and “this is what I want to achieve.” I think it’s helpful to come in with your own career goals. But it has been helpful to talk to fellowship staff with more experience about how to prioritize my goals, realistic timelines, and practical ways to achieve them. I came in with a list of about 4-5 things that I wanted to achieve, and I showed my program that. And, I’m lucky to be in a program where they allow me to build my schedule around my goals. Based on a list that I gave them, I was able to notch out dedicated time to do ultrasound, spend time with bone health specialists in both orthopedics and endocrinology, and teach residents. My program was really helpful once I defined my goals and helped me achieve them.

Dr. Raiser: What additional advice would you give to a resident who is considering applying for a sports fellowship?
Dr. Ramey: I remember mid-way through the fellowship application process how frustrated and tired, and frankly, broke I was. And I remember, thinking to myself, “I wonder if this is worth it.” Granted, I went to the extreme. I interviewed at 14 different programs and I really don’t think anyone needs to do that. But knowing my career goals, I really wanted to get into an ACGME-accredited PM&R fellowship. I wanted to keep every option on the board and really explore my opportunities. That being said, having gone through it now, it was 100% worth it. I know it can be competitive, and it can be frustrating when you’re trying to build your CV. But, you will learn more than you think possible during a year of fellowship training. While I can only speak for my program, a lot of friends in other programs all say the same thing. You are just amazed at how much you learn in such a short period. I would tell people that we know it’s frustrating, hard, and expensive, but if you are passionate about sports, and you know that you want to do a sports fellowship, don’t give up just because it’s hard or competitive or you might not think you’re the best applicant. Try to stick it out because it’s totally worth it.

Thank you, Dr. Ramey!


A Look at the Annual Assembly Resident Program

Vishwa Raj, MD, FAAPMR
Carolinas Medical Center

This year’s Resident Program at the Annual Assembly has been completely revamped to focus on the the needs and wants of residents moving forward with clinical practice. With the feedback and input of the PHiT, the program has been redesigned to address topics that are most pertinent to trainees today.

During the Annual Assembly, you will have the opportunity to meet leaders in the field of physiatry who can provide unique insights into clinical practice and application. Topics will be relevant to those entering practice directly or pursuing fellowship training, and the information provided could have a significant impact on future career plans and growth. Several sessions will focus on practical issues, such as integration into the workforce, tools necessary to transition into an attending, utilization of technology for PM&R education, tips and advice regarding coding and billing, MACRA, and understanding the evolution of health care as it applies to PM&R. There will also be an introductory course focused on spasticity management and musculoskeletal ultrasound. And our fellowship forum will give you a unique opportunity to interact with fellowship directors from a diverse group of subspecialties within PM&R, with opportunities for Q&A and 1:1 conversations.

We hope you share our excitement regarding this year’s program, and look forward to seeing you all in Denver!


AMA Annual Meeting Update

Brittany Bickelhaupt, MD
PGY2, University of Texas Health Science Center at San Antonio

Many pertinent issues were discussed during the AMA Annual Meeting this past June in Chicago. Delegates from specialty societies across the nation gathered for a week-long discussion regarding proposed resolutions. The proposed resolutions were designed to provide a unified platform that all AMA members from all specialties could support. The AMA then uses these supported resolutions to receive recognition from the public and government regarding these matters.

More than 100 resolutions were discussed during this year’s meeting. Topics pertaining to the PM&R field and residents were debated at length. These included regulated identification of physicians on flights, required mental health support for all residents, maternal leave and child care support during residency, required informed consent for all middle school and high school athletics, required healthy food options for hospital cafeterias and patient meals, small business exemptions to MACRA, and many more. We had an outstanding turnout of physicians, residents, fellows, and medical students across all specialties and interests. With this degree of participation, as physicians, we can continue to make our voice heard.


Top Stories You Need to Know 


Members-in-Training and Recent Graduates: Renew Your Dues

Dues renewal for in-training members is open until September 30, 2017. You are eligible for renewal if you meet 1 of the following criteria:

  • You are a resident.
  • You graduated from your residency program in 2016 or 2017.
    • If you are in a fellowship, let us know by filling out the fellowship form. We'll make sure information and resources are catered to your needs as a fellow in training!
  • You are a medical student with a current PM&R Journal subscription or a medical student interested in a PM&R Journal subscription.

Whether you’re a PGY1 or PGY4, your Academy has the resources to help you throughout residency, as well as your transition to full-time practice. Academy membership provides you with career advice, educational resources to help you prepare for the board exams, fellowship training advice, leadership opportunities, and more!

Learn more about your benefits and renew!

Vote for Your 2017-2018 PHiT Officers by August 27
Thank you to everyone who submitted nominations for the 2017-2018 Physiatrist in Training Council (PHiT) officers. Now it's time to vote! We sent you an email on Friday, August 11. Check your inbox for this email, which includes a link to the ballot. Hurry, voting closes August 27.

Help Us Dig a Little Deeper—Complete Our Brief Resident Census

The specialty of PM&R is quite broad. As you progress in your career, there are multiple practice paths you can take post-residency. AAPM&R would like to better understand the future plans of current PM&R residents to gain a sense of what the future might hold for the specialty.

Please click here to take our quick census, which should take no more than 7 minutes. In advance, thank you so much for your time and valuable insights!

Newly-Matched Fellows—Update Your Information

Have you recently matched into a fellowship? Congratulations! The PHiT Board would like to recognize you in this newsletter and website. Please fill out this brief form so we have your updated contact information.

Annual Assembly


New! Resident/Early-Career Program

The Annual Assembly is the world's largest gathering of PM&R residents, providing educational and networking events tailored specifically for you. NEW this year, resident/early-career activities will take place throughout the Annual Assembly for a complete event experience. Sessions begin on Thursday afternoon. Register by August 30 for member discounts and early registration rates.

Don’t miss:

Back for Round Two—the Resident Quiz Bowl!

Join us for the second annual Resident Quiz Bowl on October 13. This year, we’re bringing the fun to the PM&R Pavilion floor where PM&R residents from across the country can compete for fun and test their physiatry knowledge. Sign up your team here. For questions, email assembly@aapmr.org with the subject line, “2017 AAPM&R Resident Quiz Bowl.”

Run for Rehab Research!

Join your colleagues as we raise money for the Foundation for PM&R during the early-morning fun run on Friday, October 13 at Sloan Lake Park in Denver. Sign up when you register for #AAPMR2017.

New this year: A challenge is being issued to all residency programs to see who can beat the rest in fundraising and participation. Details will follow on the Foundation for PM&R Facebook page. Learn more.

Vote for Your Favorite Beer Name

Time to cheers with your PM&R peers! At the #AAPMR2017 President's Reception on October 13 at the Wynkoop Brewing Company, attendees will enjoy custom-brewed craft beer. A few of you sent in creative ideas to name our custom brew. Now it's time to vote for your favorite!

Has Your Program Registered for the 2017 PM&R Residency Fair?

Continuing an annual tradition, the Academy will be hosting a PM&R Residency Fair as part of the 2017 Medical Student Program, "Understanding PM&R." Residency programs may sign up for a COMPLIMENTARY booth. This is a great opportunity for you and your program to network with the next generation of physicians and to attract the best and brightest to your residency. Be sure your program has secured a free booth, pass the registration information along to your program coordinator.

Resources for You

What’s Coming Next
Look for the next issue of the PM&R Resident in your email inbox in September. 

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