Immersion Phase Update: Physical Medicine & Rehabilitation Elective (7/5/15 – 7/31/15)

As I alluded to in my last post, this past month I took an elective that offered an introduction to physical medicine and rehabilitation (PM&R).  This specialty looks at restoring or maintaining activities of daily living, mobility, functional capabilities, etc, in patients with permanent or temporary disabilities.   It’s a broad field, dealing with everything from chronic musculoskeletal pain to cerebral palsy to traumatic brain injuries.  Physicians in the field–known as physiatrists–work closely with physical, occupational, and speech therapists in both inpatient and outpatient settings.  The department and the residency program are quite new to Vanderbilt, but they welcomed me with open arms for the month and taught me so much about the specialty.  I initially chose this elective because I’d had absolutely no exposure to PM&R, and I was pleasantly surprised by how much I enjoyed it–in fact, I’ve been recommending it to just about every medical student I’ve talked to.

Throughout the month, I rotated through a number of outpatient settings that gave me a better idea of the breadth of PM&R.  I saw more typical clinics that served pediatric and adult patients presenting with mainly orthopedic or neurologic chief complaints.  I got to observe several procedures, such as botox injections (for limb spasticity, not for cosmetic reasons), spinal injections, and joint injections.  I even helped out with a few of these; for the most part, I simply helped the physician draw up medications into syringes or held the ultrasound probe, but one morning the attending let me inject steroid into a patient’s hip.  I was so excited to do this, even though the attending was holding my hands the whole time.

I was also placed at fairly unique clinical sites that medical students usually do not get the chance to experience.  In “wheelchair clinic” at the pediatric rehabilitation suite at 100 Oaks, I observed a physical therapist and equipment vendors as they fit children for colorful wheelchairs and car seats.  When I shadowed the physical and occupational therapists at the VA, I learned about everything from paraffin baths for arthritis to dry needling techniques for painful trigger points; I even got to go inside a balance assessment machine, which uses various tests to determine the level of function of certain neurologic components of balance.  I also observed a physical therapist in what is called lymphedema clinic; this site typically serves patients who have swelling due to lymphatic issues or muscle tightness after surgery, and the therapists there recommend equipment and perform maneuvers to help decrease patient discomfort.  On two mornings of the elective, I went to the Dayani Wellness Center, a fitness center geared toward patients with heart diseases, lung diseases, and other similar diagnoses; nurses, exercise physiologists, and other personnel create workouts, hold fitness classes, and use health coaching strategies in order to help patients meet their exercise and nutrition goals.

Additionally, I spent a week with an inpatient attending at Stallworth Rehabilitation Hospital.  Before that particular week, Stallworth was simply the place where patients often got sent when someone felt they needed “inpatient rehab” after a stroke or some other debilitating injury.  I didn’t really know anything else about it, but I learned quickly.  Typically, patients spend about 2 weeks at Stallworth, receiving some combination of physical/occupational/speech therapy daily depending on their needs and goals.  If the patient was admitted for a spinal cord injury, they usually stay a few weeks longer and receive the same services during that time.  Physicians make rounds every weekday, talking to and examining their patients, assessing for new medical concerns, writing prescriptions, and other typical tasks.  Meanwhile, case managers work on discharge planning, figuring out where the patients will go–home or to a skilled nursing facility, to name a few options–and what type of follow up they will need with therapists or physicians after they leave Stallworth.  In addition, the patient’s team of nurses, therapists, physicians, and case managers meet together during the week to discuss medical, social, and other barriers that might lengthen his or her stay.  I found that Stallworth is an environment built upon interprofessional care, with the idea that many medical professionals can and should work as a team to effectively meet their patient’s needs.  This came in handy, because I was taking a concurrent class on interprofessional education that required me to shadow two care providers who were not physicians (I chose to observe a case manager and a speech and language pathologist).  In addition to learning about the system and general routine of Stallworth, I talked at length with the PM&R attending on various topics; it turns out that he is quite interested in the intersection between his field and neuropsychiatry, so we ended up having lots to discuss!

When I wasn’t doing work for the rotation, I spent quite a bit of time working on my residency application.  This past month, I met with the Dean for Student Affairs to discuss the medical student performance evaluation (MSPE) that will accompany the application.  At this point, I am up to my neck in editing my personal statement and curriculum vitae.  At the time of my last writing, I hadn’t started writing either of them; however, I was able to put together working first drafts of both while I was away in Detroit a couple of weeks before starting the PM&R rotation.  I’ve since sent them to several friends and faculty members and have received great feedback on both.  I am also working on finalizing the list of programs I’ll apply to, as well as collecting letters of recommendation.  In the midst of all this, I found out that I passed Step 2 CK, so I’m almost done with the exams whose scores I’ll need to include with my application.

Despite having my hands full with all of the above, I still had time for some extracurriculars.  A week after I got back from Memphis, two of my dear friends from church got married; it was wonderful to be able to celebrate with them.  A week or so later, I entered a vocalist search that EDM genius Zedd opened up to his fans; I wrote and recorded lyrics for a new instrumental track that he’d made, and although I haven’t heard back from the artist himself, I’ve gotten great feedback from friends since posting my vocal demo on SoundCloud and YouTube.  In addition to all this, I joined some of my classmates in welcoming the Class of 2019 during their orientation week; aside from making me feel really old, they seem like a pretty cool bunch of people overall.  Several of them signed up to join the a cappella group, and they eagerly showed up for our first rehearsal; despite some of them saying that they had never sung before, we were able to sight-read and sing through a song that the group had performed previously.  I was also able to go back home for a children’s and youth conference at my church there, during which I met Travis Greene, a gospel artist who sings one of my current favorites (it’s such a favorite that I did a cover of it on my YouTube channel).  And this past week, I went with a friend to Bridgestone Arena for the Nashville leg of Outcry 2015, a brand-new tour featuring Christian music greats such as Passion, Trip Lee, and Hillsong.  I was exhausted the next day, but it was totally worth it.

Thanks for reading!  Stay tuned for my next update.  On Monday, I start my month of Emergency Medicine, which will include lectures and ED shifts occurring at various times of day (and night).  Wish me well!

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3 thoughts on “Immersion Phase Update: Physical Medicine & Rehabilitation Elective (7/5/15 – 7/31/15)

  1. Hi! I actually don’t know much about PM&R or physiatrists. I did meet a M3 from Meharry who told me he was doing a rotation in the same department earlier in the summer. What was the first procedure you did during your rotations by the way? I bet it is exciting to do one. Also seems like you got to experience a lot of the ‘ behind the scenes ‘ in medicine and how the system works.

    You’ve been busy, thanks for the update! Can’t wait to hear about where you interview.

    LND

    1. Hey there,

      Thanks for the comments! I can only say that i “did” one procedure on this rotation–part of a bilateral hip injection. But the first one i saw during my month on PMR was a botox injection in a kid’s arm and leg to help with spasticity (he has cerebral palsy). I wasn’t actually supposed to see any botox injections, but I happened to have a free morning and the person who put my schedule together suggested that I find the attending who was doing them that day.

      As far as first procedure I did/helped with for rotations overall…i got to observe a craniofacial reconstruction when i rotated through plastic surgery during my first core rotation last year. all of the plastics cases i saw were really cool. and then there was the time on OBGYN when the attending let me take out a woman’s IUD, which she said she’d never let a student do before.

      to be honest, i get more excited about procedures than i initially thought i would…definitely won’t rule out ECT as a part of my future psych career…

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