Best Programs for Procedures?

[Nanomed9999]

I'm looking for PM&R programs with strong procedural experience. I'm planning on doing an interventional pain fellowship and specializing in interventional pain. Preferably, I'd like to minimize my inpatient experience

From reading the other threads it sounds like Harvard/Spaulding, UMich, Mayo, UC-Davis and OSU have the most procedure-oriented programs.

I also know that RIC, although having more inpatient, does give a good deal of elective time that would enable me to do procedural electives.

Am I missing anything? Please correct me if I'm wrong about any of these programs

Stinky gave me some great background on SRH, for which I'm grateful. If anyone else has personal experience with a program, please let me know!

Thanks!

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[nvrsumr]

As a Pgy 2 at U of Mich(only 1 1/2 month into it) I have had a clinic(outpt) month where I have done 20 epidural/facet/SI injections and observed C spine procedures, partway thru pediatric month(inpt) and have done at least 10 combination botox/phenol estim injections under anesthesia in the PACU. Of course have done shoulder, trochanter, carpal, trigger point, and botox injects in clinic.

I have been really impressed with the quality of the Michigan program all around. Lectures are great, Attending are young, friendly and helpful. Pathology is great-lots of zebras to make the day interesting-and no overnight call .

PGY3 year has 3 months dedicated to EMG but Ive already observed 5+ emgs(not just carpal tunnel but things like Spinal Muscular Atrophy) + conscious sedation(peds), dorsal rhizotomy-in OR

Hope this was helpful.
Good Luck

 

[Nanomed9999]

Thanks very much for the info. I've been hearing lots of good things about UMich. It's definitely in my top 5.

 

[wscott]

Check out my post about Louisiana State Univerisity and also another residents post on scutwork.com. Our injection experience is solid and hands-on.

Beware of how you ask the question of experience in injections. They might see a lot but how much do the residents actually perform hands-on? -Particularly in big name research based private programs. Do you think that their hoity-toity patients actually want a resident to do all the work? Of course not, they want the attending to do it themselves. Be aware and beware of this - it happens a lot at some programs.

Look up Dr. Charles Aprill - he is a pioneer and leader in interventional spinal procedures and he is at LSU.

 

[Not an LSU fan]

WScott, I appreciate your enthusiasm for your program, but c'mon, if you are going to post to what is supposed to be an objective board, writing ad copy for your program seems disingenuous. Maybe you should post that to your program's website (Oh, wait, you don't HAVE a website!)

So let's debunk what you wrote:

You mentioned LSU has hands on experience, and also mentioned Dr. Aprill - how many injections do RESIDENTS do with Dr. Aprill? NONE - the fellows do all the injections, as they do in the vast majority of programs that have fellowships.

Speaking of your fellowship, remind me again, is it ACGME accredited? NOPE. If I do your fellowship, will I be able to sit for my pain boards? NOPE. Well, not many fellowships are ACGME accredited - is it at least a PASSOR approved fellowship? NOPE. Do the fellows spend all of their time working with Dr. Aprill? NOPE maybe between 50-67%, depending on how much of their fellowship they spend unsupervised doing injections at the VA (4-6 months out of the fellowship year)

So if not with Dr. Aprill, certainly you must do your injections at Charity Hospital, right? I mean, that's where all the service patients are seen, right? WRONG - again, that is where the fellows do their injections, and the residents don't do ANY spinal injections under fluroscopy at Charity

OK, then, where do LSU residents get all this hands on experience? The vast majority is at the VA, but there are a LOT of IF's - IF the one C-arm is not in the OR, IF the attending anesthesiologist (note, not a PM&R doc, NOT pain boarded) is there to supervise, IF the fellow assigned there doesn?t want to do the injections, and IF the VA staff has actually managed to book the patients appropriately that day.

Oh, wait, you must mean the two months you are at the Ochsner Clinic - for those of you not familiar, the hoity toity-est hospital in New Orleans! So the three afternoons a week for two months out of your residency, after the staff doc has gotten comfortable with your level of interest and skills, he MIGHT let you insert the needle, although he more than likely wont let you do the whole procedure yourself, 'cause as you said, those are the snooty patients who expect that the attending physician will be doing the case!

OK, last possibility - maybe you can do some electives where you can do injections? NOPE, LSU doesn't offer any elective time!

 

[wscott]

Gee... I wonder who this is? Do you have a vested interest perhaps in debunking national awareness about our program? Perhaps a genuinely positive review will make the competition too stiff for yourself when you apply for the fellowship at LSU? There is an old blues song that goes, "before you accuse me, take a look at yourself". Before you accuse me of being unobjective, you should get your facts straight.

In response to the misinformed post by "Not an LSU fan":
1. There is a web page for the LSU PM&R program.
2. Although we are not currently accredited for a pain fellowship, there are only a handful of PM&R backed programs that are. The current administration is making an effort to transition the musculoskeletal fellowship into an accredited pain fellowship.
3. Exposure to Dr. Aprill is only limited by the resident's interest. Residents have plenty of opportunity, even outside of their scheduled injection rotations, to spend extra time with him -some residents take advantage of this, some don't.
4. Residents DO have input into their schedule. Categorical residents are given input as to what medicine rotations they would prefer to do. Also, two residents this year were given the option of taking a Tulane Sports Medicine elective, in place of a month of injections; incidentally, both of these residents are interested in an interventional spine fellowship. One can surmise they might feel the current exposure to interventional techiniques is MORE than adequate.
5. As per your comment regarding Ochsner PM&R: The residents rotating spend four afternoons a week (not three) with the fifth afternoon reserved for lecture. The current resident in her first four weeks of exposure to interventional techniques has spent four weeks with a PM&R board certified interventionalist and has logged a total of 9 hands-on procedures. Of course that does not mean she was able to perform the whole precedure without the help of the attending - that's why they have fellowships. Who would want an inexperienced resident sticking a needle in their back without adequate supervision and guidance?

Don't take my word alone for it, but if anyone reading this posting would like additional information regarding the LSU PM&R residency program or the musculoskeletal fellowship that is accurate, please feel free to contact the office. I can also refer you to speak with any number of our other residents, I'm sure their opinion will not be far from my own. Better yet, the PM&R office can even refer you to talk with previous fellows.

LSU has a history of having recruited excellent fellows. A current fellow is a LSU PM&R graduate who consistently scored in the 90th percentile on the SAE exam. The other two also graduated from LSU's PM&R program - would they stick around knowing the fellowship was poor? I don't think so. Last year's fellows consisted of the former chief resident at Columbia, and the other fellow trained at Stanford. Were they all mis-informed? I don't think so. After doing their research and taking the advice of their mentors, they all chose to train at the LSU musculoskeletal fellowship because it is solid. As anyone might gather if you look between the lines.... competition is stiff.

I am also interested in interventional spinal medicine and I admit that posting this may increase my competition. My vested interest - is to continue to have the best colleagues beside me and inform those who have interest in PM&R that LSU is a solid program to be considered.

 

[Not an LSU fan]

Actually, I am not, in fact, an applicant for your fellowship, and have no vested interest. I rotated there as a student, and was underwhelmed. But do feel free to disparage me and my character. Doens't make what I said any less true, but feel free to do it anyway.

 

[Nanomed9999]

wow. That was an interesting couple of threads! Personal affronts aside, I appreciate the willingness of both of you to express your opinions of the program. As with life, there are many perspectives....and the bottom line is that I'm ultimately responsible for where I choose to go for my training (i.e. how I rank my programs). So, I best keep on doing my homework. Thanks for the input.

 

[wscott]

Actually, I am not, in fact, an applicant for your fellowship, and have no vested interest. I rotated there as a student, and was underwhelmed. But do feel free to disparage me and my character. Doens't make what I said any less true, but feel free to do it anyway.

Tell me in which line did I directly disparage your character. I believe you did that without my help when you were 'feeling free' to slander the LSU program with inaccurate information. Your games may be effective in diverting some interest, those who see your foul-ball comments will have to make up their minds for themselves. Readers who are truly interested in getting a very solid all-around education with a heavy musculoskeletal component involving a lot of injections, should not be discouraged. Again, the strength of my argument is not with my word alone - I invite you to talk with any number of our residents, current fellows. or graduated fellows. By the way, Dr. Burke PM&R medical director at Harvard, and editor-in-chief of "Rehab In Review" is an LSU graduate - was he wrong too? I don't think so.

Hey, by the way you know my name, what is yours? Or are you not willing and sure enough to put your real name behind your comments? ....We all thought so.

 

[drvlad2004]

Tell me in which line did I directly disparage your character. I believe you did that without my help when you were 'feeling free' to slander the LSU program with inaccurate information. Your games may be effective in diverting some interest, those who see your foul-ball comments will have to make up their minds for themselves. Readers who are truly interested in getting a very solid all-around education with a heavy musculoskeletal component involving a lot of injections, should not be discouraged. Again, the strength of my argument is not with my word alone - I invite you to talk with any number of our residents, current fellows. or graduated fellows. By the way, Dr. Burke PM&R medical director at Harvard, and editor-in-chief of "Rehab In Review" is an LSU graduate - was he wrong too? I don't think so.

Hey, by the way you know my name, what is yours? Or are you not willing and sure enough to put your real name behind your comments? ....We all thought so.

Wow, it has become a heated argument. Going out of the way by calling yourself "Not An LSU Fan" only intensifies the situation. Regardless, when it pertains to a musculoskeletal fellowship, I have always told that it was not necessary to do one. That is unless you medical training in msk was weak. What makes some of these msk fellowships different than others, in terms of training. Although it is early, I am interested in doing either interventional spine, & spine, or sports medicine fellowship.