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There have been extensive discussions about the best programs, but to date, I have never seen anyone try and come up with a list of the programs to be avoided, if possible.
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- Thread starter ampaphb
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There aren't a ton, that is true. I have seen lots of posts saying to avoid Tufts though...
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I wonder if it is possible to obtain a list of all programs that are on probation by the ABPMR RRC. It would seem that these programs would be obvious places for prospective resident physicians to avoid.
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Does the ABPMR certify programs?
I have looked at the ACGME list of programs on probation and there are no PM &R programs on the list.
They also have a list of institutions on probation - which I don't really know what the implications of that are for that institution's residencies. Of the four institutions, Jackson Memorial is the only one with a PM&R program that I know of, but the rereview date was earlier this year so perhaps they've corrected whatever issues.
I have looked at the ACGME list of programs on probation and there are no PM &R programs on the list.
They also have a list of institutions on probation - which I don't really know what the implications of that are for that institution's residencies. Of the four institutions, Jackson Memorial is the only one with a PM&R program that I know of, but the rereview date was earlier this year so perhaps they've corrected whatever issues.
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No - the ABPMR does NOT certify programs. Just the ACGME.
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Probably just a disgruntled former resident. You'd need to track down more former residents to formulate an opinion.
Diva Nagula, DO 2003
Lisa Choung, MD 2005
Bruce Porter, MD 2004
Steve Lobel, MD 2004 (duh)
Former staff:
Karen Barr, MD (UWash)
Robert Mehrberg (private practice, Florida)
Paul Kornberg (Florida)
SUNY Downstate was on probation when I rotated their earlier this year. They were actually being reviewed when I was doing my elective. I dont really know what became of it though...might want to check before you apply...
The Michigan State program is closing at its current hospital. There is a chance that another local hospital will pick up the program, but this is still entirely uncertain. The current residents may be left to find open positions elsewhere. This is a huge blow to the DO PM&R programs. Anyone else have any information?
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I stand corrected, it is indeed the ACGME, not the ABPMR, that accredits residency programs.
The accreditations provided by the RRC for an applying program can be 1y, 3y and 5y in duration. Regrettably, it appears that the only way to ascertain the duration of the accreditation is by asking the program. It is my understanding that this information is made available to the program, but not to everyone else. I wondered whether we could direct individuals toward the 5y programs, but it would take some effort to compile a list of which programs these were.
The accreditations provided by the RRC for an applying program can be 1y, 3y and 5y in duration. Regrettably, it appears that the only way to ascertain the duration of the accreditation is by asking the program. It is my understanding that this information is made available to the program, but not to everyone else. I wondered whether we could direct individuals toward the 5y programs, but it would take some effort to compile a list of which programs these were.
to me, is a term that implies 1. we are not a great program right now 2. we MAY be a better program in the future. often times, "up and coming" is a term that residents use to give themselves hope that their program isnt in the gutter and that it is on the right track. i dont hear too many people call RIC, Kessler, or UW "up-and-coming". my former program has been "up and coming" for about 8 or 9 years now. any decade now, i expect it to turn the corner. the truth is that meaningful change in the direction of a program is extrememly difficult and times a LONG time due to personality types and institutional expectations. if you are applying to a program that is "up-and-coming" expect it to be very similar to the way that it is now.
also, i think that it is an EXCELLENT practice to inquire about the accreditation status of the program you are interested in. if its a good program, then they have nothing to hide, even if there is a relatively shorter accreditation. in general, the better programs have longer accreditations. this isnt always the case, in general it is true.
also, i think that it is an EXCELLENT practice to inquire about the accreditation status of the program you are interested in. if its a good program, then they have nothing to hide, even if there is a relatively shorter accreditation. in general, the better programs have longer accreditations. this isnt always the case, in general it is true.
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First, someone mentioned U of Washington being a malignant program. I don't have any personal ties to the program, but from speaking to many residents, my impression is that the reputation is definitely NOT warranted. For some reason, that reputation has stuck around from over 10 years ago, when there was some issue. Again, I don't have any personal investment in Washington, but they are by all accounts a terrific program and not at all malignant
As for accreditation, programs can be accredited for 4 years, not just 1, 3, or 5 years
Finally, for what it is worth, UAMS (Arkansas) had been on probation, but the probation has been lifted, and they are on a 3 year accreditation cycle now.
As for accreditation, programs can be accredited for 4 years, not just 1, 3, or 5 years
Finally, for what it is worth, UAMS (Arkansas) had been on probation, but the probation has been lifted, and they are on a 3 year accreditation cycle now.
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Well, I'm at NYU now so I can certainly give a first-hand report. My understanding is that the past reputation of being malignant here was well deserved -- residents worked far longer hours than people in other rehab programs, and the administration was slow to respond to the suggestions (and pleas) of the struggling residents.
Today, the situation is just fine, though we continue to try to make improvements as any program should. The new program director is being proactive in effecting change for the better, and resident input is highly valued. Our hours are no different from the hours reported by residents at many other programs currently, and though we are inpatient- and call-heavy in the first year, it balances out in the final two years.
One area that, in my opinion, needs improvement at NYU is the didactics. The quality of lectures varies widely. Right now we are working on culling the best of the best from the current schedule while actively identifying new lecturers to become staples in our curriculum; we're also trying to organize the schedule in a way that makes more logical sense than it currently does (right now it seems a little disjointed, hopping from topic to topic without much rhyme or reason). We're not there yet, but we're working on it, and the program director is leading the charge.
Occasionally in this forum, the NYU name still pops up as having a reputation for being malignant. It's a holdover from older days, and really doesn't apply to today's situation. I'm hoping that my presence here on the forum will aid in dispelling the myth and reflecting the reality of the program.
Today, the situation is just fine, though we continue to try to make improvements as any program should. The new program director is being proactive in effecting change for the better, and resident input is highly valued. Our hours are no different from the hours reported by residents at many other programs currently, and though we are inpatient- and call-heavy in the first year, it balances out in the final two years.
One area that, in my opinion, needs improvement at NYU is the didactics. The quality of lectures varies widely. Right now we are working on culling the best of the best from the current schedule while actively identifying new lecturers to become staples in our curriculum; we're also trying to organize the schedule in a way that makes more logical sense than it currently does (right now it seems a little disjointed, hopping from topic to topic without much rhyme or reason). We're not there yet, but we're working on it, and the program director is leading the charge.
Occasionally in this forum, the NYU name still pops up as having a reputation for being malignant. It's a holdover from older days, and really doesn't apply to today's situation. I'm hoping that my presence here on the forum will aid in dispelling the myth and reflecting the reality of the program.
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I heard, through the interview trail way back when, that while you work hard, UW is by no means malignant as well.
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I would hold off ripping on one particular program unless you have direct knowledge...for example, when I was doing an away rotation as MS, the current PGY2 had a lot of positive things to say about EVMS...and NYU did have the reputation of being malignant a few years ago but that has changed.
As far as Tufts, it would still be considered an up and coming program with a new PD and some improvements down the pike, from what I have heard...
Good luck to all MS4s on the interview season.
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I don;t consider it ripping, and there will clearly be difference of opinion, as well as current residents who feel loyal to their program, and want to defend its rep.
That being said, I do think it is important that, just as we distinguish the 10 in the top 5, and the 20 in the top 10 (I am a believer that there are clearly more great programs than the "super six" bandied about on this board), we should make med students aware of the places that should either be avoided if possible, or used as the equivalent of safe schools when applying to college.
Will there be people on here with axes to grind? You bet! but consensus will win out over time, and I have sufficient faith in the readership of this board to give them credit for distinguishing cranks (like me
) from those with reasonable opinions.
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I am in no position right now to rip any programs. That is just something I have commonly seen scanning the threads in this forum. I personally don't have any opinions, or have any judgments about programs, which is why I tried to make sure I indicated that is what I have seen, not what I think. All I'm concerned with right now is trying to do well on Step I.
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I rotated as a medical student at UW back in the late 90's. The overall education was clearly quality, but the inpatient load was out of proportionate to what other programs were doing at the time. The attitude among the faculty was...how shall we say, "Aloof." I think that the rain really effects them there...At the time, I thought that they were the most prestigious PM&R program West of the Mississippi.
I agree with ampaphb that there are some under-recognized programs out there. One that has impressed me over the years is Columbia, Missouri. If you look at there rotation schedule it is very "balanced."
http://som.missouri.edu/PMR/RotationSchedule.html
I think that UC Davis has a very good program and is probably rapidly catching up to the UW
http://www.ucdmc.ucdavis.edu/pmr/education/index.html
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Thanks for the mention of the UC Davis program. (Excuse the slightly outdated website.) We were actually just re-accredited for five years which was great news. There are plusses and minuses to smaller programs, so program size is an important factor to consider during the whole process. However, I definitely think we have carved out a nice niche here in northern California and have put out very well-rounded graduates. While there are lots of strengths in outpatient areas, grads feel comfortable doing inpatient, peds, etc.
That being said, UW is still an academic powerhouse in my book.
The idealistic (and somewhat naive) beauty of the whole matching process is hopefully programs and applicants find the right matches for each other in the end.
E
espfactor
I would agree and disagree with some of the previous posts out there. The words "up and coming," I couldn't agree more. That is a long round-about term. That takes a while to finish. I also agree with the not ripping on program unles you are there. I disagree with the assessments of NYU. I won't say it's malignant or not. I'm just gonna lay it down like this.
1)You don't rotate through specialties, you rotate through hospitals. in our first year, you rotate through 3-4 hospitals every three months. Everytime you get used to a system you have to start over. The residents are spread out across so many darn hospitals that the call situation stinks. We are used as cheap labor for the attendings (mostly private at Rusk).
2)The curriculum: you spend more time on Cardiac Rehab than you do on any other specialty. Last I check, none of the top programs have you do more than a few weeks, if at all let alone 3 months. Then you go to a VA then another VA. There is so little TBI, SCI, MSK, etc, you are literally reading constanty just to keep up with everyone else from just their normal curriculums. Not too mention you don't touch EMG's until your last year, pretty much after you are interviewing and auditioning and the seniors arer fighting over each other if not having to stay an extra week or so just to finish the 250 required.
3)Hours? Improved...kinda. It just depends what rotation you are on. Cardiac, you are on call every weekend for the entire 3 months, sometimes twice in the same weekend. You can get this rotation in your R-2 year, so it's not all your 1st year that sucks. Moreover, the attending doesn't round until 4PM. Peds in your 4th year, hours suck.
4)Lectures: very disjointed, don't always happen, not always prepared, sometimes incredibly irrelevant. I hear from some of the people at Bellevue that they get lectures on billing and work hours. I can't even remember the last time I saw them come to Grand Rounds and they are only 2 blocks from Tisch.
5)Outpt: now I don't know about you, but I think the majority of those thinking rehab are thinking outpt. The clinics, again just from my friends there now...they tell me that there are 75-90+ patients scheduled a day. They run from one patient to another having absolutely no time to spend learning or even listening to the patient. The director there has been there for 30 years, so it won't change anytime soon.
6)MD vs DO: Almost all DO's at this point in the program. I'm a DO so I have nothing against it, but I feel like I didn't bust my butt for anything to get here. I tried to set myself apart from my DO class but ended up back surrounded 12 out of 15 in the class
7)Next year: Some people I know that are slated to start next year have started making calls looking for PGY-2 spots elsewhere. Rumor? maybe. 2008 match? Haven't seen very many students rotating except from NYCOM and those that did don't seem very interested in the curriculum.
I'm here, but the rumors of people leaving are true. Everytime I talk to someone there is a rumor of another person going back into the match or trying to switch programs. Who knows where the truth is but for every dollar of gossip there is a cent of truth. There are some attendings that are leaving, and not the bad ones. Everyone is miserable. Most of the posts you read, and no offense to karayoke, whom I don't know, but these are R-2 that are riding out the program at this point and have come too far to turn back. They are trying to make the best of a bad situation, and you have to respect that. To those that are in no situation yet, choose a good one and not one that is up and coming. Cuz it might be on its way up but not get there until after you leave. Choose one that is already there.
1)You don't rotate through specialties, you rotate through hospitals. in our first year, you rotate through 3-4 hospitals every three months. Everytime you get used to a system you have to start over. The residents are spread out across so many darn hospitals that the call situation stinks. We are used as cheap labor for the attendings (mostly private at Rusk).
2)The curriculum: you spend more time on Cardiac Rehab than you do on any other specialty. Last I check, none of the top programs have you do more than a few weeks, if at all let alone 3 months. Then you go to a VA then another VA. There is so little TBI, SCI, MSK, etc, you are literally reading constanty just to keep up with everyone else from just their normal curriculums. Not too mention you don't touch EMG's until your last year, pretty much after you are interviewing and auditioning and the seniors arer fighting over each other if not having to stay an extra week or so just to finish the 250 required.
3)Hours? Improved...kinda. It just depends what rotation you are on. Cardiac, you are on call every weekend for the entire 3 months, sometimes twice in the same weekend. You can get this rotation in your R-2 year, so it's not all your 1st year that sucks. Moreover, the attending doesn't round until 4PM. Peds in your 4th year, hours suck.
4)Lectures: very disjointed, don't always happen, not always prepared, sometimes incredibly irrelevant. I hear from some of the people at Bellevue that they get lectures on billing and work hours. I can't even remember the last time I saw them come to Grand Rounds and they are only 2 blocks from Tisch.
5)Outpt: now I don't know about you, but I think the majority of those thinking rehab are thinking outpt. The clinics, again just from my friends there now...they tell me that there are 75-90+ patients scheduled a day. They run from one patient to another having absolutely no time to spend learning or even listening to the patient. The director there has been there for 30 years, so it won't change anytime soon.
6)MD vs DO: Almost all DO's at this point in the program. I'm a DO so I have nothing against it, but I feel like I didn't bust my butt for anything to get here. I tried to set myself apart from my DO class but ended up back surrounded 12 out of 15 in the class
7)Next year: Some people I know that are slated to start next year have started making calls looking for PGY-2 spots elsewhere. Rumor? maybe. 2008 match? Haven't seen very many students rotating except from NYCOM and those that did don't seem very interested in the curriculum.
I'm here, but the rumors of people leaving are true. Everytime I talk to someone there is a rumor of another person going back into the match or trying to switch programs. Who knows where the truth is but for every dollar of gossip there is a cent of truth. There are some attendings that are leaving, and not the bad ones. Everyone is miserable. Most of the posts you read, and no offense to karayoke, whom I don't know, but these are R-2 that are riding out the program at this point and have come too far to turn back. They are trying to make the best of a bad situation, and you have to respect that. To those that are in no situation yet, choose a good one and not one that is up and coming. Cuz it might be on its way up but not get there until after you leave. Choose one that is already there.
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I agree that nobody should be dissing on a program they haven't been a part of.
I was hoping someone would defend Stanford when it was called malignant, but nobody did, so I guess it's up to me. Admittedly, in the past, the program has had some problems, but a lot of changes have been made this year and things are already much better. I don't know if there's as much injection experience as at other programs, but in general, I think you get a pretty solid education there.
I was hoping someone would defend Stanford when it was called malignant, but nobody did, so I guess it's up to me. Admittedly, in the past, the program has had some problems, but a lot of changes have been made this year and things are already much better. I don't know if there's as much injection experience as at other programs, but in general, I think you get a pretty solid education there.
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You did well to post this message.
I think the ACGME PMR RRC should make a requirement at time of accreditation that programs submit in their accreditation packet a summary of resident perceptions of the program, in areas that are relevant to the accreditation of training programs. Further, it should be made available to them...anonymously (that is, it came from the residents, but which residents did what writing remains unknown.)
I hope anyone that is thinking of applying to the NYU/Rusk program takes note of the cited post.
As an attending, it is often perceived that residents are often an unhappy lot, and are always complaining. There are never enough didactic lectures, "please spoon-feed me my knowledge," there is too much work for the amount of teaching, there is too much rehab relative to musculoskeletal teaching, there aren't enough procedures, etc. PGY-2s are the most unhappy of all residents (there are reasons for this). OK, some of the perception that residents complain a lot has a basis in fact, depending upon the resident. Having said this, there are far too many programs where the programs lost sight of the fact that the primary motivation for having a residency program is (or should be) to educate the next generation of physiatrists. If the hospital wants better/more consistent delivery of care, it should probably hire a nurse practitioner/physician's assistant. If the hospital wants a reputation in research, then sponsor a fellowship program and hire attending physicians who are also clinical investigators. Too often, attending physicians complain about the residents complaining about the obvious-the residents are expected to work, if they learn something while they work, that's a bonus.
We will need to work harder to strike a balance, and some programs will need to work harder at this than others. I would prefer fewer programs that can reach this balance well, and close down the rest.
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What do you think of the attendings at the Spine Center?
I had been at a fellowship interview there a few years ago and one of the attendings was giving a basic lecture on low back and neck pain.
I asked a question about upper extremity dural tensions signs and nobody knew what I was talking about. They kept asking if I was talking about the Adson's maneuver.
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Exactly.
That is such a BS attitude. If the residents were there just to work, they could have gotten a liscense after intern year and worked for a pharmaceutical company, or completed a short IM/FP residency and worked as a hospitalist or in urgent care.
Obviously, residents should learn by doing (working), but it is the responsibility of the program to make sure that every opportunity is made for:
1. The residents to do well on their boards
2. The residents to be well trained and marketable in whatever their chosen PM&R career path may be. If a fellowship is required, then the program should make the effort to see that the resident is set up well for that fellowship.
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It's good to hear honest feedback from the current residents.
I just wanted to say that I personally know a lot of former students who had positive experiences at Rusk. I think there's something to be said for the number of NYU/Rusk residents who choose to go there after being students in the department. As a matter of fact, I know one of the students doing a rotation there right now who says she loves it.
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There is such a survey and when RIC had our site visit - we residents had to fill out an anonymous online survey. We got the results of the survey and there definitely were differences between the internal surveys and this survey. There weren't too many shocking or disturbing findings on the survey but there definitely were problem areas that were brought up during our annual program review meeting. (residents and attendings in attendance) For example - ensuring that there is adequate work space on each floor, that we have truly "protected" lecture time (we still have nurses calling with trivial questions), etc.
A lot of times with internal surveys, people are afraid that they may be tracked. The online survey truly was anonymous - and we didn't get the results until recently - so 1/3 of the respondents had already graduated - so I think those results were more reliable. So definitely - the ACGME is aware of the issue of making sure residents are being heard.
E
espfactor
It's good to hear honest feedback from the current residents.
I just wanted to say that I personally know a lot of former students who had positive experiences at Rusk. I think there's something to be said for the number of NYU/Rusk residents who choose to go there after being students in the department. As a matter of fact, I know one of the students doing a rotation there right now who says she loves it.
Yeah, that appears to be why people apply at all is their experience at Rusk. Rusk is just one rotation that you do, though. You are there for at most 6 months out of the whole 3 years. As I said before, your rotations are every where else. The only thing they show you is Rusk as a student rotating, maybe Bellevue and the VA, thinking that those are just minor rotations, but they aren't. The running joke we all have now is we call it "the ole' bait and switch."
In all fairness, Dr. Moroz (PD) is absolutely committed to trying to change the program. This man has incredible conviction, professionalism, and is a kind person. Unfortunately, when he confronts many of the attendings to change things about the program that hinder learning and a good resident experience, he hits a brick wall. My understanding from other people is that he is even having to petition the Chief Medical Officer of NYU to change things as some attendings don't care and simply want things done their way. You understand my point, he is having to go outside the department, to the head of the hospital because he can't get things the way they should be. Dr. Moroz is the man, what stinks is that being where he is...is a waste of his creativity and talents. If Rusk can obtain a new and good Program Chair, I see this program returning to greatness. Until then?
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This is welcome news. I trained at a "top 5" program, taught at another, although I haven't been in the academic physiatric setting in a few years. I found that these programs were committed to teaching, and empowered their residents (with some constraints) to take an active role in improving their graduate educational experience.
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Disciple,
I hope you didn't infer that I thought resident learning "was a bonus". To the contrary, it IS the reason for the existence of residency training programs. Yes, residents must work in order to learn, but there must be a flexible balance of work/teaching. Those attendings who are unable to provide their share of the teaching, but carry the expectation of resident labor, probably shouldn't be assigned residents for educational rotations.
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It was not my intention to accuse you, my apologies if that's what it sounded like. I do know more than a few academic attendings with the type of attitude you describe. Not suprisingly, it happens to be the ones who could not find suitable positions in private practice.
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I don't know a lot about the fellowship, but I can tell you that the attending in our Pain & Spine Clinic is AWESOME. He's very smart, cares a lot about the residents, and is extremely dedicated to teaching. He's pretty much beloved by all. I'm not sure how long he's been with the program... he's fairly young.
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Shrike,
Given your former academic work, I'm curious about your thoughts regarding a prevalent perception that---unlike many other fields in medicine--- innovative, cutting-edge physiatric practice does not occur in our specialty's academic training centers. That is, in physiatry, the private practice sector (tail) wags the academic sector (dog). Case in point, let's consider the field's roll-out of its new journal (which I'm excited about). In part, the motivation for this was due to the perception among practicing clinicians that the scholarly content of the Archives is irrelevant to their daily practice. Could you ever imagine Internists saying the same thing about the NEJM or their academy's journal??
Over the last 5 years I've seen more PM&R training programs REACT to the changes in private practice physiatry market, demand, and service delivery instead of the other way around. I believe that it is important to have as broad-based training in PM&R as possible, but I often wonder if our "Top-5," "Super-6," or "Terrific-10" training programs are equipping trainees with an out-dated, out-of-demand, skill set...
Thoughts??
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drusso,
I think you have touched upon an extremely relevant, but complex issue(s). No question, there is some truth to the perception regarding the rapid evolution of the musculoskeletal/pain/interventional aspects of physiatric practice that have been driven by our colleagues in the private practice setting. The academic physiatric programs are responding (or reacting); some slowly, some more vigorously, perhaps some none at all.
Having said this, I think it is only fair that we acknowledge that these trends did not evolve in a vacuum. There are powerful forces, mostly economic forces/reimbursement patterns, that would likely work differently for the academic vs. private practice environments, and for inpatient versus outpatient practices, and these forces influence the evolution of the respective practice settings. I will elaborate.
On the inpatient side, there are few "engines" to drive advances in care. Financially, payors (including govt-MC, MD) don't provide incentives for improving the quality of life of our patients, or improvements in function. Cost shifting is the name of the game; payors merely capitate what we provide. Medicare has taught us how to be better cherry-pickers, to the disadvantage of some of our patients. Mortality has increased (Ottenbacher et al 2004), outcomes have not grossly improved, and the modest evolution of translation of research advances into the clinical setting has been far, far more rapidly outpaced by the drive to reduce cost. This is what has been seen for inpatient NEUROrehabilitation (academic or private); for inpatient ORTHO rehab, it has been virtually tossed out the window.
In neurorehab, I do not believe that the private practice setting is setting the pace for clinical advances. Consider that as recently as 12 years ago, I could place ALL of the published citations for botulinum toxin's role in spasticity on a single slide. Consider further that physiatrists were instrumental in bringing intrathecal baclofen into use for those with stroke and acquired brain injury, and that spasticity management as a clinical practice evolved in academic PHYSIATRY. Integration of advances in super-orthotics/robotics, integration of BWSTT into the clinical setting, are other examples of progress where we are leading or taking an active collegial role. Physiatrists, more than any other specialty, are responsible for advancing care in SCI medicine. Neurorehab skill sets are not out-of-demand, or out-of date, but they have evolved slowly. Financially, neurorehab is less lucrative, but these skill sets are still needed.
On the outpatient/musculoskeletal/pain side, intervention-oriented practices provide strong "engines" that are driving the most significant evolution of the modern physiatric practice. Historically, there was a clear "gap" in the scope-of-practice of orthopedists and anesthesiologists that our young generation of physiatrists recognized and were willing to fill. Financially, work comp/private insurance/MC rewarded our colleagues for the improvement in outcome that their broad skill sets brought to the patient, relegating surgery to those who truly needed it. One could question why this couldn't evolve from the outpatient academic physiatric setting. Having acquired the skills in the private practice setting (in many instances), and with little financial incentive to bring those skills back into the academic setting, the evolution of physiatric practice builds a virtuous cycle for the private practitioner, and a vicious one for the traditional academic setting. I know of Chairmen who would like to bring these clinicians "into the fold", making them clinical academic faculty who will teach the future generation of physiatrists (ie residents), but most private practitioners are unlikely to be willing to pay for a resident FTE. Thus, the FTEs tend to be disproportionately distributed to the inpatient-hospital and the VAs that are willing to pay for them. The cycle is thus perpetuated.
Regarding the excitement generated at the prospect of a new journal, I think the degree of excitement will be influenced by the type of practice and practitioner. In fairness to the Archives, it has had a challenging role to fill. For much of its recent history, we have shared the journal with the ACRM, and the content that was of interest to some of our Ph.D. colleagues may not have resonated to the same degree with us. Even so, we return again to the multifaceted (diverging?) aspects of our field. Our musculoskeletal/pain colleagues in private practice almost certainly don't use the Archives as their primary literature source of cutting edge MSK/pain knowledge, augmenting their reading with journals such as Spine, Pain, JBJS, etc. Our neurorehab colleagues similarly will augment their reading with journals such as Stroke, Brain Injury, JHTR, JNNP, etc., and our spinal cord & pediatric rehab colleagues have several journals that more admirably fit their needs. Do you believe that one journal can be all things to all of our physiatrists and subspecialists? It can't, but it should do its best to address some of the needs of each, and to the large contingent of generalists that still make up a large part of the field. (Cardiologists probably read JACC more than NEJM, general internists read Ann Intern Med also, no journal can be all things to all clinicians, in ANY specialty.) The review article-oriented format of our new journal will help improve relevance to many clinicians, but no field can thrive on review articles alone. We still need the research, and it needs to be published somewhere.
In summary, drusso, our specialty (including both practitioners AND academicians) has its work cut out for it. Our broad scope of practice is a great advantage, and in some aspects a notable challenge at the same time. Our strongest academic programs, whether they be "top-5" or "top-10", will need to work hard to bring the advances of ALL of the best aspects of our diverse specialty, whether they are MSK/pain or neuro, pedi or geriatric, to our next generation of physiatrists. If successful, our trainees will hopefully then be ready to branch out on their own, whether in private or academic practice, and push the field further forward in whatever directions they lead.
Well, that's my 2 cents worth. I would be interested in hearing your response.
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I think it's such a poor idea to start a thread of this sorts, very poor taste to say the least. You're going to offend a lot of people and you have dragged so many good programs through the mud. I hope we end this right here and now!
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I originated this thread, so I will take it upon myself to defend it's purpose
No program wants to be last, but we all know there are programs that have less than stellar reputations.
Med students are entitled to know the good AND the bad about all programs.
We argue ad nauseum about the best programs, but no one is willing to discuss which programs ought to be avoided.
I do not wish to deride, impugn, or in anyway speak ill of programs. None the less, facts like which programs have had three residents leave in one year, which programs have been on probation, etc, are only part of the story. Residents are unhappy at times during their residency - that is a fact of life. However, some programs' residents are consistently unhappy, and those are the programs med students should be made aware of.
I am sorry if that offends sensibilities, and if you go to one of the programs listed, by all means, use this as a forum to tout the virtues of your training. No program is all good or all bad, and the more details that are available for potential applicants to use in weighing the pros and cons of individual programs, the better, IMHO.
Sunshine is the best disinfectant.
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I disagree with you 100% and I think that up to this point everyone has behaved professionally and discussed an otherwise contentious issue with fair-handedness and balance.
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No one is trying to drag any program through the mud. I think it is fair, however, to encourage colleagues to identify programs that are in need of improvement through first-hand reports of educational conditions in those programs.
I don't think there is a single program where educational conditions couldn't be improved, and that is in the best of programs. I have given grand rounds presentations at a substantial number of programs, and have had the opportunity of meeting the residents for subsequent lectures. In a few instances, my encounters with the residents and junior faculty left me with an uneasy sense about the overall quality of their educational experience relative to some of the strongest programs (high faculty turnover, high resident turnover, physiatry departments being swallowed by other departments, poor structure in the didactic programs, poor balance in outpatient vs inpt/MSK vs CNS vs EDX).
I think this is a legitimate forum to address these concerns, and focus attention of other attendings, residents, and potential future residents on the limitations of these educational settings. Again, if you read the posts, you will find that first-hand experiences are given the most consideration. No mud-slinging here.
I don't think there is a single program where educational conditions couldn't be improved, and that is in the best of programs. I have given grand rounds presentations at a substantial number of programs, and have had the opportunity of meeting the residents for subsequent lectures. In a few instances, my encounters with the residents and junior faculty left me with an uneasy sense about the overall quality of their educational experience relative to some of the strongest programs (high faculty turnover, high resident turnover, physiatry departments being swallowed by other departments, poor structure in the didactic programs, poor balance in outpatient vs inpt/MSK vs CNS vs EDX).
I think this is a legitimate forum to address these concerns, and focus attention of other attendings, residents, and potential future residents on the limitations of these educational settings. Again, if you read the posts, you will find that first-hand experiences are given the most consideration. No mud-slinging here.
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I disagree. I feel chlorine, alcohol, chlorhexidine, and benzylkonium all superior to sunshine.
The biggest problem is the ACGME RRC for PM&R would rather not hear about any of these things from residents. And once you are out of the program (graduated/transferred), you go from disgruntled resident, to disgruntled former resident. EVMS had its accreditation yanked for a full week in the winter of 03-04. The powers that be had the disciplinary action wiped away and made it disappear. THe folks who were residents at the time probably all still have the letter from GME.
This thread is too important not to exist and be added to frequently. There are 80+ training programs and only 5 top programs. The remaining 75+ programs need to be discussed and programs with serious problems need to be addressed at the residnet level in a public forum such as this.
My recommendation to anyone who sees things that are not right within their program/department is to keep your mouth shut and serve your time. Even after you get the piece of paper, you are still beholden (if its a word) to the program for eternity for letters of recommendation/certification. Any bad blood between you and the program will come back to bite you every time you want privilges or licensure.
Progress within a program can only come with staff changes. It would be wise to post under a pseudonym if you are a current resident or send the post via PM to an attending on this board to post for you. Why do you think I disguise my identity?
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I think the problem is the subject of this thread, "Bottom 5-10". I'm sure there are residents willing to admit their program has issues or even tell med students to avoid it. But I'm sure those same residents wouldn't like to think of themselves as being in a "Bottom 5" program. That's just insulting.
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The point is that it is equally ridiculous to consider yourself being from a "Top 5" program. The "Fantastic-5, Super-6, Terrific-10" or whatever are designations largely driven by reputation alone.
I think that the point of this thread is to expose the "active ingredients" in a good PM&R residency. There must be some very good programs and there must be some very bad programs out there too. Differentiating what makes one program good and the other bad is important.
PM&R training programs should avoid succumbing to the Dodo Bird Verdict; "Everybody has won and all must have prizes."
http://en.wikipedia.org/wiki/Dodo_bird_verdict
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Interesting comments from above but I feel the need to correct/address the comments from the previous post from the clearly disgruntled pgy-2 at Rusk/NYU. The fact that you rotate through 4 hospitals (Rusk, Bellevue, Manhattan VA, and Hospital for Joint Disease) is an asset to the program and should not be looked at negatively b/c "everytime you get used to a system you have to start over." You see private pts at Rusk, a wide variety of medically underserved patients at Bellevue including war victims seeking asylum in NYC from other countries, you see veterans including those from Middle East at the VA, and you see a large amt of MSK patients at Hospital for Joint Disease. All hospitals within walking distance from 17th St to 34 St. You don't need a car which can't be said for MANY programs.
As for the comment about not getting TBI, SCI, MSK, that couldn't be farther from the truth. Half of the 6th flr at Bellevue Hospital's rehab unit is practically all TBI - 20+ beds alone. SCI patients are throughout Rusk and Bellevue and no MSK? I'm not even sure how to address that one. All I ever do is address MSK patients especially in outpt clinic. As for EMGs, all pgy-3s have already started logging in EMGs - especially at the Manhattan VA and Brooklyn VA and on the EMG rotation. Want more? You have a total of 3 more months of elective time. Granted, its harder to do them at Rusk and Bellevue b/c of the inpt duties and Bellevue clinic. Trust me, "the seniors are fighting over each other if not having to stay an extra week or so just to finish the 250 required" is not a true statement. We're only 4 months into the academic year, so how is it that you're seeing seniors fighting over each other? I can tell you that I have not seen such a thing. Last year's senior class actually helped each other quite a bit- especially when they saw interesting cases. All seniors that wanted their quota, got their quota.
Didactics have always been on the weaker side, but they're still not bad. Many are actually outstanding. I've never really seen a lecture that wasn't prepared. Most of the lectures are from faculty members at NYU Med Ctr or outside hospitals and they know their stuff. Not sure what you mean by that. As for the Bellevue Hosp people that don't show to lectures, the people that don't show are the very people who have been complaining about the didactics - pgy2s. If you don't show, you don't know... right?
Look, I can go on and on all night about every issue, but ESPfactor, along with some other of his classmates, are clearly disgruntled. Been there, done that. The pgy-2 yr among most programs is least favorable out of the three. As has been mentioned in previous posts, it gets much better as a pgy-3 and 4 mainly b/c the call schedule gets better. But if you go into it with a bad attitude, then it'll all be bad no matter what. NYU/Rusk is not perfect, but I don't know of too many programs that are. We've made BIG time changes in the last 16 months since Dr Moroz took over. I've seen it. And changes will continue to occur. I was just in a mtg today with Dr Moroz and the Chiefs to completely revamp the interview day/tour this year.
If people want to txfr out and find another program, I encourage it cause let's face it, these are the very people that are more than likely to be just as unhappy in another program. Some people see the glass half empty, others half full.
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I'd have to agree. Every program being "outstanding", "fantastic" or "up & coming" doesn't really provide useful information to anybody.
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What if you do that and come out weak clinically?
Or come out with solid skills, just not the ones you want?
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Then seek the training you desire/need while in practice through colleagues and CME.
Changing from within is hazardous at best, career ending at worst.
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Two programs I interviewed at have a one-year accreditation, and a two-year accreditation. How heavily should I consider this in making my decisions about my ROL? Is the difference between a 1-yr program and 5-year one that would be noticable on a resident-level?
