M3 Shadowing Home PM&R Program Next Week- Tips?

[HinduHammer]

Hi, I'm an M3 and going to be shadowing my home PM&R program for the first time next week with a couple docs in the afternoons after morning radiology clerkship. I was wondering what are some things I should know/do/ask in order to make a good impression and get the most out of my time?

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[DMBandFan86]

what are you shadowing? inpatient stroke unit, TBI unit, outpatient EMG clinic, pain specialist, sports clinic, etc ?

 

[HinduHammer]

what are you shadowing? inpatient stroke unit, TBI unit, outpatient EMG clinic, pain specialist, sports clinic, etc ?

Hi there-

One day is "Spine Clinic", the other day is "General MSK/Spine with Injections" ... thanks!

 

[j4pac]

There is nothing particularly special about PM&R vs other specialties.

- be on time
- don’t be trying to leave early
- show interest
- know your patients
- be a team player
- be good with patients
- be good with the entire staff
- be genuine

In regards to medical competence, just know what you’re suppose to know at your current level of training: MSK and neuroanatomy, basic neuro and MSK exam

 

[HinduHammer]

There is nothing particularly special about PM&R vs other specialties.

- be on time
- don’t be trying to leave early
- show interest
- know your patients
- be a team player
- be good with patients
- be good with the entire staff
- be genuine

In regards to medical competence, just know what you’re suppose to know at your current level of training: MSK and neuroanatomy, basic neuro and MSK exam

Thanks, that's always helpful to hear- the basics are the most important. I'm only going to be there for a few hours for a few afternoons, though I hope to increase my shadowing time after the visiting students leave, and theoretically do a sub-I next year, so I guess I'll just focus on the MSK/Neuro exams. When you say MSK exam, do you mean me able to perform a basic physical exam testing for strength, tone, reflexes, and maybe like an anterior drawer test or obturator sign? Since it's outpatient I guess I will brush up on my spinal anatomy and common spinal injuries.

 

[j4pac]

Thanks, that's always helpful to hear- the basics are the most important. I'm only going to be there for a few hours for a few afternoons, though I hope to increase my shadowing time after the visiting students leave, and theoretically do a sub-I next year, so I guess I'll just focus on the MSK/Neuro exams. When you say MSK exam, do you mean me able to perform a basic physical exam testing for strength, tone, reflexes, and maybe like an anterior drawer test or obturator sign? Since it's outpatient I guess I will brush up on my spinal anatomy and common spinal injuries.

I’d know a basic neurological exam and spine exam. Inspection, ROM, palpation, strength, sensation, reflexes, and special tests for the cervical and lumbar regions.

I’m sure there is something on YouTube that can give you a demonstration.

Know the C5-T1 myotomes, dermatomes, an bicep/triceps/Hoffman reflex...an ASIA exam serves as a decent starting point. I’d also know how to perform a Spurlings maneuver, the definition of a positive finding, and screening for carpal and cubital tunnel (Tinels is fine).

I’d also know the ASIA exam for the L2-S1 segments (I’d throw in hip abductors and foot evertors as part of the exam), patella/medial hamstring/Achilles reflexes and plantar response. For special tests know straight leg raise, what constitutes as positive, and a basic hip OA screening (internal/external rotation of the hip is a good starting point).

Just about everything will be myofascial/facet/radiculopathy, but don’t forget to be a physician. You have to consider things like myelopathy (reflexes are super important), cancer, infection (inspection very important), inflammatory disease (history very important), and neurologic disease such as ALS/myopathy/CIDP. But if you take a decent history and physical, you’ll be fine.

 

[HinduHammer]

I’d know a basic neurological exam and spine exam. Inspection, ROM, palpation, strength, sensation, reflexes, and special tests for the cervical and lumbar regions.

I’m sure there is something on YouTube that can give you a demonstration.

Know the C5-T1 myotomes, dermatomes, an bicep/triceps/Hoffman reflex...an ASIA exam serves as a decent starting point. I’d also know how to perform a Spurlings maneuver, the definition of a positive finding, and screening for carpal and cubital tunnel (Tinels is fine).

I’d also know the ASIA exam for the L2-S1 segments (I’d throw in hip abductors and foot evertors as part of the exam), patella/medial hamstring/Achilles reflexes and plantar response. For special tests know straight leg raise, what constitutes as positive, and a basic hip OA screening (internal/external rotation of the hip is a good starting point).

Just about everything will be myofascial/facet/radiculopathy, but don’t forget to be a physician. You have to consider things like myelopathy (reflexes are super important), cancer, infection (inspection very important), inflammatory disease (history very important), and neurologic disease such as ALS/myopathy/CIDP. But if you take a decent history and physical, you’ll be fine.

Thanks...I definitely have my evening reading for the next few days! I'll let you know how much of this stuff comes up this week.

 

[HinduHammer]

I’d know a basic neurological exam and spine exam. Inspection, ROM, palpation, strength, sensation, reflexes, and special tests for the cervical and lumbar regions.

I’m sure there is something on YouTube that can give you a demonstration.

Know the C5-T1 myotomes, dermatomes, an bicep/triceps/Hoffman reflex...an ASIA exam serves as a decent starting point. I’d also know how to perform a Spurlings maneuver, the definition of a positive finding, and screening for carpal and cubital tunnel (Tinels is fine).

I’d also know the ASIA exam for the L2-S1 segments (I’d throw in hip abductors and foot evertors as part of the exam), patella/medial hamstring/Achilles reflexes and plantar response. For special tests know straight leg raise, what constitutes as positive, and a basic hip OA screening (internal/external rotation of the hip is a good starting point).

Just about everything will be myofascial/facet/radiculopathy, but don’t forget to be a physician. You have to consider things like myelopathy (reflexes are super important), cancer, infection (inspection very important), inflammatory disease (history very important), and neurologic disease such as ALS/myopathy/CIDP. But if you take a decent history and physical, you’ll be fine.

Just wanted to give you an update-- I didn't use any of that except the Sperlings and Tinels sign hahaha. However I was overprepared which was good. The two docs I shadowed were very different and I really enjoyed my time, I am 80-90% sure that I will be pursuing PMR. Thanks