Andrew

Author's details

Date registered: July 27, 2011

Latest posts

  1. Book Review. Better: A Surgeon’s Notes on Performance — April 18, 2017
  2. How to Match into a Great Emergency Medicine Residency — July 13, 2015
  3. Why did you go into Emergency Medicine? — July 13, 2015
  4. Best Books and Resources for the Internal Medicine Rotation — July 13, 2015
  5. Best Books and Resources for the Family Medicine Rotation — July 13, 2015

Most commented posts

  1. Top 10 Most Disgusting Medical Conditions — 37 comments
  2. Radiology: “Don’t Choose Something You Hate” — 33 comments
  3. Goljan Audio Lectures and High Yield Notes — 27 comments
  4. Comparing the Best Human Anatomy Atlases — 20 comments
  5. Conversion Disorder vs Factitious Disorder vs Malingering — 13 comments

Author's posts listings

Best Books for the Emergency Medicine Rotation

 

This post is part of our series on the best books and resources to help you perform well on your third year rotations and shelf exams. Also check out our lists for clerkships in Internal MedicineFamily MedicineOB/GYNGeneral SurgeryNeurologyPsychiatryPediatrics, and Emergency Medicine. You can also check out our complete list of "Best Books" lists for medical students here

Background: Clerkship Grades

At the beginning of each of these clerkship lists there are a few things I must say. First, your grade on clinical rotations will depend on both your clinical performance and your performance on a shelf exam at the end of the rotation. While it is true that how you work with your teams and patients will play into your evaluation, there is no denying that your knowledge of the subject matter is, by far, the most important part of your final grade because it directly affects both of these two areas of evaluation. As a resident, I currently find myself filling out medical student evaluations every week. There are very few 'incredible' medical students and very few 'terrible' medical students. The vast majority of you (~95%) fit into the "good and easy to work with" group; the only thing you have to set you apart from others is your knowledge base. You have no alternative but to study! First Aid for the Wards is a great resource to understand the dynamics of your clinical rotations, I highly recommend it.

Essential Resources

The resources I will describe in the clerkship lists are books and online question banks. From the onset let me point out two indespesible resources that I will not list for each rotation individually.

  • First, I consider a great online question bank essential. Both Kaplan and USMLE World are very good products. I highly recommend purchasing a one year subscription to one of these USMLE Step 2 question banks. As you complete your third year rotations, these question banks will prepare you for 1- your clinical duties, 2- your rotation shelf exam, and 3- the USMLE Step 2 during your fourth year.  
  • Second, online review materials (e.g. Medscape, UpToDate, etc.) are essential resources to prepare for your patients in the hospital. The books and question banks can never provide the type of in-depth detail about disease processes that you will need to learn how to properly take care of your specific patients. To be a great medical student, you must prepare more profoundly for the diseases you are encountering personally in the hospital.

Book Series for Third Year

Medical students are not all made the same; we are all very different learners. There are a number of companies producing review materials for third year medical students, each with a slightly different focus. Each of these companies produce a different book for each clerkship. Interestingly, some companies' books are rated higher in some clerkships than others. If you find a product that works for you, consider sticking with it during your third year even if that product is not 'rated' as highly for a specific clerkship. Below are a few of the review products and their features.

  1. The Case Files Series: A unique teaching model; the Case Files series introduces a number of important clinical cases and follows them up with clinical pearls and important concepts. For students who need vivid clinical situations to remember factoids and concepts, this is a great series. (Case Files Emergency Medicine)
  2. The PreTest Series: The PreTest series is a classic question bank format with questions and detailed explanations. As I previously mentioned, I believe there is no substitute for a great question bank. While an online resource (USMLE World or Kaplan) can be more robust and mobile, a good question book is still a great option. The PreTest series produces a couple fantastic question banks. (PreTest Emergency Medicine).
  3. The BluePrints Series: The BluePrints series has a beautiful format that is very easy to read. The text is laid out in a bulleted lists, but with more details and descriptions than the First Aid series with which most students are familiar. I think very highly of these review books. (Blueprints Emergency Medicine).
  4. First Aid Clerkship Series: The First Aid series well known to most students also produces review books for third year clerkships. The content is similar to what students are used to, bulleted lists of high yield information. While I highly recommend many of the First Aid review books for USMLE Step preparation, the books are not quite as widely read and recommended for clerkships. (First Aid Emergency Medicine).

Best Books for Emergency Medicine Rotation

So, we can agree that books are not sufficient for success on your clerkships, but they are still an incredible resource that you should tap into. Let's review the best books and resources for your General Surgery rotation. These lists come from both my experience and also from one medical school's annual survey of its 250 graduating medical students who try to detail which resources were the most useful on their rotations.

Most medical students will complete their Emergency Medicine clerkship in their fourth year, which means you will be well trained and there will be much expected of you. On the wards and operating rooms of your third year of medical school you rarely encountered medical emergencies; these are now the most important thing. While you know a lot about medicine now, you don't know much about the acute treatment of medical emergencies. When you are in the ED, you must change your mindset; you are no longer trying to cure disease, you are trying to stabilize patients so they can be transferred safely to the wards. The best way to change this mindset is to read clinical scenarios that put you in these situations. Also, don't forget to touch up on your EKG interpretation (Rapid Interpretation of EKG's), which will be highly relevant tot his rotation.

 

1. Emergency Medicine Secrets:

The most well-respected text by medical students for the Emergency Medicine clerkship; Secrets provides high yield bulleted lists and clinical scenarios. I highly recommend this book.


 

2. Case Files Emergency Medicine:

Case Files is a great addition when preparing for the Emergency Department and the EM shelf exam. By now, many of you know this series well and know what to expect from this well-regarded series of clinical scenarios.

3. An Introduction to Clinical Emergency Medicine:

A great introduction to clinical EM, this book is often provided to medical students. This would also be a great reference in a general practice clinic, so you will likely refer to it over and over again even if you are not going into emergency medicine.


 

4. Tintinalli's Emergency Medicine Just the Facts:

The Tintinalli name is well known in Emergency Medicine. This book is small text made specifically for the EM clerkship. It has a clean format and is well received by most medical students. 


 

Basics of Fundus Drawing

Few ophthalmology residents today learn the art of color fundus drawing. This used to be a fundamental skill required by all ophthalmologists. With the advent of electronic medical records, wide angle fundus photography, and the never ending push to see more patients, the art has nearly died. However, there are a number of reasons why the art should not be ignored by ophthalmology residents; allow me to try and persuade you.

Why should I still be drawing the retina?

First, you will need to be able to read old medical charts; some of which have only fundus drawings without text descriptions of the retina. No matter what form of ophthalmology you practice, you will need to read and interpret these intricate fundus photography. Second, many retina specialists suggest that taking time to produce a proper fundus drawing is the best way to coerce residents and ophthalmologists into a proper, complete retinal examination. Retina specialists in particular have been known to spend more time on a colored pencil drawing of the retina than on the retinal exam itself. Finally, if you are at all interested in a retina fellowship, there are few better ways to impress your old-school retina faculty than to produce great fundus drawings. So, with that in mind, here is a quick primer.

The Fundus Skeleton

A true retina drawing will contain three concentric circles. The first represents the equator, the second represents the ora serrata, and the third represents the pars plana. There should also be 12 tick marks indicating each clock hour of the retina. (See a great example here). 

A Work of Art

Next come the colors. A normal retina should have a red hue and most ophthalmologists will color in the entire first two circles (out to the ora serrata) with a light red color. The image on the left is representative of how to draw most common findings in the retina. Feel free to download and print this image, I have found it very useful. Let's break up the details by color.

Color Fundus Drawing

Click for full size [large] image file

Brown:

Any alteration in the choroidal pigment. Brown is usually reserved for a nevus or melanoma.

Black:

Any alterations in the retinal pigment including pigment mottling, lattice degeneration, dark retinal pigmentation (CHRPE), or laser scars.

Blue:

A sign of fluid, blue can represent veins, sub retinal fluid surrounding a retinal tear, retinal or macular edema, or a frank retinal detachment.

Red:

As previously stated, normal retina is red and most ophthalmologist paint the entire fundus with a light red color. Arteries are also red and any retinal neovascularization is red as well. A darker red is used inside of a blue outline to demonstrate retinal holes or tears. 

Green:

Anything in the pre-retinal space. This includes media opacities, vitreous hemorrhage, pre-retinal hemorrhage, pre-retinal gliosis, epi-retinal membrane.

Yellow:

Exudative processes including retinal exudation, drusen, retinal scars, emboli, choroidal neovascular membranes.

Good Luck!

Tips for the USMLE Step 3

Master the Boards Step 3

 

The USMLE Step 3 represents an interesting paradox in medical education: it is the board exam whose results are the least important, but whose content is the most important. Maybe we medical students and medical educators have our priorities backwards? Here we have an exam that determines if you can competently diagnose and treat patients, and it is an afterthought when compared to an exam that tests whether or not we can memorize with perfection the Kreb's cycle. Does anyone else see a problem here? The truth is, you can not completely blow off Step 3 or you are in for trouble. Here are a few pointers on how to prepare for the exam

 Scheduling

Ideally, everyone should take Step 3 in the second half of intern year. This will give you ample time to hone your inpatient hospital skills, something that will be critical for the new Computer-based Case Simulations (CSS), but not too much time to forget everything you learned in medical school and internship. Too often I meet specialists who are taking Step 3 at the end of their residency. There is nothing about a 5 year orthopedics residency (or any other residency) that will prepare you better for Step 3. To put off the exam for many years of residency will leave you unprepared and you will have lived with a weight over your head unnecessarily. 

Remember, USMLE Step 3 is written specifically for the broad training culminating at the end of your internship. Technically, after your internship, if you pass Step 3, you can be licensed to practice medicine in the United States. Do whatever you can to get the test done during your internship.

Studying

You are going to be busy as an intern. If you have free time, you will want to sleep or relax; the last thing you will want to do is study for another board exam. You will not need much time to prepare for this exam, but you cannot completely blow it off. You need to find a way to reject the old saying, "two months for Step 1, two weeks for Step 2, two pencils for Step 3". If you think this way you are likely to waste your time and money. Let me illustrate two reasons why you should consider a small amount of studying: 

  1. Most of you will focus either on children or adults during internship. You must be prepared to answer difficult questions about all age ranges on Step 3. If you are out of practice in pediatrics, study up.
  2. Very few of you will take care of OB/GYN patients during your internship. This is something else you will need to study
  3. The CSS is unique and has many quirks that you have not experienced yet. You MUST take the time to familiarize yourself with the format and how to succeed. If you do not prepare for this strange new testing format, you could make some logical choices during your exam that will not count. You simply need to spend a couple of days learning about the test itself and taking some of the CSS practice questions through the ACGME website. There is a great review of the CSS format and some of its nuances here

Questions

As I have said before about other USMLE board exams, there is no substitute for a great question bank. Both Kaplan and USMLE World have great Q-banks, though I tend to prefer USMLE World. If you spend a solid week or two on questions, you will be more than ready.

Books

I think that one or two good review books can help a lot. The main goal of a review book will be to re-familiarize yourself with the specialties that you have not thought about in two years (pediatrics vs. adults, medicine vs. surgery, OB/GYN vs. everything else). Below is a list of books that I found useful. Again, you probably only need one or two of these.  

  • Updated June 2015

1. First Aid for Step 3:

I am a sucker for the First Aid series. Even for Step 3 I think they produce a fantastic review book. You should know, there are many residents who prefer the two books below (or others) to the First Aid for Step 3 book. What draws me to this book is that it contains a brief review of all required specialties and a great review of the CSS format with great CSS practice questions all in the same book.

 

2. Master the Boards USMLE Step 3:

I have always been impressed with review books written by Conrad Fischer, the author of this book. Master the Boards for USMLE Step 3 is no different, it is a great review of the entire exam. I also highly recommend this book.

3. Crush Step 3:

Many residents swear by the Crush series for Step 3. One downside is that they seem to be branching into two separate books, the main Crush Step 3 book for the clinical content, and the new Crush Step 3 CCS book as a primer on the CCS question system. So, you might end up buying two book if you go with this brand, but I have never met someone who regretted studying from Crush Step 3. 

 

 
 
 

Interview: The in’s and out’s of radiation oncology

 
radiation oncology

 

A Radiation Oncology Attending's Perspective: From an interview with a radiation oncology attending.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to radiation oncology?

I realized that a radiation oncologist has a unique opportunity to serve as a physician for patients at a very difficult time, and I appreciated the emphasis on shared decision making and communication skill by my mentors in the field. I also enjoyed the emphasis on anatomy and imaging.

 

  • Describe a radiation oncologist's typical work day?

I typically arrive at around 7am when treatment begins for the day. Most of a radiation oncologist’s work is in an outpatient clinic. The day is spent seeing new consultations, follow-up visits, and evaluating patients who are currently under treatment. When you aren’t seeing patients, your time is usually spent creating individualized radiation treatment plans for new patients, which includes doing a CT simulation, contouring, and planning with a dosimetrist and physicist.

 

  • What type of lifestyle can a radiation oncologist expect?  

Nearly all of a radiation oncologist’s work is in an outpatient setting, which means that nights, weekends, and holidays are usually free. This is one of the more attractive features of the specialty.

 

  • What is the potential salary of a radiation oncologist?

The average salary varies significantly between academic settings and private practice. There is a wide variety of compensation agreements depending on each unique situation.

 

  • What is the job market like for radiation oncology?

Radiation Oncology is a very small field. For example, in some less populous regions, an entire state might have around 16 radiation oncologists. Because of that, it can be challenging to find a job in a specific geographic region. If it is essential for you to live in a certain region, be aware that it might be difficult to make that happen, and that you might have to accept significant compromises to get a job in a given area. This is one of the drawbacks of radiation oncology. If geography and flexible location are important to you, other larger specialties might make for an easier job search (e.g. internal medicine, anesthesiology, etc).

 

  • What can you tell us about radiation oncology subspecialties?

Most radiation oncologists complete their training after the 5 year residency without doing a fellowship. A fellowship can sometimes help to bolster academic credentials if needed or be used as a segue into a job at a desirable institution. Common fellowships include pediatric radiation oncology and proton therapy.

 

  • What are the potential downsides of radiation oncology that students should be aware of?

If you have academic aspirations, it can be difficult to find protected time as a radiation oncologist. Geographic limitations are an important consideration (see above).

 

  • How competitive is the radiation oncology match?

Very. Radiation Oncology attracts students with great boards scores, strong letters of recommendation from mentors, and ample research experience.

 

  • What must a student do to match well in radiation oncology?

Students must obtain great board scores, demonstrate research productivity, and produce strong letters of support from mentors who know you well.

 

  • What are residencies looking for in a radiation oncology resident?

Strong credentials will open the door for an interview. Beyond that, programs are looking for someone who can carry on a normal conversation and has a pleasant personality.

 

  • What should students be looking for in a radiation oncology residency?

It can be interesting to look at where graduates end up after residency. There is a wide variety in the quality of didactics, with most radiation biology and physics courses being something that you just have to endure no matter where you match.

 

  • What else would you tell medical students who are considering radiation oncology?

While radiation oncology offers a desirable schedule and good compensation, it is important to go into the field for the right reasons. Keep in mind that as a radiation oncologist, you will be taking care of patients who are very ill, and are often approaching the end of life. To be successful, you will need to develop the skill of navigating these sensitive discussions with agility, and sometimes it can be emotionally exhausting. At the same time, helping patients and their families work through these scenarios is very meaningful and fulfilling work.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Best Books for USMLE Step 2 Clinical Skills (CS)

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

As many of you know, the pass rate for USMLE Step 2 CS is very high, usually 97% or 98% for first-time test takers from the USA. Many will take that to mean that they don't need to study, but I think it means something slightly different. Here is a 2% that you really don't want to be part of! Studying for Step 2 CS is really not difficult, you already know the material, you just have to learn about the test. I don't think you need to spend much time studying, but reading one or two review books will prepare you in three ways 

  1. what the test will be like,
  2. what you will be tested on (it's NOT just the medical content!)
  3. a review of the most commonly tested cases. 

I will list the two most widely used books and highlight some subtle differences. You really only need one of these. Good Luck.

  • Updated June 2015

1. First Aid for Step 2 CS:

This book will prepare you for what to expect in the testing center. I felt much more comfortable just know what was going to happen, step by step, after reading this book.I think this is the strength of this book, it lays out the nature of the exam very well. There is also a good review of some of the highest yield cases you might encounter during the clinical skills test. This book prepares students very well for the Integrated Clinical Encounter (ICE) portion of the exam. For most people, reading through this book one time would be sufficient prior to taking the USMLE Step 2 CS.

 

2. Kaplan USMLE Step 2 CS Core Cases:

Like the First Aid book, Kaplan's USMLE Step 2 CS book is a great resource and one quick read through it would be sufficient for most students. The one thing that Kaplan's book has is a better explanation of how to act during the exam so you can maximize Communication and Interpretation Skills (CIS) portion of the exam. Browse the format of each book, you probably just need to choose one.

 
 
 

When should I schedule USMLE Step 2?

Calendar

One of the important questions all medical students have to answer in their fourth year of medical school is when to take the USMLE Step 2 exams. The answer to this question depends on each student's individual circumstances. Let me list a few pointers that might help you in making your decision. At the onset let me state that I do not know of a good reason to not release your scores to residency programs. Everyone should release scores, to do otherwise suggests you are hiding something. If you don't want your scores to be known by potential residencies, you simply need to schedule the test after your information is sent to programs, this is a much better alternative. 

After you have decided on a time to take the test, check out my list of the best resources to study for Step 2 CK.

  • The only nationwide deadline facing medical students is that prior to obtaining a license and starting internships and residencies, students will have to pass the USMLE Step 1, Step 2 CK, and Step 2 CS. So all medical students will have to pass these exams before July 1st after their fourth year. However, most medical schools have their own deadlines. If your school requires both Step 2 exams to be done before January 1st of your fourth year, you need to plan accordingly.
  • The next question you must answer is whether or not you need your Step 2 CK score to be available when you are applying for residency. There are two situations where this might be the case. If you are applying to a competitive residency and your Step 1 score is not impressive, most people recommend doing everything you can to obtain a great Step 2 CK score to send to residency programs. Alternatively, no matter what residency you are applying to, if your Step 1 score is below the national average (usually ~218 or below), most people recommend sending a Step 2 CK score to potential residency programs so they know you have passed the boards and will be eligible to start residency on time. If you fit into either of these situations, you should take Step 2 CK before the end of September in order to have the score available during residency application.
  • If you have a deadline from your school but you do not need to send a Step 2 CK score report to your potential residency programs, there are still some scheduling conflicts to consider. Students applying to early match residencies or other competitive residencies will spend most of the months of November and December interviewing. Available interview dates in these situations are usually sparse and difficult to manage. The last thing you want is to miss the only available interview date at a top choice residency because you have Step 2 CK or Step 2 CS scheduled the same day. If you can move your Step 2 dates earlier or later, I would recommend doing that. If you have a January 1st deadline like many schools but will be interviewing in November/December, consider taking your Step 2 exams in the September/October time period.
  • It is important to remember that Step 2 CS is not a very important exam for most fourth year medical students. The vast majority of students pass the exam and there is no numeric score released to students and residency programs. Therefore, it is in your best interest to simply schedule this exam when it interferes the least with your interviewing and clinical rotations.
  • If you are trying to cram your Step 2 CS or Step 2 CK in December before a deadline, beware of unpredictable winter weather. I have known a number of students who missed clinical duties or interviews as they were stuck in the airport after the Step 2 CS exam. Many of you will be traveling to cities prone to snowfall (Chicago, Philadelphia), so bear that in mind when scheduling.

If you have any other advice for the four year students reading this, please post below. Good luck to everyone and don't forget to check out my list of the best books for Step 2. 

Top Ten Books for the USMLE Step 2 CK Exam

This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.

There is a lot of weight placed on the USMLE Step 1 exam as it has a significant effect on how competitive you are as a residency candidate. I submit to you that the UMSLE Step 2 CK is far more important in the long run because it will test you on things that are actually relevant to your future practice and your patients. You take Step 1 for yourself, you take Step 2 for your patients. This is stuff that we all just need to know. So, don't worry about score and just worry about the material, your patients will be greatful.  Below is a list of the books I found most helpful for USMLE Step 2 CK. 

  • Updated May 2015

1. First Aid for Step 2 CK:

There are a few brands that have never let me down in USMLE test preparation: First Aid, Kaplan, and USMLE World. I swear by First Aid for Step 1, and I found First Aid for Step 2 to be nearly as concise and comprehensive. A great resource

 

2. USMLE Step 2 Secrets:

This is a fantastic summary book that does not take long to read. Rather than a list of all the facts, like First Aid give you, Secrets gives the reader a great review of high yield information. This would be a great book to read the week or two before the exam to help you pick up a number of extra nuggets.

 

3. Crush Step 2:

Crush Step 2 is written by the same author as USMLE Step 2 Secrets (#2). The content of the two books is mostly the same. Crush Step 2 is written in prose and paragraphs rather than in clinical scenarios and question format. Decide which format you prefer, because you certainly wouldn't need both books.

 

4. Master the Boards, USMLE Step 2 CK:

This book induces a borderline personality disorder. Some students love it, some students hate it. The book does not attempt to be a complete review, it tries to hit hard only the high yield points. Students who are looking for a more complete review of the information should probably not purchase this book.


.

5. Step-Up to Medicine:

This is a tried and true book for many aspects of the second half of medical school. A great book for many rotations and shelf exams, it is also a fantastic preparation USMLE Step 2 CK. Much of this board exam will rely on basic internal medicine knowledge. The book is also great for Step 3, so you can kill two birds with one stone. 

 

6. Kaplan USMLE Step 2 Qbook:

If you frequent this website, you know that I believe STRONGLY that the best way to prepare for a board exam made up of hundreds of questions is to do thousands of questions. I really like both Kaplan's online QBank as well as USMLE World's online QBank. However, you are not always at a computer and you will find that question books are a nice rest from the screen. Kaplan's Step 2 Qbooks one of the best on the market.

7. First Aid Cases, USMLE Step 2:

Like Kaplan's Step 2 Qbook (#6), the First Aid company has also produced some great print question banks. The 'Cases" book is a case-based approach with great review questions. In addition, they also publish First Aid Q&A for the USMLE Step 2 CK which rivals Kaplan's Step 2 Qbook as the best print question book on the market.

8. Kaplan USMLE Step 2 Lecture Notes:

Recently, Kaplan has allowed students to purchase their complete Lecture Notes for board exams, including these Step 2 notes, without actually taking their in-person classes. This was not always the case. I have used these texts and I was very impressed. Altogether these review books are very long and very expensive. However, they come from a company that knows very well how to get students good exam scores.

 

9. Step-Up to USMLE Step 2:

It may seem counter-intuitive, but I prefer Step-Up to Medicine (#5) as a Step 2 study resource to the book that Step-Up wrote specifically for Step 2. I used the second edition of Step-Up to USMLE Step 2 and it was good, but from what I am hearing the third edition has a poor layout and not well updated. 

 

10. Travel Book du jour:

You need to study for Step 2, it will help you be a better intern and resident. However, you are probably a fourth year student getting ready to fly around the country. You may not ever travel this much in this short of a time. Here is some unsolicited advice, take an hour to enjoy the city you are in…so see some of the stuff in this book.

 
 
 

Spotlight Interview: How to Match in Physical Medicine and Rehabilitation

PM&R Vintage

 

A Physical Medicine and Rehabilitation (PM&R) Resident’s Perspective:  From an interview with a PM&R resident from Ohio.

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the PM&R match?

Matching in PM&R is not as competitive as some fields, such as radiology, neurosurgery, dermatology, etc. However, it also used to be a relatively unknown specialty. Medical student exposure to PM&R has improved and the number of applicants seems to be steadily increasing, so it is becoming more competitive.

 

  •  What must a student do to match well in PM&R?

A student looking to match well in PM&R should focus on the same things students would pursuing other specialties. Like any specialty, doing well on boards is important. Most programs have now instituted board score cut-offs for applicants, which are around 200-220 for USMLE Step 1. In general, students should perform well on their clinical clerkships throughout medical school, and a rotation is PM&R is preferred. Strong supportive letters of recommendation, including one from someone in PM&R, is preferred. At least some exposure to or participation in research is also a plus.

 

  • What are residencies looking for in a PM&R applicant?
PM&R residencies look for all the usual strengths in an applicant like good board scores and academic performance, good clinical performance on your clerkships, research exposure, etc. In my experience, PM&R residencies also tend to appreciate individuals with additional interests like sports and music. There are many in PM&R who followed non-traditional paths to medicine and may have had other careers first. Personality is also very important, as it takes pretty caring and compassionate people to be providers for individuals with disabilities as well as an ability to work with a multi-disciplinary team. In addition to a student's application, their interview day with a residency program will be very important

 

  • What should students look for in a PM&R residency?

If you are pursuing PM&R but not yet sure whether you want to do a fellowship, look for a well-rounded PM&R program with opportunities for exposure to the subspecialties. I looked for a program with a good balance of inpatient and outpatient clinical duties and wanted exposure to all the major areas: Sports/MSK, stroke, TBI (traumatic brain injury), SCI (spinal cord injury), amputation and pediatric rehab. I also looked for programs that had an ultrasound curriculum, as well as plenty of exposure to procedures including electrodiagnosis (EMG), botox, interventional spine and baclofen pumps. Beyond curriculum, the deciding factor in residency programs for me was finding a good “fit.” I paid close attention to interactions with residents, students, fellows and faculty on interview days to try and get a feel for whether this was a place I would like to train or not. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Like any other specialty, having a well-rounded application is important. Although board scores are important and used as a screening tool, residencies want to see much more than that. Do at least one rotation in PM&R, even if you have to arrange an away rotation. Also try and have at least one Letter of Recommendation from someone in PM&R. I looked for well-rounded programs to rank, but ultimately my rank list came down to finding a good fit on my interview day. Pick a program where you can see yourself being both well trained and happy for 4 years

 

  • What do you wish you knew before application/interview season?  

Although I did a lot of practice interview questions before my interviews, one question I didn’t have a great answer for was “So what is a Physiatrist?” I struggled with this question because the scope of our field is pretty broad, but having a decent answer will help guide your personal statement and save you the embarrassment if asked on the interview trail

 
  • What other advice do you have for students applying for PM&R residency?  

People like to say “plenty of money and relaxation,” and although the lifestyle is good there are long days and hard days. We take care of very sick patients, many of which have experienced something catastrophic, and as their physiatrist we can be their greatest advocate or on some days just their cheerleader. In PM&R, you have to be willing to wear many different hats. Also, make sure you write “PM&R” NOT “PMNR,” and know how to pronounce “Physiatrist.”  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the MatchThe Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

Spotlight Interview: Why Did You Choose Physical Medicine and Rehabilitation (PM&R)?

 
EMG2

 

 

A Physical Medicine and Rehabilitation PM&R) Resident’s Perspective: From an interview with a PM&R resident from Ohio.. 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to physical medicine and rehabilitation (PM&R)?

I initially explored PM&R because I always had an interest in neurophysiology and neuroanatomy, and I knew that physiatrists took care of patients with stroke, traumatic brain injury, spinal cord injury, and other disorders of the nervous and musculoskeletal systems. During my first rotation in PM&R was when I learned that physiatrists primary focus in helping their patients is by improving function. This focus on function is ultimately what attracted me to PM&R, because enabling patients with different abilities to function can substantially affect quality of life. Another aspect of PM&R that attracted me to the specialty was working with a multidisciplinary team to provide care. 

 

  • Describe a physiatrist's typical work day?

The workday of a typical physiatrist is quite regular, usually from about 8am to 5pm, but this can vary somewhat depending on your type of practice. There are many physiatrists who only do outpatient clinic, while others do both inpatient and outpatient. 

 

  • What type of lifestyle can a physiatrist expect?  

Lifestyle of a physiatrist can be somewhat variable depending on practice setup and location, but overall is considered to be well balanced relative to other specialties in medicine. We also have a high job satisfaction. PM&R is a very family friendly field, with plenty of free time and family time. Most physiatrists do not work nights, but there is some call coverage for those with inpatient duties. On average, call is usually about one week and one weekend per month, but can be less frequent depending on size of the department. Primary (first) call at large hospitals is most often covered by residents and fellows, and the attending is only called when needed. Call does usually include rounding on the weekend, which is usually brief.

 

  • What is the potential salary of a physiatrist?

The average salary of a physiatrist is around $180,000-190,000. 

 

  • What is the job market like for PM&R?

The job market for physiatrists is excellent both immediately following completion of residency as well as after advanced fellowship training

 

  • What can you tell us about PM&R subspecialties?

Another advantage to training in PM&R is that there are many options for subspecialty training. PM&R residents can pursue fellowship in many areas including the following: Interventional Pain/Spine, Sports Medicine, Cancer Rehabilitation, Stroke Rehabilitation, Traumatic Brain Injury, Spinal Cord Injury, Pediatric Rehabilitation Medicine, Neuromuscular Medicine/EMG, Informatics and Research. Most of the clinical fellowships are 1 year of additional training, and Pediatric Rehabilitation Medicine can be 1 year for those who completed a combined residency and 2 years for those who completed a general PM&R residency 

 

  • What are the potential downsides of PM&R that students should be aware of?

Although I did not consider salary when making my career decisions, it is an important consideration for students to think about as many of us have student loan debt and families to provide for. One potential downside of PM&R that students should be aware of is reimbursement changes for procedures, particularly electrodiagnostic testing. The salary I mentioned earlier is at or just below the average for all physicians.

 

  • What else would you tell medical students who are considering PM&R?

I highly recommend considering a career in PM&R. It is a fairly small field of medicine but it is growing and evolving, with so many exciting possibilities particularly with advances in technology. Being a physiatrist is incredibly rewarding. It is difficult to describe what it feels like when you see someone who had a stroke, spinal cord injury, or amputation walk again, but it’s pretty awesome to be a part of the team making that happen 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

Spotlight Interview: How to match in neurosurgery

Recklinghausen neurosurgery

 

A Neurosurgery Resident’s Perspective:  From an interview with a neurosurgery resident from a top program in the Midwest.

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the neurosurgery match?

Neurosurgery is among the very competitive specialties. Still though, I think that 80% of U.S. grads match somewhere.

 

 

  •  What must a student do to match well in neurosurgery?

All students should rotate at their home institution as well as at least one away rotation (almost everyone in my medical school class did at least two away rotations).  Boards are important.  Research and publications are very well looked on, as is performance on the sub-internship.  Being a good sub-intern is not about how much you know, but rather how hard you work, how willing you are to be at the hospital constantly, and how easy to get along with you are.

 

  • What are residencies looking for in a neurosurgery applicant?
The answers are the same as what I mentioned earlier. As a resident, I want someone who’s going to work their tail off on service and not let down the rest of the team.  

 

  • What should students look for in a neurosurgery residency?

Make sure the fit of your personality matches the department.  Seven years is a long time to be miserable if you don’t like the people, no matter how prestigious the place. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Letters of recommendation should be from neurosurgeons (it’s a very small world), or research mentors. Perhaps other types of surgeons can write your letter of recommendation if you’ve worked with them a lot.   Other letters really won’t count for anything.  You should get one from the chair at the places where you rotate.  It doesn’t matter if you didn’t really work with them at all; they will solicit feedback from the residents and staff you did work with and their letter serves as a summary of your time there.  

 

  • What do you wish you knew before application/interview season?  

It’s well worth it to interview at a lot of places and get a “tour” of neurosurgery.  It really is a small world and you’ll run into people over and over.  

 
  • What other advice do you have for students applying for neurosurgery residency?  

It’s an awesome privilege to be able to do this stuff. Good luck!  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the MatchThe Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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