Rehabilitation Research— My MSSCE Experience
PM&R. Truth be told, I did not understand the significance of these three letters until I stepped foot at Johns Hopkins Hospital for my two month Medical Student Summer Clinical Externship (MSSCE). I initially applied for the externship because my friend after finishing her first year of Physical Medicine and Rehabilitation (PM&R) residency described PM&R as “the coolest field ever”. She had piqued my curiosity with her enthusiasm for her profession and I was determined to experience PM&R for myself.
Each week during my externship I experienced something entirely new as I learned PM&R encompasses numerous subspecialty clinics including Brain Injury, Spinal Cord Injury, Pain, and Pediatrics just to name a few. I found out the hospital even had a clinic just for patients who were a fall risk! While during residency each resident physician spends a month or more on each unit, I unfortunately only had a week to experience as much as I could in each area of PM&R.
My first day during general outpatient clinic exposed me to the world of intrathecal Baclofen pumps and ultrasound guided injections for the treatment of spasticity. It was a short time later when unique medications common to the field such as Gabapentin became second nature to me. I also learned how to do a complete American Spinal Injury Association (ASIA) exam while on the inpatient spinal cord injury unit. In the pediatric clinic, I saw how paraplegics used electrical stimulation, aquatic therapy, and/or a robotic exoskeleton to help them regain their mobility.
One of the most surprising facts I learned about this field was the use of a multi-disciplinary approach to patient care. A patient’s care routinely includes the coordination of care between a physiatrist (PM&R phsyician), a physical therapist, occupational therapist, speech therapist, a prothetist/orthotist and more! In a meeting, the entire team would discuss not only the patient and their current status but also their individual lifestyle and goals to come up with a unique rehabilitation plan that worked just for them. This is very unique to PM&R and something I really appreciated given that a common complaint from patients is the diminished time spent with medical providers in the current health care climate.
However, the most important lesson I learned came from using a wheelchair for an entire day. I found that although using my hands would ultimately leave them sore for days, there was a psychological impact that I could never forget. Almost immediately, I struggled with making turns and rolling backwards into an elevator. Some people would notice my struggles and jump to help, but others would avoid me or look down at me. It also didn’t help that it was raining all day. How do you move the wheelchair and hold an umbrella? How do you go up a ramp when your wet wheels keep slipping as you desperately try to keep a hold on them? My experiences that day opened my eyes to the struggle that some people face everyday.
The rewarding benefits of targeted therapy and the more individualized doctor-patient relationships were immediate indicators that this is a field of medicine where I could best utilize my years of medical education and training to make a positive difference in the lives of my future patients for years to come.
Shelly Gulhar is a second year medical student at Howard University College of Medicine. She is active in the Physical Medicine and Rehabilitation interest group there and seeks to pursue her interest in spinal cord injuries in the future.
The Medical Student Summer Clinical Externship (MSSCE) program has been developed for medical students with a strong desire for clinical experience in the field of Physical Medicine & Rehabilitation (PM&R) and who are eagerly seeking opportunities in the field. The program aims to provide a wide range of inpatient and outpatient clinical exposure and to allow students to explore the human side of patient care and the psychosocial environments their patients face. More details, including the application process, can be found at the AAP website.
