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Department of Physical Medicine and Rehabilitation

Department of Physical Medicine and Rehabilitation

Residency Training Program

The Department of Physical Medicine and Rehabilitation, UC Davis Health System, offers a comprehensive training program, originally approved by the Accreditation Council on Graduate Medical Education (ACGME) in July of 1971 and most recently re-accredited in 2012.

The department has fifteen faculty physiatrists based at UC Davis Medical Center, three based at VA Northern California Healthcare System in Sacramento, with numerous volunteer clinical faculty members from the Northern California region. The department maintains eleven residency positions. Residents are provided a wide variety of clinical experience through rotations at UC Davis Medical Center and our primary affiliations, VA Northern California Healthcare System, Kaiser Foundation Hospital, and Shriners Hospitals for Children, Northern California.  All the affiliates are within 30 minutes of the University Medical Center in Sacramento.  

Outpatient physical medicine and rehabilitation clinics offer general and specialized care to those with neurological, musculoskeletal, and neuromuscular disorders. Multispecialty clinics include the Spine Program, Sports Medicine Program and ALS clinic.  The department houses the primary electrodiagnostic laboratory for the health system with over 1200 studies performed annually. Within the university hospital (a Level 1 trauma center), a 19-bed adult and four-bed pediatric rehabilitation unit serve the needs of patients requiring inpatient rehabilitation. There is an active inpatient consultation service.

Objectives

  • Provide trainees with exposure to patients with a wide range of physical impairments and disabilities who may benefit from physiatric care.
  • Develop diagnostic and therapeutic skills which are both current and scientifically based.
  • Provide a didactic framework of the basic sciences, interrelated disciplines, and medical rehabilitaton.
  • Teach and develop the skills necessary to critically analyze and communicate research literature as a basis for lifelong learning.
  • Develop competence in the six core aspects of medical practice: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice.
  • Provide the comprehensive training and experience necessary to succeed in specialty examination by the American Board of Physical Medicine and Rehabilitation.

Duration of Training

We currently offer two categorical positions (four years of training) and one advanced (three years of training starting at the PGY-II level) position per year.  A trainee may enter the four-year program at the first year (PGY-1) of post-graduate training, or the three-year program at the PGY-II level if there has been one or more years of training in another related specialty acceptable to the American Board of Physical Medicine and Rehabilitation. 

PGY-I Year (Internship):  This first year of training consists of six months in internal medicine (one in CCU) and one month each of burn surgery, general surgery, neurology, emergency medicine, orthopaedic spine surgery, and one month rotation in inpatient physical medicine and rehabilitation. Training takes place primarily at UC Davis Medical Center, with several rotations to associated institutions, Kaiser Permanente Hospital and Mather VA Hospital.

PG-II Year: For the residents continuing from the PGY-I level, a one-month rotation to orthopaedic hand completes one year of non-physical medicine and rehabilitation training.  Seven months of outpatient physical medicine and rehabilitation clinic experience is scheduled along with three months of UC Davis Medical Center inpatient ward service. For the residents entering at the PGY-II level, four months are spent on the UC Davis Medical Center inpatient rehabilitation ward and seven months in outpatient clinics.  All PGY-2 residents rotate to Mercy General Rehabilitation Unit for inpatient rehabilitation experience in a community setting.

PG-III Year:  All residents spend two two-month blocks as senior UC Davis Medical Center ward resident. A total of three months are spent assigned to physical medicine and rehabilitation EMG clinics, VA clinics, and specific specialty clinics including: fracture, rheumatology, and musculoskeletal radiology. There is also allotted time for research during these months. One month is spent on the comprehensive pain service. The remaining four months are completed at Shriners Hospital adjacent to UC Davis Medical Center, where the trainee manages the inpatient rehabilitation of children and adolescents with orthopaedic, neurologic, and burn disabilities.

PG-IV Year: The senior trainee performs inpatient consultations at UC Davis Medical Center during two two-month rotations. During four months as chief clinic resident, there are administrative duties as well as responsibility for supervision of other trainees and advanced clinical experience in an outpatient setting. A one-month elective may be used to complement clinical experience or complete research. The final three months consist of outpatient clinical physical medicine and rehabilitation training, including private hospital clinic experience. 

Subspecialty Experiences

Neuromuscular Disease Clinics (Sponsored in part by the Muscular Dystrophy Association): The regional Muscular Dystrophy Association (MDA) Clinic includes neuromuscular disorders sponsored by the MDA. This multidisciplinary clinic is directed by Physical Medicine and Rehabilitation faculty with expertise in these neuromuscular disorders. New diagnostic workups, including electrodiagnostic studies, molecular genetic studies, and pathologic evaluations are coordinated by Physical Medicine and Rehabilitation faculty and residents. Neurology, orthopaedic surgery, pulmonary, and medical genetics faculty are also available for consultation. The clinics include adult neuromuscular disease, child neuromuscular disease, and restrictive lung disease.  In addition, the department maintains a multi-specialty, multidisciplinary clinic with the neurology department for ALS patients and an active post-polio clinic.

Pediatric Rehabilitation: Training in care of disabled children is provided through inpatient services and ambulatory clinics at both UC Davis Medical Center and Shriners Northern California.  Outpatient clinics include general pediatric, pediatric pump, pediatric amputee, and pediatric neuromuscular disease clinics. Some of these clinics are interdisciplinary, with faculty from the Division of Pulmonary and Critical Care and Department of Orthopaedic Surgery in attendance as well as a nurse specialist and medical social worker. Physical and occupational therapists, orthotists and prosthetists, speech pathologists and a medical social worker are available for consultation. The physical medicine and rehabilitation pediatric inpatient program includes consultations and inpatient care. The Shriners Northern California regional facility is the only Shriners Hospital in the United States with a burn institute, full service orthopaedic hospital, and pediatric spinal cord injury unit within a single complex. This facility is located across the street from UC Davis Medical Center.

Electrodiagnostic Laboratory: Electrodiagnosis is used to evaluate neuromuscular diseases and muscle function, and training in this technique improves knowledge of topographical anatomy. Experience starts in the PGY-2 year and is continuous throughout the outpatient rotations, representing approximately six months of full-time experience. This electrodiagnostic instruction and experience provides the background for certification by the American Board of Neuromuscular and Electrodiagnostic Medicine. Didactic training is through a 6-month weekly EMG workshop and bimonthly electromyography case discussions.

Prosthetics/Orthotics:  Prosthetics training is primarily through the adult and child amputee clinics. The UC Davis Medical Center amputee clinic is a multidisciplinary clinic attended by faculty and prosthetic consultants from the community. A large number of traumatic amputees are evaluated as well as those with extremity loss due to vascular disease. The VA amputee clinic provides similar experience with the advantage of an on-site prosthetics and orthotics lab. The child amputee clinic at Shriners evaluates children with both congenital and acquired limb deficiencies. Orthotic training is primarily through post-polio, NMD and general rehabilitation clinics.  Instruction in prosthetics/orthotics involves didactic seminars including visits to the prosthetics laboratory for exposure to fabrication and fitting skills.

Traumatic Brain Injury:  Traumatic brain injury rehabilitation is provided in multiple settings.  The UC Davis Health System adult and pediatric inpatient rehabilitation services and the inpatient rehabilitation service at Mercy General Hospital provide acute inpatient rehabilitation.  Outpatient care is continued in the Hospital Discharge clinic and general clinics.  Mild concussive injuries are assessed in both general PM&R and sports medicine clinics. 

Spinal Cord Injury:  The pediatric spinal cord injury program, housed primarily at Shriners Hospital, includes acute rehabilitation, follow-up multi-disciplinary inpatient and outpatient assessments, post-operative rehabilitation and management of congenital spine conditions, i.e. myelomeningocele.  Inpatient adult SCI training is provided at both UC Davis Health System and at Mercy General Rehabilitation Unit.  Long term management of medical and rehabilitation issues related to spinal cord injury are addressed in the Spinal Cord Injury outpatient clinic and the VA clinics. 

Spine: The comprehensive spine program is run as a multispecialty program including physical medicine and rehabilitation, orthopaedic surgery, neurosurgery, and pain management with onsite physical therapy, psychology and orthotic services. This program focuses on providing the skills to thoroughly evaluate spinal disorders, prescribe conservative treatment, and provide knowledge of surgical indications.

Sports Medicine: A broad spectrum of musculoskeletal conditions are diagnosed and treated in our sports medicine clinics.  Experience is provided in physical medicine and rehabilitation clinics, an integrated sports medicine program with family medicine and orthopaedic surgery and outside clinics.  Musculoskeletal ultrasound is utilized for evaluation and guidance of injections.  Training in musculoskeletal ultrasound is included in the didactic curriculum with additional workshops.  Extra-curricular opportunities include high school team physician experience, collegiate and professional sporting event coverage and US boxing event coverage.

Didactics

The didactic program provides a foundation for the basic sciences, interrelated disciplines, and medical rehabilitation. It also develops the skills necessary to critically analyze and communicate research literature.

Physical Medicine and Rehabilitation Basic and Clinical Science Series: These seminars consist of weekly three hour sessions with core topics repeated over a 12 month cycle. Lectures are given by physical medicine and rehabilitation faculty, faculty from other departments or guest speakers. Residents present at least one formal lecture a year.

Journal club:  Residents are assigned to review current journals and analyze articles for presentation at these monthly meetings. Journal club is supplemented by review of a classic article accompanied by an in-depth discussion of statistical methodology.

EMG conference:  At these bi-monthly meetings, a case-presentation format is used for discussion of interesting or unusual cases requiring electrodiagnostic consultation. Clinical and electrodiagnostic work up is reviewed.

Grand rounds: A monthly presentation, usually by an outside speaker on a topic relevant to physical medicine and rehabilitation.

Case conference: Monthly focused review of a clinical case presenting diagnostic or therapeutic challenges.

Imaging conference:  Monthly clinical case conference provides an in-depth review of pertinent imaging studies.

Spine conference: Yearly conference held in conjunction with orthopaedic spine, neurosurgery, and pain management presenting a broad spectrum of spine-related topics.

Anatomy lab: Held on the UC Davis campus, residents have the opportunity to review anatomical dissections of the upper and lower extremities and spine. Other prosections are reviewed as available.

Shriners didactic lectures: Orthopaedics lectures are presented each Monday morning. Didactic curriculum lectures are presented each Tuesday morning.

Teaching Experience

The department provides a popular fourth-year elective rotation to UC Davis and visiting medical students. Residents are responsible for bedside teaching, clinic supervision, and providing a didactic lecture to the students during each rotation. They also present lectures yearly as part of the resident didactic series and as therapy in-service training.

Research Experience

Residents are required to develop a research project and carry it to conclusion, which is the preparation of a manuscript appropriate for publication in a scientific journal. Residents present their research as a Grand Rounds during the senior year. They are also encouraged to present at a national conference and to publish their research in a peer-reviewed journal. The department sponsors residents for all national and major regional meetings at which they present a paper, subject to approval by the chair. Instruction in research methods, data collection, and analysis is provided during the seminar series.

Resident Evaluations

The program’s primary objective is to provide training to enable the resident to become a competent clinician through acquisition of the knowledge and experience required by the American Board of Physical Medicine and Rehabilitation for specialty certification. The faculty evaluates the resident's knowledge, skills, performance, judgment and professionalism every six months. In addition, residents are required to take the yearly Medical Knowledge Self-Assessment Exam (SAE) prepared by the American Academy of Physical Medicine and Rehabilitation. This provides an annual assessment of the resident's knowledge as well as comparison with other residents nationwide. Evaluation of electrodiagnostic training is assessed through the self-assessment examination provided by the American Board of Neuromuscular and Electrodiagnostic Medicine (EMG-SAE). A yearly oral examination by the faculty allows the trainee to assess their progress as well as provides practice preparation for Part II of the specialty certification examination.

Salary / Vacation / Leave / Benefits

Housestaff Salary:  Salary is determined by hospital and university policy.

Vacation:  The amount of vacation time is determined by hospital and university policy (24 days per year). However, resident vacation time is scheduled by the chief residents and based on seniority.  Any changes to the schedule must be approved by the department. Vacation time for the PGY-1 year is taken in one full block (four weeks).

Paid Leave:  The amount of sick leave is determined by hospital and university policy (12 days per year). Sick leave may be accrued from year to year. Personal or maternity/paternity leave is in accordance with the published policies of the hospital and university. Educational leave is allowed senior residents subject to approval by the residency program director.

Benefits:  Health, dental, vision, and life insurance are provided and paid for by the University. Disability insurance is available.

Link to UC Davis Graduate Medical Education (GME)

Residency Application Information

Student Elective

Fourth year medical student electives are available for medical students from other medical schools. For information and available dates, please call Patricia Settje, at (916) 734-5292 or e-mail: patricia.settje@ucdmc.ucdavis.edu.

Detailed Application Process is available (after connecting to this link please ignore the message that appears and wait a few moments for the correct link to appear) http://som.ucdavis.edu/ea/records/visstudents/ choose academic programs/choose externships/choose U.S. visiting students/select application packet and then follow all instructions.

Fellowships

The UC Davis Physical Medicine and Rehabilitation Department offers two sub-specialty fellowship programs. The Neuromuscular and Electrodiagnostic Medicine Fellowship was established in 2007 under the direction of Dr. Craig McDonald and Dr. Jay Han. The Sports Medicine Fellowship was established in 2008 under Dr. Brian Davis and Dr. Brandee Waite. Both fellowships are one-year, ACGME- accredited programs. Below are links to further information about the fellowships: