Clinical

Our Inpatient Adult Service Line Model Provides Continuity of Care and Education

Residents and faculty provide a continuous line of care for patients with cancer rehabilitation and spinal cord injury rehabilitation needs in a service line model. Residents work with patients from the earliest phase of functional recovery (upon initial consultation), and care for these patients through admission and ultimately through discharge, sometimes seeing the patient upon return visit in continuity clinic. Being able to work with a specialized attending through this course enables focused education in sub-specialty care.

Patients with rehabilitation needs pertaining to brain injurystroke or medical complexity are seen by consulting resident and attending pair. They may admitted either to our 16-bed University Hospitals site or to our inpatient rehabilitation unit at Chelsea Hospital (24 beds, with two inpatient residents and 2-3 attendings).

Rotations

rotations

 

Rotations offer flexibility and high quality education across varied settings.  

Inpatient and Consult Rotations

Starting September 2020, Michigan Medicine inpatient PM&R expands services, opening a 24-bed inpatient rehabilitation unit at St. Joseph Mercy Chelsea (SJMC) Hospital. The total Michigan Medicine IRF bed complement will be at a first-time high of 40, with 16 beds at University Hospitals and 24 beds at St. Joseph Mercy Chelsea (SJMC) Hospital.

Medical direction of the units will emphasize the integration of the two units into one inpatient rehabilitation service, with the development of a rehabilitation network for Michigan Medicine.

Pediatric Rehabilitation at C.S. Mott Children's Hospital (2 months): The resident will work under the supervision of a pediatric physiatrist attending and fellow.  The resident will run the inpatient service and participate in inpatient consults.

Spinal Cord Injury Inpatient Rehabilitation at University Hospitals (2 months): Residents will work mostly with patients with spinal cord injury from different causes including trauma, transverse myelitis, cancer, and ischemia.  They will gain experience managing ventilator-dependent patients.  Residents will also assist a spinal cord injury fellow or physician assistant with spinal cord consults.

Cancer Inpatient Rehabilitation at University Hospitals (2 months): Residents will work with patients with functional deficits due to their diagnoses of cancer. Some diagnoses residents will experience are supplementary motor area syndrome, radiation fibrosis, peripheral neuropathy and deconditioning due to chemotherapy. Residents will also gain experience in caring for recent bone marrow transplant recipients which will provide exposure to graft versus host disease. Residents may get to work with cancer rehabilitation fellows during their two months on this rotation.  During these two months resident will participate in M-CORE (mobile cancer rehabilitation team) rounds, twice weekly, and have special weekly didactic sessions dedicated to cancer rehabilitation with the cancer rehabilitation attending/fellow.  

General Inpatient Rehabilitation at SJMC Hospital (2 months): During these two months, residents will work mostly with patients with history of critical illness myopathy/neuropathy, amputation, orthopedic trauma, acute immune-mediated neuropathies, and other complex conditions.

Neurological Inpatient Rehabilitation at SJMC Hospital (2 months): Residents will work mostly with patients with history of recent ischemic or hemorrhagic stroke or traumatic brain injury. 

Medically Complex Rehabilitation and Consults at University Hospitals (2 months): Residents will work mostly with patients with high medical complexity, including those who have had solid organ transplant, or those with complex needs (hemodialysis, intravenous immunoglobulin therapy, other infusables).  Where possible they will follow this patients in service line model from consult through admission.

Community Inpatient Rehabilitation at St. Joseph Medical Center (2 months): Two months are spent at St. Joseph Medical Center on the private rehabilitation service. This acute rehabilitation hospital has 30 beds. On this senior rotation, residents gain experience in a community hospital setting and work with physician assistants. 

Senior Electrodiagnostic and Consult Rotation (2 months): Two months are spent as the senior resident performing consults as well teaching and leading junior residents on the inpatient floor at UH. Two half days per week are spent in the electrodiagnostic lab.

Outpatient Rotations

Electrodiagnostic Medicine (EDX) (3 months): Initial training includes three continuous months (generally during the PGY3 year) of learning how to perform electromyography and nerve conduction studies. Time will be spent with both Neurology and PM&R EDX clinics. Overall, residents will get about six months of EDX training.

Musculoskeletal (2 months): This rotation will give exposure to the evaluation and management of common musculoskeletal problems, concussion management in athletes, participation in team clinics, and learning the basics of diagnostic ultrasound, ultrasound-guided injections, as well as tenex and other cutting edge procedures. 

Orthotics and Prosthetics (2 months): Two months are spent on the Orthotics and Prosthetics service, which includes inpatient consults and outpatient clinics. (Wound care, lower extremity, upper extremity amputees, and adult and pediatric peripheral nerve injury clinics.)

Procedures (1 month): This senior rotation allows the resident to get more experience with specific procedures including baclofen pump refills, botolinum toxin injections, MSK procedures, and interventional spine procedures.

Spine (2 months): Two months are spent at the Spine Center, an outpatient facility dedicated to the prevention and comprehensive care of spine injuries with clinic days in our fluoroscopic-guided spine injection suite.

Subspecialty (1 month): During this rotation, the resident spends time in the rheumatology, spinal cord injury, and pediatric rehab clinics as well as multidisciplinary clinics including ALS clinic, cancer rehab clinic, Down Syndrome clinic, ventilator clinic, wheelchair seating, and wound care clinic

Veterans Affairs (4 months): Four months are spent at Ann Arbor VA Hospital through the course of the residency program. During the PGY-2 and PGY-3 years, a total of two months are spent working in a variety of outpatient clinics including musculoskeletal, orthotics and prosthetics, spinal cord injury, spasticity and pain management. During the PGY-4 year another two months are spent in same outpatient clinics as the clinics during PGY-2 and PGY-3 year with the addition of EMG as well as opportunities for Botox and ultrasound guided procedures. Overall, a large volume of musculoskeletal care and injection opportunities can be expected at the VA.     

Resident Continuity Clinic: PGY-3 & 4 residents have their own continuity clinic one half day a week. This provides an invaluable opportunity to gain experience in seeing how disease processes mature while allowing residents to closely monitor the outcomes of the plans that they have put in place. This clinic also provides the resident with the opportunity to be a leading partner with the patient to help facilitate a patient's return to community/work/driving while navigating through the challenges that are presented to both the patient and the resident.

Research and Flexible Rotations

Elective (1 month*): Residents build a clinical elective, seeking clinical experiences of their interest. There is also the opportunity to do an away elective during this time.

Subspecialty Selective (2 months*):  We are currently developing these customized electives to represent a menu of specialized outpatient experiences in a resident's chosen area of interest: experiences recommended by faculty who enjoy teaching, who teach regularly and are ready to mentor and give feedback.

Jeopardy (2 months*): The resident will cover other residents at the Inpatient Rehabilitation Facility,  pediatric rehabilitation unit and consultative services when they take days off. During the times when the resident is not covering for a colleague, the time constitutes additional clinical elective.

Research (6 weeks): Six weeks of research are scheduled during outpatient and flexible rotations (see *rotations above); they are carved out in 1-week or 2-week blocks of protected time. The flexibility of scheduling affords residents the flexibility to invest in research projects at the times when project progress most demands it. 

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