Clinical Rotations

Inpatient Months (Service Line Model) 

The goal of the service line model is to ensure more continuity of care from consult to acute inpatient stay to outpatient continuity clinic, which residents have during a their PGY-3 and PGY-4 years. 

Pediatric Rehabilitation (2 months)
Two months are spent at the C.S. Mott Children's Hospital, a 348-bed acute care children's hospital with a pediatric rehabilitation service. The resident will work under the supervision of a pediatric physiatrist attending and fellow. Here the resident will run the inpatient service and help with inpatient consults.
 
University Hospital Spinal Cord Injury Inpatient Rehabilitation (2 months)
Two months are spent on the inpatient spinal cord service, which is part of the 32-bed acute inpatient rehabilitation hospital at Michigan Medicine. Residents will work mostly with patients with spinal cord injury from different causes including trauma, transverse myelitis, cancer, and ischemia.  Residents will gain experience managing ventilator-dependent patients.  Residents will also assist a spinal cord injury fellow or physician assistant with spinal cord consults during this rotation.

University Hospital Medically Complex Inpatient Rehabilitation (2 months)
Two months are spent on the inpatient medically complex rehabilitation service, which is part of the 32-bed acute inpatient rehabilitation hospital at Michigan Medicine. Residents will work mostly with patients with high medical complexity. These patients usually include, but are not exclusive to the following: transplant patients, polytraumatic patients without traumatic brain injury, and amputees.  

University Hospital Stroke Inpatient Rehabilitation (2 months)
Two months are spent on the inpatient stroke rehabilitation service, which is part of the 32-bed acute inpatient rehabilitation hospital at Michigan Medicine. During these two months, residents will work mostly with patients with history of recent ischemic or hemorrhagic stroke. 

University Hospital Brain Injury Inpatient Rehabilitation (2 months)
Two months are spent on the inpatient brain injury rehabilitation service, which is part of the 32-bed acute inpatient rehabilitation hospital at Michigan Medicine. Residents will work with patients with diagnoses of traumatic brain injury and non-traumatic brain injury, along with disorders of consciousness. During these two months, residents will participate in special brain injury didactic series on a weekly basis with Dr. Stork, one of our brain injury attendings. 

University Hospital Cancer Inpatient Rehabilitation (2 months)
Two months are spent on the inpatient cancer rehabilitation service, which is part of the 32-bed acute inpatient rehabilitation hospital at Michigan Medicine. 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.  

Veteran’s Affairs Subacute Inpatient Rehabilitation (2 months)
Four months are spent at the 200-bed Ann Arbor VA Hospital through the course of the residency program. During the PGY-2 and PGY-3 years, two months are spent managing the medical care and rehabilitation needs of veterans staying in the Veteran’s Affairs subacute inpatient rehabilitation facility, as well as attending a variety of outpatient clinics which include PM&R, orthotics and prosthetics, geriatrics, and neurology. During the PGY-4 year another two months are spent in outpatient clinics including the EMG lab, musculoskeletal clinic, spinal cord injury clinic, and pain management clinic.

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. 

Senior Resident Inpatient Rehabilitation (2 months)
Two months are spent as the senior resident on the inpatient floor. Here, the resident will act in a more supervisory role and teach the other residents. The resident also will work with the attending in reviewing possible admissions from outside hospitals. Four half days per week are spent in the EMG lab.

Outpatient Months

EMG 
Initial training includes three continuous months (generally during the PGY-3 year) of learning how to perform electromyography and nerve conduction studies. Time will be spent with both Neurology and PM&R EMG clinics. Overall, residents will get about six months of EMG training.
 
Musculoskeletal (1 month)
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, botox 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
      

Other

Elective (2 months)
Two months will be spent on electives. This is generally in the senior year within the Health System, and include going to outpatient clinics or working on research.  There is also the opportunity to do an away elective during this time.
 
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, time will be spent in the outpatient clinics or doing research.
           
Research (2 months)
Two months will be spent doing research. Prior to completing their residency training, residents are expected to complete a project such as a poster presentation, literature review with presentation or completion of a manuscript. There are multiple funding opportunities for resident research
 
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.