Perspectives

Hassen Berri, DO - Alumnus (Chief Resident for Class of 2016)

I was looking for a distinguished academic center with exposure to a variety of complex pathologies in addition to great resources for resident education. University of Michigan has been a staple in healthcare in the Midwest and the department of Physical Medicine and Rehabilitation is continuing to grow and improve. I wanted a training program that allowed residents to the gain experience needed to develop confidence in diagnosing and managing, even the most difficult clinical presentations.

The diversity of Physical Medicine and Rehabilitation is probably my favorite aspect of this area of medicine. Our resident physicians get a wide variety of exposure, and then are able to hone into their clinical/research areas of interest, and in-turn become leaders in the field of PM&R.

Jasmine Zheng, MD - Alumna (Chief Resident for Class of 2017)

The University of Michigan PM&R residency program was a fantastic place to spend my 3 years of PM&R training. I found the environment a welcoming place to ask questions, to learn, and to support one another through times in our growths as physicians-in-training. The expertise of the attending physicians was diverse and allowed me to learn about many PM&R subspecialties and see a variety of interesting cases. The program encouraged feedback and positive change occurred in response. Working at University of Michigan also offered the opportunity to work with and learn from talented therapists, physician specialists, and researchers. I highly encourage those interested in a dynamic and supportive residency to consider University of Michigan!

Cory Wernimont, MD - PGY4 Perspective (2018-19)

Early PGY4

My time in residency is quickly drawing to a close as I am now down to my remaining few days as a resident.  While diploma is now officially in hand, I have a few more days of elective to sharpen a few more skills before moving on to my fellowship in spinal cord injury.  The last six months has been quite a bit busier then I initially expected heading into the final leg of residency, however it was well worth it.  Clinically, I wrapped up a great O&P experience, was able to get back into the fluoro suite for my last spine rotation, knock out some more EMG/spasticity management during my electives, and dusted off my inpatient skills with my final rotation on 6A (our inpatient unit).  The 6A experience was incredibly valuable given it was my first time on our newly established formal cancer rehab service.  I was able to not only pick the brain of one of the newest leaders in this field, Dr. Sean Smith, but also dig deeper into cancer rehab as it relates to spinal cord and brain involvement which will be completely up my ally going forward. 

While clinical work certainly kept me busy, I think the things that prompted the greatest challenge over the past few months was my preparation for my capstone grand rounds as well as re-writing a SCI chapter for the mainstay pediatric rehab textbook.  This was my first foray into book/chapter writing mode and it was certainly a learning experience.  I definitely tip my hat to anyone who takes on writing a chapter from scratch or writing a book on any subject matter.  It is a lot of work!  While not completely finished up with the chapter (it is currently with the editors who will …hmm…hopefully be merciful on this inexperienced writer) it is officially out of my hands for the time being with all of the content included.  We are hoping to complete edits this summer with the updated book out next year which I am thrilled about.  My grand rounds, in which I spoke about ambulation after a spinal cord injury, came shortly after this, and I’ll say that I may have had a nice cold adult beverage once both of these projects were completed.  These projects were time consuming, but extremely rewarding to work on.

Outside of work, we had a great season in our residency/faculty city rec hoops team.  Well, when I say great season, we were better than the previous year and had tons of fun!  We were just under .500, but games were competitive and it was a blast integrating residents, our resident assistant, therapists, a rehab psychologist, and a few faculty.  Bonding time with the rehab team is never a bad thing. We also celebrated the marriages of not one, not two, but three of our resident colleagues.  Lots of dancing and lots of smiles.  All in all, this has been a great way to go out. 

Late PGY4

My time in residency is quickly drawing to a close as I am now down to my remaining few days as a resident.  While diploma is now officially in hand, I have a few more days of elective to sharpen a few more skills before moving on to my fellowship in spinal cord injury.  The last six months has been quite a bit busier then I initially expected heading into the final leg of residency, however it was well worth it.  Clinically, I wrapped up a great O&P experience, was able to get back into the fluoro suite for my last spine rotation, knock out some more EMG/spasticity management during my electives, and dusted off my inpatient skills with my final rotation on 6A (our inpatient unit).  The 6A experience was incredibly valuable given it was my first time on our newly established formal cancer rehab service.  I was able to not only pick the brain of one of the newest leaders in this field, Dr. Sean Smith, but also dig deeper into cancer rehab as it relates to spinal cord and brain involvement which will be completely up my ally going forward. 

While clinical work certainly kept me busy, I think the things that prompted the greatest challenge over the past few months was my preparation for my capstone grand rounds as well as re-writing a SCI chapter for the mainstay pediatric rehab textbook.  This was my first foray into book/chapter writing mode and it was certainly a learning experience.  I definitely tip my hat to anyone who takes on writing a chapter from scratch or writing a book on any subject matter.  It is a lot of work!  While not completely finished up with the chapter (it is currently with the editors who will …hmm…hopefully be merciful on this inexperienced writer) it is officially out of my hands for the time being with all of the content included.  We are hoping to complete edits this summer with the updated book out next year which I am thrilled about.  My grand rounds, in which I spoke about ambulation after a spinal cord injury, came shortly after this, and I’ll say that I may have had a nice cold adult beverage once both of these projects were completed.  These projects were time consuming, but extremely rewarding to work on.

Outside of work, we had a great season in our residency/faculty city rec hoops team.  Well, when I say great season, we were better than the previous year and had tons of fun!  We were just under .500, but games were competitive and it was a blast integrating residents, our resident assistant, therapists, a rehab psychologist, and a few faculty.  Bonding time with the rehab team is never a bad thing. We also celebrated the marriages of not one, not two, but three of our resident colleagues.  Lots of dancing and lots of smiles.  All in all, this has been a great way to go out. 

Trent Hall, DO - PGY4 Perspective (2018-19)

Early PGY4

At this point in the year, I'm beginning to feel excitement for the next step in my training mixed with the first twinges of what it will be like to miss everyone here at Michigan. I've definitely met a lot of great people on this leg of my journey and it will be tough to leave these relationships behind in July when I begin fellowship at Ohio State University in Addiction Medicine.

Right now I am trying to make the most of what is left of my senior year. There is still a lot to learn. I'm trying to absorb as much as I can clinically and academically while balancing study time with some really cool extracurricular activities. I just finished another manuscript to submit for publication. I have two additional research projects that are still ongoing but making progress. I hope to finish both prior to graduation. I'm collaborating with my co-resident Steve Pirnie, PGY-II and our faculty mentor Dr. Danko to start the Michigan Medicine PM&R podcast. Finally, I'm working with Harris Imam, PGY-III and our faculty mentors Dr. Chiodo and Dr. Claflin in an effort to update our official unit policy on venous thromboembolism prophylaxis. For me as a senior wrapping up my last year at Michigan it is incredibly meaningful to be a part of these projects that I hope will leave a lasting impact after I am gone.

Kimberly Casten, MD -  PGY3 Perspective (2018-19)

Early PGY3

Spending the early months of my PGY3 year in EMG completely changed my residency experience.  I enjoyed becoming proficient at doing daily procedures and correlating my physical exam findings with definitive findings on nerve conduction and needle EMG.  I also realized how painful the procedure is!  While it was trying to watch myself inflict pain for the good of the diagnosis, it was rewarding to give patients answers, oftentimes better than we can offer in the clinic. Working with Dr. Richarsdson, Spires, Laidlaw, Chiodo, DiPonio, Hearn, and Schott was such a fun time. I learned so much while laughing and had a great time.

Meanwhile, I’ve been planning to apply for sports medicine fellowships at the end of this year.  I enjoyed EMG so much, that I’m even looking at how much EMG is offered in sports fellowships. 

Late PGY3

The second half of my PGY3 year was blessed with tapering off call.  I found myself suddenly quite interested in spinal cord injury and had a great time on inpatient.  Amazing what sleeping does.  I felt more comfortable in my final pediatrics rehab rotation, and was really grateful that I got to work with Dr. Pruente to learn about how we can help neonates who are at risk for CP and other developmental disorders.  I started developing interest in adaptive sports at the VA after working with Dr. Tinney, seeing all the options, and getting involved.  I'm now nearing the end of my O&P rotation, which I've also enjoyed. Dr. Kelly is an excellent teacher.

Joshua Startup, MD - PGY3 Perspective (2018-19)

Early PGY3

I really enjoyed the broad depth of experiences that we get here.  We have a great balance of inpatient and outpatient experiences. We have significant autonomy and choosing what clinics we can work in, especially if we take advantage of our research, elective, and jeopardy months. As a whole, faculties in the program are open to feedback and changes continue to be made. We have a graded supervision where we have is much supervision as we needed beginning, with a great balance of autonomy that only continues to grow as time progresses. If she makes the time you have significant opportunity for procedures and learning especially in the areas of electrodiagnostics. we have the opportunity to independently take a history, examination, perform nerve conduction studies, and needle electromyography on patients with a variety of disorders such as carpal tunnel syndrome, ulnar neuropathy, radiculopathy, distal symmetric polyneuropathy of multiple etiologies, and other compression type mono-neuropathies or transections following trauma. while working with a neurologist we also have the opportunity to see many varieties of neuromuscular disorders such as ALS, myasthenia gravis, varying types of myopathies, and hereditary neuropathies.  This gives us a great opportunity to see and understand nearly any type of pathophysiology if we choose to continue to perform such studies independently after graduation. There are adequate didactic sessions specifically focused on electrodiagnostics where we focused on the theory and practice of planning and interpreting an electrodiagnostic examination, even in rare cases. Some of this is at the level of neuromuscular fellows while some his basic enough for someone who has had no experience with EMG. Fellow residents are all down to earth. Fellow residents are also very supportive of all activities such as learning, patient care, and research. Many residents even spend their off time together doing recreational activities such as floating down the river, enjoying new breweries, and trivia.

Laura Mattson, DO - PGY2 Perspective (2018-19)

Early PGY2

The first year of PM&R, the second year of residency, is definitely a BIG adjustment, but an awesome one!

Intern year is spent toiling through various specialties, gleaning all the outside information/experience that you can in preparation for your ultimate career (i.e. acute and chronic management of various medical issues [pertinent to life on inpatient rehabilitation], identifying the "sick" vs "not sick" patient [helpful for decisions regarding the medical stability of a patient to participate in rehab], developing some basic procedural skills [sterile technique, ultrasound] and much more). 

PGY-2 year then shifts your clinical lens to that of a rehabilitation physician, an adjacent but vastly different vantage point than any other! As a PM&R resident, your time is spent learning the key components of a comprehensive functional assessment and treatment plan for a variety of patient populations (including those with traumatic brain injury, stroke, cancer, general medical complexity, spinal cord injury, congenital derangements, chronic pain and musculoskeletal ailments). 

It feels incredible to finally immerse yourself in your chosen specialty, albeit at times frustrating as the learning curve can feel a bit steep. Believe me though, we all progress faster and in greater magnitude than we ever expect! 

Your call nights, however sleepless, do in fact build your confidence in medical decision making and provide important experiences you would otherwise miss. Our inpatient service months (during which we take call) are then balanced by a lighter load on outpatient rotations, where you have more time to study but also to enjoy time with your family and co-residents. 

Some of my most favorite memories of this year are those I spent with my new residency family. We had a blast during board game nights after journal club at Dr. Hearn's, our friendsgiving feast at Stephen's, our Christmas cookie decorating day at Snacks' and our restaurant excursions in the foodie city of Ann Arbor. We make a point of getting together regularly, to relax & because we just genuinely like each other.

In PM&R, we are fervently dedicated to improving the quality of life of our patients and advancing our field, but the importance of self-care and life outside of work is not lost on us. You've picked a wonderful specialty filled with inspiring stories and hope; congratulations and welcome aboard!

Late PGY2

The second half of this year has been a whirlwind. I now have more than half of our core inpatient rotations under my belt! I feel incredibly more confident in the evaluation and management of rehabilitation issues related to stroke, cancer, brain injury, amputation and spinal cord injury. The inpatient environment and overnight call have challenged me to think critically and trust my medical knowledge, as well as my clinical suspicion and the other members of my treatment team. I can sense the growth I've gone through.

Inpatient rehabilitation truly embodies a community of interdisciplinary collaboration and I find relief in our collective focus on a patient's function and quality of life. We guide patients on a path to greater independence and we coach their loved ones to feel more confident in their care.  It is truly one of the most beautiful, awe-inspiring things to see patients and their families not only survive horrendous injuries, but triumph over them. At the end of the day, despite the toils of the EMR and the battles with insurance companies, we really have one of the coolest jobs. 

I am also so grateful for the support of my co-residents and attendings throughout this past year. We make things fun and carry each other through stressful times with comedic relief and teamwork. I look forward to starting PGY3 in a few weeks! Also, I happened to get married during PGY2 year, which shows how life still continues despite the sometimes hectic schedule of residency.