COMMITMENT AND OBJECTIVES OF RESIDENCY
The Medical College of Wisconsin PMR Residency is committed to developing outstanding clinical and academic physiatrists. The Program is committed to:
* Supporting the residents. The Residency assists and supports each resident in maintaining his/her well being; assisting in caring for and serving patients and families; and preparing for his/her future.
* State-of-the-art care and services. The Program assists the PMR Department, healthcare professionals, and others in providing state-of-the-art care and services for patients and families.
* Knowledge, skills, behavior, attitude. The Residency develops physiatrists that possess the competencies expected of an outstanding new practitioner.
* Desired in marketplace. The Program develops physiatrists that are desired in today's and tomorrow's marketplaces.
* Board certification. The Residency develops physiatrists that are able to pass the American Board of PMR general certification examination upon their initial attempt.
* Passionate professionalism. The Program develops physiatrists that are passionate about helping patients and families; enhancing their knowledge, skills, and careers; and advancing the field of Physical Medicine and Rehabilitation.
ROTATIONS
During residency the residents rotate through all services necessary for ACGME accreditation and to meet their Board requirements. The first year is primarily inpatient work at one of our hospitals. During the second and third years of the residency (PGYIII and PGYIV) residents are given ample opportunity to work in the outpatient clinics as well as pursue electives. Research opportunities are available for residents and can range from a case report to a retrospective study. The residency program's clinical curriculum consists of thirteen core rotations. Each rotation is typically a two month experience in which the resident learns to provide subspecialty care and services. The residency program consists of four types of rotations. These include inpatient management, consultative management at one of our affiliated hospitals, general outpatient rotations and elective rotations. In these rotations, all aspects of Physical Medicine and Rehabilitation are addressed.
CLINICAL CURRICULUM OF RESIDENCY
The clinical curriculum consists of thirteencore rotations. Each rotation is typically a two-month experience allowing the resident to optimize their learning.
Each rotation includes educational activities and events, including bedside teaching, discussions and lectures with a specific set of pertinent reading material.
EDUCATIONAL CURRICULUM OF RESIDENCY
The educational curriculum consists of four components.
* Didactic Series. The Didactic series is 36 months long. It consists of numerous courses pertaining to core subjects and issues of Physical Medicine and Rehabilitation.
* Electrodiagnostic Course. The Electrodiagnostic course is ten months long and occurs every year during one's residency. There is a basic course for the PGY2 & PGY3 residents which consists of weekly presentations and discussions pertaining to the key aspects of electrodiagnostic medicine; the advanced course for the PGY4 residents allows for more hands-on training.
* Anatomy Course. The Functional Anatomy course is six months long and occurs the first year during one's residency. It consists of presentations and laboratory experiences that focus on pertinent anatomy and kinesiology for physiatrists.
* Journal Club. The resident Journal Club occurs once every month. Residents and faculty typically meet for dinner and review current articles related to the Field of Physical Medicine and Rehabilitation with attending faculty to facilitate these discussions.
* Board Review course. The residents run a board review course that includes discussions of self assessment examination (SAE) questions, classic articles, and other materials.
* Rotation specific didactics. Each rotation includes its own reading materials and discussions with attending faculty and allied professionals.
A typical week would encompass an hour of teaching with the rotation attending, four hours of Wednesday didactics, journal club on Thursday night, and grand rounds on Friday at noon.
PROCEDURES LEARNED DURING THE RESIDENCY
In order to become a physiatrist, the residency experience must train you in a core group of procedures. We developed rotations and a curriculum to ensure that you achieve competence in the procedures necessary to provide state-of-the-art care for your patients upon graduation. These important clinical procedures and diagnostic tests include; i) electromyography (EMG) and nerve conduction studies (NCS), ii) soft tissue peri-articular injections, iii) neurolytic spasticity management using botulinum toxin (BOTOX®) and phenol injections, iv) intra-articular small and large joint injections, v) lumbar spine transforaminal and caudal steroid injections, vi) lumbar facet joint injections, and vii) sacroiliac joint injections.
Electrodiagnostic medicine (EMG and NCS) is a strength of our department and we have several faculty who are well published leaders in this field. Through rotations at Froedtert Hospital and the VA, residents easily achieve their required 200 supervised patient consultations. Our electrodiagnostic medicine didactic series with its clinical laboratory sessions further augments the resident's level of confidence in conducting these studies.
Soft tissue and intra-articular joint injection experience is derived from our many outpatient rotations in pain management and in physical medicine. The FMLH Pain Clinic rotations provide an excellent opportunity for residents to gain experience in these management techniques.
Spasticity and tone management is an important area of care that is useful for patients with spinal injuries, brain injuries, strokes, cerebral palsy, and other upper motor neuron syndromes. Our department is fortunate to have John McGuire, MD, an associate professor with a decade of research and clinical experience in this area to teach our residents. Dr. McGuire is a federally funded investigator with a robust research agenda in this area. Each resident rotates for two months with Dr. McGuire and learns the latest techniques in BOTOX and phenol neurolysis as well as the use of intrathecal anti-spasticity medications such as Baclofen. Elizabeth Moberg-Wolff, MD, a pediatric physiatrist is an expert in pediatric spasticity management and will teach our residents about these techniques in children.
Lumbar spine injections with corticosteroids is a burgeoning area for physiatrists who are increasingly the primary care doctors for persons suffering from a variety of back and musculoskeletal disorders. Traditionally, residents finishing a PMR residency need to take a fellowship to achieve competence in the use of lumbar and sacroiliac injection procedures. In our residency, we have incorporated these procedures in rotations, such that graduating residents will have sufficient training to competently utilize basic lumbar injection procedures in their practices. We have three faculty members with fellowship training in spinal injections and residents have substantial time working with them during their residencies.
ON-CALL AND CROSS COVERAGE RESPONSIBILITIES
The Physical Medicine and Rehabilitation department monitors resident work hours to ensure compliance with all ACGME mandates. We are always in compliance with the 80-hour work week. Residents take call from home covering one of our affiliate hospitals. The call frequency is increased for the PGYII residents and is less frequent for the PGYIII and PGYIV residents. Call is approximately once every 4 – 6 weeks during the PGYII year and every 8-10 weeks during the PGYIII and PGYIV years. Call is always from home. On the weekends, the resident on-call rounds in the hospital and writes notes with the attending on-call.
Each resident has three weeks of vacation during which time the residents cover each other. Services requiring vacation coverage include consult services and inpatient services.
RESEARCH
The Physical Medicine and Rehabilitation department is committed to expanding the science and practice of rehabilitation. Towards this end we instituted a resident research requirement. Each resident must complete a research project during the three years of his/her residency.
Each resident attends the Clinical Scholars Research Methods Course during the PGYIII year. This course sponsored by the Medical College of Wisconsin occurs in September and October of each year. It is a focused lecture series tailored to develop an individual research project. Residents write a protocol, complete an Institutional Review Board (IRB) application, and learn the basics of study design, epidemiology, statistics, and research.
All residents are expected to complete a project by the end of their three-year residency. They fulfill this requirement by teaming up with one of our faculty. For all residents we encourage quality science that will result in a national presentation and a peer-reviewed publication.
We have an active research committee that helps the resident find a mentor and develop a project that is within the scope of the residency. During the PGYII year the resident identifies and submits a research topic for discussion to the research committee. They present their ideas at one of our research committee meetings. During their PGYII and PGYIII years the resident works on completing the project. The necessary time is carved out of clinical duties such that the expectations of the project are met with sufficient time to complete the goals of the investigation. Optimally, during the PGYIV year the resident submits an abstract to our national meeting as well as submits a manuscript for publication. Residents are provided the time, resources, and mentorship needed for their research project.