Subspecialty Experiences – Residency Program
Electrodiagnosis is used to evaluate various muscle, nerve and neuromuscular junction conditions. Training in this technique leverages coordinated education to broaden basic knowledge base in physiology and anatomy regarding various neuromuscular conditions to assist in diagnosis and monitoring of numerous neuromuscular disorders. Experience starts in the PGY-2 year and is continuous throughout the outpatient rotations, representing approximately six months of full-time experience. The structured Electrodiagnostic instruction and ample experience in both common and unusual conditions during training provide a solid foundation for graduates to practice independently, and also prepare graduates for certification examination by the American Board of Electrodiagnostic Medicine. Didactic training is through a 6-month weekly workshops and bimonthly case discussions.
Our large regional Muscular Dystrophy Association (MDA) Clinic provides care for neuromuscular disorders sponsored by the MDA. This multidisciplinary clinic is directed by Physical Medicine and Rehabilitation faculty with expertise in neuromuscular medicine. Diagnostic workups including, Electrodiagnostic studies, molecular genetic studies, muscle biopsies with histopathologic evaluations are coordinated by Physical Medicine and Rehabilitation faculty, fellows and residents. Neurology, orthopaedic surgery, pulmonology, pathology and medical genetics faculty are available for consultation. The clinics include pediatric and adult neuromuscular disease, associated restrictive lung disease, a Multidisciplinary ALS Clinic of Excellence as designated by the ALS association in collaboration with the neurology department, as well as a leading regional post-polio clinic.
Training in the care of children with congenital and acquired disability is provided through inpatient and ambulatory clinics at both UC Davis Medical Center and Shriners Northern California. Outpatient clinics include general pediatric, spasticity management, spina bifida, spinal cord injury, cerebral palsy, brachial plexus, pediatric amputee, and pediatric neuromuscular disease clinics. Some of these clinics are interdisciplinary, with faculty from the Division of Pulmonary and Critical Care, Orthopaedic Surgery and Urology in attendance as well as a nurse specialist and medical social worker.
The pediatric rehabilitation inpatient program at UC Davis is a comprehensive multi-disciplinary program providing trainees experience in managing patients on an acute inpatient rehabilitation service as well as providing consultation on patients throughout the hospital. While at Shriners, trainees will primarily manage inpatients with spinal cord injury, burn injury, or complex orthopedic conditions.
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.
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.
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, neuromuscular disease and general rehabilitation clinics. Instruction in prosthetics/orthotics involves didactic seminars including visits to the prosthetics laboratory for exposure to fabrication and fitting skills.
The pediatric spinal cord injury (SCI) program, housed primarily at Shriners Hospital, includes both acute as well as secondary rehabilitation and offers reconstructive options such as phrenic pacers, upper extremity tendon transfers and reconstructive GI and urologic management of bowel and bladder. Inpatient adult SCI training is provided at both UC Davis Health 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 clinics (UC Davis Health and Shriners) and the VA clinics.
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.
Traumatic brain injury rehabilitation is provided in multiple settings. The UC Davis Health 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 PMR and sports medicine clinics.