Residency Program: the training program
Throughout the three-year residency program, residents are supervised by a staff of teaching clinicians. As the resident progresses he/she is given increasing clinical responsibilities and is expected to participate in the teaching activities for junior residents and medical students.
Most of the teaching occurs around individual patient encounters in the clinics and on the wards. In addition, there are clinical teaching rounds, conferences, and lectures on all services. The PM&R department also conducts regular teaching rounds, seminars, and a journal club.
The program is fully integrated in that residents are assigned to rotations at LLUMC, Jerry L. Pettis Memorial Veterans Medical Center, and Kaiser Hospital. The assignments are made by the residency program committee, which takes into account the level of training, the needs of that resident, the wishes and career objectives of the resident, and the balance of assignments between the three institutions. Some activities may be offered at all three. Each of the clinical experiences is designed to facilitate rational planning of each resident's clinical assignments. Although a major core experience is common to all residents, there is some flexibility in assigning specific rotations.
Structured teachingThe department offers a structured didactic teaching program for all residents. The components of the teaching schedule are as follows:
1. Didactic Curriculum in Basic and Clinical Science of PMR
Two seminars are held weekly, and over an 18-month repeating cycle they cover the broad content of the specialty of PM&R. The topics generally follow the learning objectives of the Self-Assessment Program published by the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The specific topics are developed in advance by faculty, who give many of the lectures.
2. Resident Lecture Series
Formal presentations on assigned topics are given by residents. All residents and faculty are expected to attend.
3. Neurogenic Urology Rounds
Case presentation and discussion of patient management issues by the consulting urologist, held the 2nd Monday of the month and attended by faculty and residents. The session is scheduled on Monday mornings at 7am in Conference Room ORC-129.
4. Journal Club
Held once a month, the 4th Monday of each month. The most recent issues of the Archives of PM&R and American Journal of PM&R are systematically reviewed, plus core and current articles brought for discussion by residents and faculty. Each year an introduction is given on how to read journal articles critically.
5. Case Presentation
Once a week some more formal clinical teaching occurs around clinical problems encountered with patients on the ward. The session comprises a presentation by a resident of a case currently under his/her care on the ward. A question and answer discussion is led by the service director.
Lectures are given weekly by faculty from other departments at Loma Linda University, PM&R Department faculty and occasionally by residents, and cover additional material on special topics of particular interest or importance not covered otherwise in the seminar series. Some typical series of lectures are: skeletal radiology, neuroimaging, cardiac rehabilitation, sports medicine, neuropsychology, medical administration, etc.
7. Neuromuscular Disease/EMG Seminars
The didactic teaching program in EMG is directed by Dr. Sarah Humbert. Two seminars are held weekly, one on clinical neuromuscular diseases and one on EMG topics. They are directed primarily to the residents on the EMG service. The format is a presentation by the resident of an assigned topic after in-depth review, interspersed with formal presentations by Dr. Humbert. The topics cover clinical neuromuscular diseases and diagnostic electromyography, and are given over a 6-month cycle.
A special arrangement has been established by which the residents in PM&R have an in-depth experience in locomotor anatomy. All residents in the second year of PM&R training serve as laboratory assistants in the Department of Anatomy for the gross musculoskeletal component of the anatomy course given to undergraduate medical students. The residents join two orthopedic residents in doing some dissection, supervising students on cadaver work, and leading seminar discussions. They will also attend all lectures by the anatomy faculty. The commitment is for one-half day per week for 4 months.
All residents participate as group discussion leaders in the neuroscience program offered to medical students. This is an interdisciplinary program which integrates basic and clinical sciences. Residents gain a rich experience in the clinical neurosciences under the direction of neurology faculty. The teaching program uses problem-based, small group learning, with residents serving as group leaders.
RESEARCHThe department is committed to an active research program and each resident is expected to participate in and complete a research project by the end of their residency program. The director of research for the PM&R Department is responsible for the teaching program in research methology.
All residents attend journal club and receive an initial orientation to critical appraisal of scientific literature and an introduction to study design.
At the end of the residency, graduating residents are required to present a research seminar on a topic of his/her choice. This task involves a write-up, with references, as well as a verbal presentation.
A formal course on the Basics of Clinical Research is provided through the Core Curriculum.