UC Irvine PMR Question

UC Irvine is not a program that is discussed often on this board, for whatever reason. Your best bet would (if you haven't done so already), is to comb through the archives of the PM&R forum, and PM SCIronMike, as he's there now.

 

Not discussed frequently? This will be an epic post then.

UCI has five residents per year and each academic year is broken up into 5 equal length rotations. Over 3 years, each resident does 15 rotations. It is basically 50/50 inpatient/outpatient. Below, I'll list what the rotations are.

The MSK education at UCI is VERY strong. In the PGY3 year, each rotation is accompanied by an anatomy module. Each anatomy module is taught by reading, lectures, cadaver lab (this is new), and group presentations/discussions. At the end of each anatomy module, there is a 30 minute oral exam given by the attendings, one who is an oral board examiner. The oral exam is pretty tough can cover ANY aspect of that part of the body including anatomy, pathology, electrodiagnostics, physical exam technique, etc.

In the outpatient clinics, we inject any joint you can name and there are A LOT of injections. It gets really old and pretty soon we just have the rotating med students do the injections. We have a Philips HD3 ultrasound machine that we can use at any time for MSK diagnosis or guided injections. The current PGY3 residents are getting very comfortable with MSK ultrasound. We do quite a few fluoro guided injections during our residency. This includes pretty much all the lumbar spine procedures such as transforaminals, interlaminars, caudals, MBNB, facet blocks, lumbar sympathetic blocks, RFAs, etc. There are also cervical facet blocks, cervical epidurals, stellate ganglion blocks, etc, but in lesser numbers. At THIS point in my residency (50% done with my PGY4) year, I am at about 110 fluoroscopy procedures PERFORMED, with easily over 250+ with observation and assisting. I will easily hit over 120-130 performed by the end of this year.

Basically in this program, you will graduate knowing your anatomy inside and out. Your MSK physical exam skills will be first rate. You will have an excellent exposure to ultrasound and be able to do any injection necessary. MSK and electrodiagnostics are the strongest parts of this residency program. I honestly believe our EMG training is second to none. Our didactics are first rate. We are quizzed and tested frequently. We are held to a VERY high standard by the attendings. We also take the EMG SAE yearly and class after class the residents have scored REALLY REALLY well. I didn't even have to prepare significantly for the test and scored in the top 5 of all test takers.

As you may expect with such a MSK focus, a lot of our residents are interested in fellowship. Out of the 5 residents in my class, 3 of us are doing spine/pain fellowships next year.

The UCI rotations are:

PGY2
1. Long Beach VA Inpatient wards - resident manages the 10 inpatient beds + any overflow and also does some outpatient TBI clinics
2. Long Beach VA Inpatient consults - resident does all the inpatient consults
3. Long Beach VA Outpatient - outpatient clinics including general PM&R clinic, general Neurology clinic, specialty Neurology clinics (motor neuron disease, movement disorders), SCI shoulder clinic, SCI annual exam clinic, Orthopedics clinic, Urology clinic, etc
4 and 5. UC Irvine Inpatient Wards - 14 bed inpatient rehab + outpatient amputee clinic + outpatient PM&R clinic

PGY3 - This is a year where there is NO inpatient call and all the residents are only in outpatient clinics. On each of the rotations, the residents spend the MAJORITY of the time in general outpatient PM&R clinic and EMG clinic.

1. Long Beach VA Outpatient with Wheelchair clinic emphasis - electric mobility clinic and ortho hand clinic and Whirlpool clinic
2. Long Beach VA Outpatient with P&O clinic emphasis - shoe and brace clinic and amputee clinic
3. Long Beach VA Outpatient with Pain clinic emphasis - 1.5 days / week in fluoroscopy. Acupuncture clinic. Multidisciplinary pain clinic
4. Long Beach VA Outpatient with Cardiac rehab clinic emphasis - 0.5 day / week allocated for cardiac rehab
5. Long Beach VA Outpatient with ??? emphasis - I don't even remember anymore. If I remember, I'll edit it in

PGY4-
1. UC Irvine Inpatient Ward Senior - Round with the PGY2s in the early AM and then off to the Pain clinics for outpatient consults, follow-ups, and fluoroscopy suite procedures until noon. In the afternoon, inpatient consultations daily and PM&R outpatient clinic 1 day / week.
2. Kaiser Sand Canyon / Chapman - Monday you go to Kaiser Sand Canyon and do ALL the fluoroscopy procedures there. It is BEYOND sweet. You just go in, examine the patients with the attendings, do the procedures, and the attending writes the notes. I generally bum around Kaiser picking up procedures until about 3 PM and then head back to UCI to do consults. Tuesday through Friday, in the AM the resident goes to Kaiser Chapman and does outpatient PM&R clinic with the attendings there. In the PM, back to UCI for inpatient consults.
3. Long Beach Memorial Inpatient Neuro - Inpatient ward resident for anything Neuro including TBI and stroke + consults
4. Long Beach Memorial Inpatient Peds/SCI - Inpatient ward resident for pediatrics rehab unit and the adult SCI patients + consults
5. Long Beach Memorial Inpatient General rehab / Ortho rehab - Inpatient ward resident for general rehab and ortho rehab adult patients + consults

Long Beach Memorial is really busy. It is a 62 bed adult + pediatrics inpatient unit. You learn A LOT by doing A LOT, but the hospital is VERY well run. There is basically NO scut. You do the doctor thing, everything else basically gets taken care of.

Anyways, I hope this helps. If there are any questions, post them up. Let's get some UCI discussion going

 

What fellowships, if I can ask

 

I don't want to speak for my classmates, but we all pretty much needed to and are staying in CA for fellowship. I will be at Cedars-Sinai.

 

It mostly depends on which outpatient rotation you are on. Some have 3 half days of general PM&R outpatient clinic per week. Some have 5 half day so fgeneral PM&R outpatient clinic per week. But certainly on each of the outpatient rotations, the majority of your time is between general PM&R clinic and EMG/NCS clinic.

We definitely have great exposure. I just did 8 fluoro procedures this morning. 2 caudals, a pair of TFESIs, a cervical RFA, a lumbar RFA, a stellate ganglion block, a two sets of MBNBs. Now, off to do inpatient consults

 

Sounds like you have a great experience there at UCIrvine. Why is most of your class doing fellowships? Sounds like you could start practicing right out residency.
Are non-pain board boarded physiatrists having difficulty getting credentialed to perform procedures in LA/Orange County?

 

The job market in Los Angeles and Orange County is tremendously competitive. One reason that the majority of us are going to fellowships is probably because it seems that the majority of employers are looking for fellowship trained physiatrists. In recent years, the program has shifted to be more MSK/pain focused and maybe that has caused the 3 of us to be focused and intersted in these areas. In the past, this wasn't typical. In the past 4 graduating classes, only 1 resident per class chose to go into pain fellowship.