UCDavis PM&R Residency Evaluation

Discussion in 'PM&R' started by PostureGuru, Jun 14, 2008.

  1. PostureGuru

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    Having just finished the UCDavis program, I would, without a doubt choose to go to another program if I were able to do it again. The inpatient experience is very disjointed with three different attendings "covering" the floor patients every week. Monday through Wednesday, Thursday – Friday, and Weekend all have a different attendings. On the inpatient service you also cover pediatric patients which has a separate attending. The consult attending is also a different attending every day so there is not any sort of continuity between consults and admissions in terms of attending presence. During my entire time at UCDavis, the attendings never once attended a family conference. Even when first year Residents and Interns asked the attendings to attend a family conference to provide feedback and/or show them how a family conference should run – they refused. The pediatric attending went to family conferences only because it was required by CCS (the payor for pediatric services). The inpatient gym is in the basement 6 floors down from the inpatient floor so your chances to actually see your patients doing therapy is limited. We never once did therapy rounds to see the patients doing therapy with the attendings in my four years there (including the 2 months my intern year) which is mind boggling. In terms of getting fellowships, myself and another resident both applied to pain fellowships and did not get into a single one. We both applied to the UCDavis program which has six positions a year and did not get in. One of the attendings (who blogs on this sight) in our program approached me to write a letter when he heard that I was applying. A couple of days later at the end of year graduation two of the secretaries in the PM&R office told me that they were sorry that this attending had not given me a strong recommendation. When I discussed the matter with the attending, he said that he thought I was a great candidate and that he did give me a strong recommendation – only to boast (as described by the resident) to another resident months later that they did not feel that I really wanted to do the fellowship and, as a result did not give me a strong recommendation. UCDavis started a sports medicine fellowship this year that one of the graduating residents landed, but the attending that runs the fellowship was not even asked by the resident to write her a letter of recommendation for application to other programs that she applied to. When the residency director was asked about this issue she told myself and the head of graduate medical education that this had happened before. The resident who applied to the pain fellowship this year was actually told during his interviews that the UCDavis pain program did not prefer internal PM&R candidates. The residency director also informed me, after myself and the other resident were not offered a spot, that the last UCDavis PM&R candidate did not work out well and that the pain program here was reluctant to take another UCDavis PM&R graduate. Something that I don't imagine happens at other programs. In terms of getting a job, there were five local jobs four of which were being offered by alumni. For 2 of the jobs myself and the other candidate, who were looking to stay locally, did not even get an interview. When I asked the department chair how that could have happened he only said that he never got a call from them. This was after he had been asked and agreed to make a call 2 months prior. For the other two positions – the department chairman could not even make a call to the alumnus – he sent an email. When asked why he played such a passive role he informed me that the last resident he had recommended did not work out and was not sure how much an endorsement from him would be valued by the hiring alumnus. Information that would have been helpful upfront. The unbelievable part is that yet another attending let me know, FYI, that he told several prospective employers that I suffered from a medical condition. When I told the residency director about it – nothing was done. Only after having to go to the head of graduate education did the residency director tell the attending to stop divulging this information. Most of the local jobs and a lot of the Northern California jobs went to graduates of programs with a stronger reputation. That being said – the support of attendings to get jobs out this program can only get better, because in my estimation it cannot get any worse. If you have any questions feel free to contact me at [email protected]. I relied on contacts outside of UCDavis and relied heavily on a UW alumnus to help me land an academic job at UCSF. Although I had reservations for months in posting the warts of the program, the way in which the department handled my future and culmination of over 12 years of hardwork left me with no ther choice but to bring this to light so it does not happen to anyone else.
     
    #1 PostureGuru, Jun 14, 2008
    Last edited: Jun 14, 2008
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  3. SportsMed09

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    As a med student, I'd like to thank you for posting this. I was considering applying to UCDavis this coming year before I kept reading that you had to be "self-motivated" to succeed there (I know that; what's the point of the residency program then?). But learning about such a gross lack of support for helping you attain the ultimate prize for your years in med school and residency...that's unbelievable.
     
  4. topwise

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    Wow, I am totally shocked to hear this. I thought UC Davis was an extremely strong program and everyone in my program talks enviously about how the attendings there are not resident-dependent.

    I go to your neighbor program (Stanford), which has had some problems in the past. However, I've (mostly) been pleased with my experience. And if I get the senior rotations I've requested (which is very likely) for next year, I'll have well over 300 EMGs under my belt when I graduate.
     
  5. GQPMR

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    Correct me if I am wrong, but from what I know about the UC Davis PM&R program, it was never a powerhouse when it came to inpatient rehab, maybe that was why it was so lackluster.

    Someone mentioned being self-motivated will be the key to this residency. Self-motivation is the key to most PM&R residencies in the country. There are very few residencies that will feed you all of your info you need off a silver platter. Even those that provide the best eduction expect you to open a book once in awhile to supplement or create ideas for you to ponder on. Best thing is to learn everything your attendings can teach you (which usually is alot) and then supplement that with outside readings to create the best learning environment for yourself.

    This is an issue that is always the case when you have a consult service. Unless your program makes you as the resident (and your attending) see the consult you are admitting to your service, you will always feel like there is no continuity of care. The flip side is that when you get this so called "continuity of care" with following the patient from the acute side of the hospital and finally admitting them to your service on the rehab floors, you will eventually feel overwhelmed with the amount of work by seeing your own consults, follow-up patients (the consults that needed an extra day or so to make it to rehab) and taking care of your own patients on the floor that you may not get to see the patient doing therapy even if you wanted to. This is something that likely will be personal preference and each residency program struggles with this exact issue.

    This actually does suck. What were the reasons why the attendings would not show up or refuse to come? You as the resident should be learning how to deal with the delicate issues of how to deal with family during this time of healing. Ultimately it will fall on the attending physician (in terms of litigation against the medical staff) should you or the staff say or do something to offend the family or patient. If I were the attending I sure as hell would be present to monitor if nothing else.

    Sometimes asking a fellowship director for a letter of rec for another fellowship is seen as a slap in the face for their own fellowship. This is a fine line to walk on and unless you are sure the fellowship director will be able to consider you fairly for their fellowship knowing that you are applying elsewhere you may want to reconsider this approach. The good thing is that the resident did actually get the fellowship position, so all was not lost.

    Did your program director or the people interviewing him/her at the pain fellowship state what was the actual problem with the in-house resident that they took? If it was an attitude issue, those can be simply overlooked as each person is a very different human being, some are great and some not so much (even if they look great on paper)... If it was an educational issue, then that might be something that might reflect poorly on the PM&R program as a whole. This would be something the program would have to pursue to change.

    Most pain fellowships that have in-house PM&R may prefer internal candidates, but not always. I have known quite a few pain programs that have said the exact thing that you mentioned, previous PM&R fellow did not work out so no more from this program or PM&R in general. One thing to always remember regarding pain fellowships is that no matter how much integrated pain medicine is becoming with psych, PM&R and Neurology, it is still the domain of Anesthesia. So if you go in stating/acting like your the best thing since sliced bread (we are truely functional docs and function is a reflection of how well pain is being controlled), you are going to make waves with these Anesthesia faculty. The real world is quite doggy-dogg so learning how to be diplomatic now during residency will do you wonders once out looking for jobs.


    This is a tough call and it sucks if you were discriminated against regarding this type of issue, but I can tell you that things like this happen all the time. I have heard many times from attendings when asked for recommendations from employers, especially if they were phone calls, that quite candid conversation ensued and if the applicant knew of the stuff mentioned they would not be happy. Recommendation is to keep your attendings and program director happy during residency and good news will follow you wherever you need to go.

    I have dealt with two co-residents actually getting very sick (both ended up in the ICU, but both ended up doing well) due to medical conditions. But afterwards, everyone was on edge and worried will they may be out sick again, cuz as much as the residents banded together to help out to cover patients and services during their time out they really did not want to have to deal with this burden again.

    This is why I tell all of the residents below me that they need to start networking with other residents and with faculty at other programs, because you never know when someone can come handy.

    At least you did land a very good job at UCSF, you should pat yourself on the back for that one. Does UCSF have rehabilitation program, cuz I was under the impression they don't have a PM&R residency?
     
  6. SportsMed09

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    Just wanting to clarify about the self-motivation comment: I know that being self motivated is the key to being successful in any PM&R program, or any endeavor in life, for that matter. But, you don't read Mayo or RIC interview feedback or comments that you need to be "self-motivated" to succeed in their programs. That to me seems like code for the program having holes in its education that you need to cover. While I have no problem reading on my own and enhancing my own knowledge, I don't think the residency should have a weak didactic system and pass the blame to their residents.
     
  7. GQPMR

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    You are right to have some apprehension if a program continually gets labeled as a self motivated program, but that preclude any reference to whether or not Mayo or RIC are or are not the same way. The only way to truly find out is to probably rotate at these institutions and find out for yourself.

    Given that these two institutions have unprecedented reputations, I do know for a fact that some educational requirements at these places are resident driven and your seniors/fellows are your lifeline to learn some apects of residency. I have also heard that some outpatient rotations are not freely available to everyone and a sort of match process takes place for sought after rotations. I also know of a particular resident who was presenting a poster at the AAP in Puerto Rico and was only given two days off to do that poster. So basically that person flew into San Juan the eve before, presented his poster in the AM the next day and was on a plane that afternoon to get back to work for his rotation the next day. Kind of sucks, since this will probably be the only time in the next probably 5-10 years that a primary PM&R conference will be held in the caribbean.

    Its really all in the perspective of what you want or are looking for in a residency. Someone's bad luck may be another person's good fortune. I believe there has to be a balance and definitely the primary education should be emphasized during the residency by attendings, but the resident also has to do his or her part to be able to capitalize and excel. I have seen way too many residents in various programs act as if the silver spoon needs to be in their mouth otherwise they won't learn a thing. One last word of advice, no matter how much you disagree with or dislike a faculty member just be humble and give them the benefit of the doubt. If you have to disagree with them, then do it gently in a way that is non-threatening or non-accusatory.
     
    #6 GQPMR, Jun 14, 2008
    Last edited: Jun 14, 2008
  8. lobelsteve

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  9. Llenroc

    Llenroc Bandidos Motorcycle Club

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    Excellent post. I think you should also post a copy of this at www.scutwork.com, which is where applicants go to read reviews of programs. :thumbup:
     
  10. drusso

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    Hmm...I think that the "self-motivated" comment gets tossed around quite liberally at most PM&R residencies regardless of reputational tier. It's especially nonsensical if you consider that the criticism is usually being hurled by *salaried* physiatrists with posts in the VA system or in large academic institutions amounting to little more than glorified administrative sinecureships.

    By virtue of the fact that you: a) went to college; b) finished college; c) matriculated to medical school; d) graduated from medical school; and e) completed an internship you have already demonstrated more self-motivational force than 99.999% of people walking around on the planet.

    That's too bad about UC Davis. Hopefully your comments and experiences will be taken seriously and corrective actions instituted.
     
  11. PMR 4 MSK

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    From looking at this, I noticed Marty Hoffman is on the Faculty. He used to be my attending at MCW, mainly outpt, pain and research. More of a quiet guy, I always liked him, and learned a lot from him.

    I appreciate your bravery for posting this, but I'd worry about long-term ramifications if I were doing it.
     
  12. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved

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    Why?

    I think that the OP is trying to point out some serious deficits in his training. He or she obviously has a bit of axe to grind, but this a discussion forum not a peer reviewed publication.

    I don't think that the field has any reasonable hopes of educational reform unless it takes a "Dr. Phil" approach about its issues and starts "telling it like it is" and "getting real" about the state of PM&R training.
     
  13. PostureGuru

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    The training at UCDavis overall is pretty good. There are problems, but if you go to conferences and talk to other residents from other program you will find out that every training program has its drawbacks. At UCDavis the attendings are pretty easy going, but their commitment to resident training is not very strong. Hence the "self motivated" reputation. The graduating residents do well on the boards and will tell you they got the job they wanted which . . . The reason I posted was simple. When I interviewed at UCDavis I asked what the program did to ensure that graduating residents got the jobs and fellowships that they wanted and I also asked if there was a strong culture of mentoring. What I was told at my interview was not consistent at all with my experience at UCDavis. Is this an isolated case - maybe - but I also know that residents who graduated one and two years before me also felt that the support just was not there when they were trying to land jobs. When you are looking at residencies you want to know how the program is going to help you and support you so you can get the job or fellowship you want. A program should understand this - UCDavis doesn't seem to get it.
     
  14. ShrikeMD

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    Why?

    There should be no long-term ramifications for sharing one's experience in this manner.

    As for UC-Davis, unfortunately, there probably won't be any long-term ramifications either.

    I think the poster did what he/she thought was right. Future medical students need to know about these things. Current faculty members need to (re)examine feedback from their trainees in an effort to improve the training program.
     
  15. ampaphb

    ampaphb Interventional Spine

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    Because every time the program director is now asked to write a letter of recommendation for the OP, the description will include the adjective "disgruntled"
     
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  17. PMR 4 MSK

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    While relatively anonymous here, it would not be difficult to for his/her former chair or program director to figure who he/she is, and as ampaphb says, they can make future LOR's and credentialling difficult.

    A few years ago, I got into a mis-understanding with my old program's new chairman and got a nasty letter sent to my group's lead physician, causing me problems. Chairs and PD's are not above retribution when angered, which can cause long term problems for you.
     
  18. ShrikeMD

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    I don't dispute your contention that repercussions COULD happen, but they SHOULD NOT happen.
     
  19. ShrikeMD

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    Wow. Your group's "lead physician" acted upon a nasty letter sent from your old program's new Chair? What is up with that? (I am not asking for details, but that seems weird to me.)

    Even if you were trying to recruit patients from his referral sources, faculty or residents from his staff, or even his favorite secretary (I do not necessarily endorse these actions, but they happen in the real world), it would seem inappropriate for your lead physician to take any action on a nasty letter from the Chair. I can think of few scenarios that would get me to write such a letter if I were a Chair, such as first-hand knowledge of obvious illegal/professionally unethical behavior, slander/libel against a colleague, or testifying falsely in civil/malpractice litigation. Similarly, few scenarios could prompt me, as lead physician, to act on a letter from the Chair, such as first-hand reports of a group-member engaging in such behavior. Even then, there would be due process--and the benefit of the doubt in case of a "he said/she said" scenario.

    I am unsure who is the bad guy here, your old program's new Chair, or your group's lead physician.
     
  20. SpineBound

    SpineBound Large Member

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    It is actually illegal for someone to not hire you based on a medical condition. If you can prove that this happened you can get enough money from UCD to pay for a few years of work. I have been reading a book called "california hiring practices" its very clear about this. I think you have a case if you wanted to pursue it. Having an axe to grind is only good if you grind it sharp and then cut off someones head!!!;)

    I sure am glad I didn't get in to UCD, they were my #2 (I got my #1)
     
    #18 SpineBound, Jun 18, 2008
    Last edited: Jun 18, 2008
  21. Paulyfarmacy

    Paulyfarmacy Bigfootsd!ck

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    Free speech. Awesome post! This sort of info is invaluble as a medical student. Thank you postureguru…
     
  22. UCDR4

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    I don't want to take away from the experience of PostureGuru, but I wanted to offer another perspective from a current UCD R4. I have thoroughly enjoyed my training here at UCD and have had a very different interaction with the faculty. I feel that all faculty members have been very supportive of my training and education. As I am just beginning my job search, I can't comment on how this will extend into me obtaining an ideal job, but I have every reason to believe I will continue to receive the same level of support I have experienced throughout residency. I feel confident that I will be able to find a job or fellowship that I will be quite happy with, and am not in the least bit worried.

    The UCD PM&R residency program has many, many strengths and the faculty & resident rapport and camaraderie is one of the highlights in my mind. I think we have a very balanced training in inpatient rehab, outpatient neurorehab, EMG, and MSK (sports/spine) that will prepare me well for a career in whatever aspects of PM&R I would like to pursue.

    If you are considering applying to the UCD PM&R program, I encourage you to take PostureGuru's post as only one person's perspective. It would be a shame to miss out on a wonderful residency program based on the experience of one person only. I also encourage you to take a closer look at us...we are very open to rotating students, emails and phone calls. I know that I am happy to talk to any prospective applicants at any time during the application process. I know our program director and chair are always available and approachable as well. I believe any of the current residents or other recent grad's would be happy to discuss their personal experiences. If you are interested, just contact our program coordinator and give her your email. She generally forwards it on to us and we'll be in touch. And if you were thinking of applying to UCD before reading this post....just apply, come interview, and then decide for yourselves.

    Thank you.
     
  23. wrentana

    wrentana Junior Member

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    I wanted to add my perspective on the UC Davis program as well. I recently finished a PM&R rotation at UCD and thoroughly enjoyed the experience. I was looking for a relatively small program with good EMG and MSK exposure and a group of residents who were smart and academically driven while having lives outside of medicine.

    I feel like UCD hit the mark on all of these fronts. The most remarkable thing about the program was, in my mind, the residents. Over my four weeks there every resident took time to answer my questions, provide me with opportunities, and made sure that I was able to maximize my time. They are also an active group- yoga, cycling, triathlons, surfing, hiking, etc. There were many other things I loved about the program, but I'm not going to go into those in detail. The point is that the program met/exceeded my expectations.

    I spoke at length with many of the residents regarding their experience in the program. If there are monsters lurking in the shadows I want to know about it before I apply this fall. In all of my conversations, the only real criticism came from postureguru. I'm not discounting any of his points, in fact I know very little about any of his complaints, but his concerns were not widespread within the residency.

    I'd like to echo the thoughts of the poster above. I thought it was a great program and would hate to see quality applicants scared away due to one person's experience. If the UCD program sounds like it could be your kind of place, don't let one resident's experience hold too much sway over your view. Get in touch with some of the current residents and find out what they think of the program.
     
  24. melancholy

    melancholy 1K Member

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    I apologize I have not been able to post a timely response. I will try to give my perspective on this as recently-turned PGY-3.



    True, we usually have two different attendings that split coverage of our inpatient unit on weekdays. Weekend coverage rotates between different attendings. Of our two main attendings, one is our main inpatient attending who is an MD/PhD with special interest in SCI and trained at Pittsburgh under Zafonte. Our other attending is the chair of our program. I admit it keeps me on my toes to work with different practicing styles and occasionally it is a chore to re-present a patient to a second attending, however I get very different teaching points from both attendings which I've found to cover more ground. Consult attendings do rotate and in my short experience, I could see the benefits of having the same consult and ward attendings for a longer period of time to allow for more communication on admissions. Occasionally, an attending will be both on consults and wards which is helpful.

    Another variable not specifically mentioned above is whether or not attendings are present in the afternoons for admissions. At UCD, attendings are usually in clinics due to scheduling and are not on the unit during admissions. I did rotate at other places where an attending would be present. Not sure what the majority of rehab programs do though. I can see plusses and minuses to this- early on, I would think there is benefit from oversight by attending to ensure residents perform a thorough admission examination. I have almost never felt lost while doing admissions as there is always an attending available on campus via page if any issues come up. There are also two senior residents available if there are any questions that pop up regarding the admit.



    I cannot speak for Postureguru's experience, however I recently completed my PGY-2 year on an inpatient rotation. In my four inpatient months last year, I had an attending present at maybe two conferences where I requested their presence due to more complex issues. I admit early on, it would have been nice to watch one or two family conferences to get the feel of things, however it isn't too difficult to figure out how to run things after a few meetings and getting feedback from therapists, social worker, discharge planner, and even patient's families. I already had some family conference experience during internship (on different issues), but I have never had any attending refuse to show up. I did rotate at other rehab units as a medical student where the attending showed up for every family conference. While it is nice to have the attending around, I'm not sure if it is a little redundant for the majority of family conferences.. and it does build a certain confidence in being able to run a smooth conference and troubleshoot when needed.



    Plans are in place for the new inpatient unit to be built adjacent to the hospital and completed approximately 2010. It will be on the ground floor with the patient rooms located centrally and the gyms and offices within close proximity. Once in awhile, I have rounded on a few patients in the gym with my attending. I think the benefit of this is the dynamic environment where you can often visualize concepts and identify deficits. I've never formally had therapy rounds before and I'm not sure how other programs do this without taking too much time away from the flow of therapy. I can see it being useful at least once a week to see each new patient once in the gym with an attending.



    I can't really comment on this as I don't know all factors involved and I realize there are a lot of things that go into selection of fellows. I will state that in the end, one graduate will be heading up the Spine program at Mercy General Hospital and the other took a position in Spine at UCSF.

    I'm not sure what basis there is for mentioning a "weak didactic system" as Postureguru actually does not state this. "Self-motivated" is something that can be thrown out to cover weaknesses in a program, however I think you would be hard-pressed to find a resident at a top-notch program to state that they weren't self-motivated. One factor may be learning style- some may like information spoon-fed to them more than others. I feel my program gives me a fair amount of independence without throwing me out to dry.



    The website is actually fairly updated compared to the beginning of last year when I started residency. Nowhere do I see on the departmental website do a statement where we are advertised as a top choice for those wishing to specialize in Pain Medicine. I honestly don't recall seeing anyone advertising that on SDN over the past few years as well (although I have not done a search to check for this).

    According to our website:

    "A unique aspect of our residency training program is the excellent training in outpatient musculoskeletal, EMG, and occupational medicine, highly desirable for PM&R physicians in the 21st century. Additionally, the resident rotation at Shriners' Hospital provides superior training in Pediatric Rehabilitation."

    As far as I've gone in my training, I feel this statement is still accurate. We have a great deal of time as well as breadth of outpatient exposure to traditional rehab clinics such as SCI, general adult/peds/TBI/stroke, amputee/gait, post-polio as well as our MDA clinic where we see all kinds of neuromuscular disorders. Sports/msk/spine clinics are in abudance with adequate opportunity for joint injections. Exposure to electrodiagnostic medicine is started early in the PGY-2 year and continued throughout residency until graduation. I feel our exposure to NMD actually helps reinforce our EDx training.

    Our inpatient training is not excessive by any means. Initially, I was skeptical that I would get enough exposure and patient volume. After my first year, I don't feel this is the case at all. We get all sorts of traditional rehab diagnoses as well as more rare cases that we are consulted for from being at a larger academic institution. In addition to the UCD inpatient unit, we rotate at Mercy (community-based rehab unit) with a recent grad of RIC where we gain exposure to the community/private setting as well as learn more of the business side of rehab medicine. As stated previously, we take the "mixed bag" approach towards inpatients, so there is no separate unit for SCI, TBI, ortho/amputee, etc. Preference for this type of learning will vary from person to person, so I highly recommend a rotation to check it out. In the end, I feel like I could run a small inpatient unit in the community without much difficulty, even for a program that has more of an outpatient focus.

    In conclusion, I agree with above that everyone will have unique experiences within residency, especially with job and fellowship searches. In addition to previous graduates who have gone onto the Kaiser system, we've had others who have gone on to Peds Rehab fellowship as well as an osteopathic NMM fellowship. A current resident who came into the program interested in Pain was just accepted to the UCD Pain Fellowship. Quite a few residents have come to this program knowing they wanted to do general rehab due to its well-rounded training. We have not had a lot in the past that were interested in fellowships and this has obviously reflected in where our graduates go- we do not have a plethora of people going to fellowships in pain, interventional spine, etc. like some other programs that advertise this. However, most of my current class seem to be fellowship-oriented so we will see where that takes us.

    As with any statement or review on SDN, I have ALWAYS recommended readers to take comments with a grain of salt and to really try and get first-hand exposure however possible. As UCDR4 stated, we are always available via email if students or applicants have questions about the program. I am also open to answer questions via PM here.
     

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