Our Fellowship Programs are committed to providing the highest possible quality of interdisciplinary postgraduate fellowship training for rehabilitation professionals. To this end, our Department offers a range of specialized fellowship opportunities through programs supported by federal training grants and through the support of our affiliated institutions.
Brain Injury Medicine Fellowship Program
Dr. Monica Verduzo-Gutierrez is the Fellowship Program Director to the newly-accredited Brain Injury Medicine Fellowship Program.
Brain Injury Medicine is a new subspecialty board certification under the ABPMR in cooperation with the ABPN. The new subspeciality was created due to the increased diagnosis and treatment options for patients with acquired brain injuries.
TIRR Memorial Hermann, the primary teaching hospital of the fellowship program, is a national leader in both inpatient and outpatient rehabilitation. Our rehabilitation hospital lends itself to training the highest quality brain injury physicians. The fellow rotates in both inpatient and outpatient settings with physiatrists, as well as learn from Neuropsychologists, researchers, Neuropsychiatrists, and therapists. Furthermore, the trainees are exposed to national expertise in the field with leadership of world-renowned Brain Injury specialist, Dr. Gerard Francisco, multiple researchers with R0-1 grants, such as Dr. Sheng Li, and the highest number of Board Certified Brain Injury specialists in one institution in the United States. The trainee is also exposed to more than 1,000 procedures involving spasticity management and intrathecal baclofen pump management.
Spinal Cord Medicine Fellowship Program
The Spinal Cord Injury fellowship prepares fellows to develop skills in acute SCI management, acute rehabilitation, and long-term care of persons with SCI. Our fellows spend six months of the year at The Institute for Rehabilitation and Research (TIRR) and Memorial Hermann Hospital-Texas Medical Center (MH-TMC) and the other six months at the Michael E. Debakey VA Medical Center. This arrangement provides a well-balanced exposure to both acute and chronic SCI in the various settings in which SCI professionals typically practice.
Unique experiences at the VA include:
– Weekly bedside wound care rounds with attending physicians, residents, and plastic surgeons.
– Weekly urology rounds hosted by a neuro-urologist. During this time the fellow learns to read urodynamic tracings and learns about the different treatment options for neurogenic bladder.
– Weekly infectious disease rounds and orthopedic surgery rounds, both of which are hosted by specialists who are innovators, leaders, and vested heavily into research of SCI patients.
– Opportunities to observe and perform procedures including chemodenenervation, urodynamic studies, and orthopedic surgery.
– Outpatient clinics involving yearly physicals, during which the fellow acts as the primary care physician for patients with SCI under the guidance of an attending physician who is double boarded in SCI and Internal Medicine.
The Rotation at MH-TMC and TIRR is a markedly different experience, providing exposure to recently injured patients and the acute rehabilitation process. Two of the six months are spent at Memorial Hermann, one of the busiest level one trauma centers in the country — which receives patients from many areas of Texas and surrounding states. At MH-TMC, the fellow is a consultant responsible for making recommendations for the acute management of SCI patients in the intensive care unit setting, working closely with neurosurgeons and intensivists. The fellow is exposed to multiple levels of spinal cord injuries from traumatic and atraumatic causes.
The remaining 4 months of this rotation involve managing an inpatient service at TIRR, a freestanding acute rehabilitation hospital with 3 active inpatient SCI services. TIRR is internationally recognized for excellence in rehabilitative medicine. Each member of the teams on the SCI service (PT, OT, psychology, social work, etc.) see SCI patients almost exclusively – allowing for a focus and expertise not only of the physician but of the whole team. At TIRR, fellows are exposed to specialty wheelchair and seating clinic, management of patients on mechanical ventilators (along with placement of diaphragmatic pacers), robotics, and other cutting-edge practices not commonly seen in rehabilitation centers with a smaller SCI census.
TIRR’s Case Mix Index indicates that we care for some of the most acute and medically complicated patients seen by any rehabilitation facility in the country. At any given time, each inpatient service at TIRR may carry 2-5 patients on ventilators. By the end of their time at TIRR, fellows should be competent to care for the most complex SCI patients.
The six months at TIRR/ MH-TMC includes participation in an active outpatient SCI clinic. The fellow is provided the opportunity to spend at minimum three half-days per week seeing SCI outpatients with a wide array of medical, psychosocial, and musculoskeletal problems. Procedures include trigger point injections, intra-articular injections, ultrasound-guided botulinum and phenol injections, intrathecal baclofen pump refills, and musculoskeletal ultrasound. Ongoing SCI-related clinics include an orthotics clinic, Urology Clinic, Obstetrics and Gynecology and Fertility Clinic. Other specialists including psychiatrists, internists, neurosurgeons, podiatrists, a wound care nurse, a social worker and others are also available.
Fellows complete their training with a solid foundation in SCI medicine. A survey of past fellows indicates that most have gone on to practice SCI medicine in academic settings, continuing to contribute to the care of SCI patients and educating future SCI practitioners.
In summary, unique strengths of our fellowship experience include:
• A good balance of both acute and chronic SCI, VA and private/academic practice, inpatient and outpatient experience, in the settings SCI-professionals typically practice.
• Opportunities for learning and mentorship from a total of ten actively practicing, subspecialty- certified SCI physicians.
• A strong faculty commitment to fellow education, in which the faculty often outnumber the fellows.
• An opportunity to practice in a freestanding rehabilitation hospital with an SCI center that is internationally recognized for excellence in clinical care and research.