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Amputation Rehabilitation Fellowship

VA Puget Sound Health Care System in Seattle, WA offers an amputation rehabilitation fellowship to physicians who have completed an ACGME accredited residency program. Opportunities are available for a 1 year clinical fellowship or a 2 year combined clinical and research fellowship. Based upon qualified candidates, there may be 1 to 2 fellows per year.

Fellows will work in an exciting clinical and research milieu at VA Puget Sound that includes a CARF accredited Amputation Specialty Program, VA Regional Amputation Center, full service Prosthetics and Orthotics lab, and VA Center of Excellence for Limb Loss Prevention and Prosthetic Engineering. The VA amputation rehabilitation team provides lifelong care for servicemembers with combat-related amputations and for Veterans with amputations from diabetes, dysvascular disease, combat-related injuries, or other medical conditions. Throughout the U.S., VA facilities provide care for more than 50,000 Veterans with amputations.

The curriculum for the fellowship is collaboratively developed by the fellow and fellowship director and consists of didactic education, clinical education and training, evaluation and research. For both fellowship tracks, one-sixth of the fellow’s time may be spent at affiliated institutions. This allows the fellow to work in clinics at Harborview Medical Center, a Level 1 Trauma Center or other University of Washington-affiliated medical centers as meets his or her education, clinical and research training goals.

Clinical Activities

The Amputation Rehabilitation Fellow will have the opportunity to foster their skill development throughout the continuum of care for Veterans with limb loss including inpatient, consultative and outpatient clinical rotations. Clinical activities will rotate on a quarterly basis to increase breadth of clinical exposure. Clinical responsibilities will include developing plan of care, communication with other clinical services, communication with family members, and resident supervision and teaching. The fellow will have the opportunity to work with the interdisciplinary team in inpatient and outpatient settings. The fellow will have the opportunity to prescribe artificial limbs as well as evaluate patients who have already received their prostheses.

Core amputee rehabilitation clinical activities will include:

  • Inpatient consultations: pre-surgical and post-operative consultations on patients on acute care services who have undergone an amputation or are at risk for amputation.
  • Inpatient acute and subacute rehabilitation: initial consultation and close follow-up of patients admitted to inpatient acute or subacute rehabilitation for initial post-amputation rehabilitation or prosthetic training.
  • Fellows can participate in weekly interdisciplinary admissions conferences to understand the admissions process, patient selection, and resource utilization.
  • Fellows participate in weekly interdisciplinary rounds with podiatry, vascular surgery, orthopedic surgery, wound care, and prosthetics to discuss and coordinate care of patients.
  • Outpatient amputation clinics at the VA Puget Sound Health Care System- Seattle Division and American Lake Campus. Clinics typically include an amputee rehabilitation attending physician, a rehabilitation medicine resident and/or fellow, a prosthetist and prosthetics residents, and a physical therapist. Responsibilities of the fellow in the outpatient setting will include the evaluation and management of both new referrals and returning patients.
  • Outpatient amputee rehabilitation clinic at Harborview Medical Center, Seattle, WA.
  • Regional Amputation Center Telehealth clinics. This program provides important amputee clinic services to other VA facilities where these services are not available.

In addition, direct clinical work in the following areas can be arranged to meet the clinical training goals of the fellow:

  • Vascular surgery clinic
  • Wound care clinic
  • Podiatry clinic
  • Exposure in the operating room with vascular surgery, orthopedic surgery, or podiatry
  • Other rehabilitation medicine clinics such as musculoskeletal, electrodiagnostics, or polytrauma/TBI
  • The fellow will also have the opportunity to rotate with community-based prosthetic providers who are contracted for services with VA Puget Sound.

Potential procedures include botulinum toxin injections for hyperhidrosis of residual limb, musculoskeletal ultrasound for diagnosis and treatment of neuroma, observation of prosthesis fabrication and modification, and electromyography.

Educational activities

The fellowship program provides ample opportunities for teaching and learning in the classroom setting. A weekly hour clinical teaching and discussion with the program director or research mentor will be a routine part of the fellowship training. The Fellow will participate in a structured educational curriculum. This will include relevant amputation rehabilitation topics. Reading assignments will also be included on a weekly basis. Fellows will be expected to regularly contribute to curriculum by identifying and presenting current literature. A weekly round table will be held to discuss current issues. The Fellow will have the opportunity to participate in the PM&R didactic curriculum at VA Puget Sound. Additionally, there are weekly didactic lectures, journal clubs, and case presentations for the Amputation Fellowship Program.

During the fellowship program, the fellow is expected to complete at least one academic project. Each project will be developed by the fellow with guidance of faculty mentors. Examples of potential projects include:

  • Developing an educational curriculum for trainees in the area of Amputation Rehabilitation
  • Primary authorship on a clinically-based manuscript (Case Study, Review Paper).
  • Leading a topic-driven symposium on a clinically relevant topic.
  • Participation in either an independent or collaborative research project that has the potential to result in publication.

Research activities

Fellows in the 2 year track will identify a main research project with an amputee rehabilitation faculty member as research mentor. As part of their application for the fellowship, they will write a short research proposal. In addition to this main research project, they may pursue other research projects or grant applications as meet their academic goals. Fellows may seek research opportunities within the VA Puget Sound Center of Excellence for Limb Loss Prevention and Prosthetic Engineering or other opportunities as arise. Possible areas of focus include epidemiology, biomechanics, or others depending on the fellow’s area of academic interest. Research fellows will have opportunities to work with experts in biomechanics, rehabilitation psychology, epidemiology, and biostatistics in addition to the core amputee rehabilitation faculty.

The 2 year research track fellowship includes a $10,000 stipend for research expenses (does not include travel expenses or computing equipment).

To learn more about the Amputation Rehabilitation Fellowship, please explore the links below:

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