Integrating physical medicine and rehabilitation into the curriculum of Iranian medical students

Purpose. To evaluate the attitude of interns toward Physical Medicine and Rehabilitation (PM&R) and design a PM&R curriculum for medical students with continued medical education programmes and workshops based on the needs and interest of Iranian medical community.

Method. Eighty questionnaires were distributed to the medical interns on the last day after attendance in the PM&R ward after participating in a one-month outpatient and inpatient course including 12 lectures.

Results. Out of 80 participants, 34 (42.5%) were female and 46 (57.5%) were male. All the participants believed

participating in a rehabilitation course was necessary; 52 (65%) believed that participating in a separate course of PM&R was necessary, and 28 (35%) believed that rehabilitation of each field of medicine should be presented in its course. A significant percentage (31.4%) of the participants were interested in continuing their education in PM&R specialty.

Conclusion. The enthusiasm of the medical students towards PM&R is a promising sign toward progress of PM&R in Iran which must be directed through a strong effort of physiatrists through setting up appropriate educational programmes for medical students and continued medical education programme s in the universities.     

La chirurgie fonctionnelle du ou des membres supérieurs chez la personne tétraplégique

Upper limb functional surgery has been endorsed by over 40 years of clinical experience and practice (Ann Readapt Med Phys 46 (2003) 144–55). The procedures are standardized and the techniques mastered. The physical medicine and rehabilitation (PM&R) teams that focus on rehabilitation of tetraplegics with upper limb surgery are aware that this clinical experience is built on communication between the surgeon and the PM&R teams and that post-surgical care is critical and key to the best possible functional outcome. This text aims to introduce a special edition of La lettre de MPR (the PM&R letter) dedicated to this subject, which will be published in the coming months.     

Programmes de rééducation avant et après chirurgie fonctionnelle du membre supérieur chez la personne tétraplégique: principes et pratiques

With over 30 years experience in functional surgery we can now offer upper-limb functional surgery to almost 7 or 8 out of every 10 tetraplegic patients. Multidisciplinary collaboration in this field needs proper preparation. The patient’s post-surgery rehabilitation must be based on specific programs already validated by experienced physical medicine and rehabilitation (PM&R) teams. The constant interaction between the surgeon and the PM&R team aims to shorten the immobilization time and prevent any risk of ruptures, adhesions or other local complications.     

Medical school effect on student selection of physical medicine and rehabilitation as a specialty

Of the several roads that lead to practice in the specialty of physical medicine and rehabilitation (PM&R), the most common is from a US medical school to a PM&R residency to specialty practice. To reduce the predicted shortage of PM&R physicians, more medical students must be attracted to the specialty. Past studies have failed to show success of various mechanisms, designed to expose students to the field, to attract to the residency programs. The current study was designed to further explore the medical school factors contributing to choice of the PM&R residency. The number of PM&R residents produced by each of the US medical schools was related to various characteristics of these schools: size, presence of a PM&R department, presence of a PM&R residency program. Only school size was found to explain the sizable observed variation in number of residents. Additional research incorporating quality and quantity of curricular exposure to PM&R is suggested.     

Rééducation et réinsertion des blessés de guerre : approche multidisciplinaire et intégrative du rôle 4 au « rôle 5 »

When a French service member is wounded in a conflict area, a chain of medical and surgical support is deployed, first with emergency measures (echelon 1), then with the surgical treatment (echelons 2 and 3), and finally the service wounded is repatriated to a military hospital in France (echelon 4). The physical medicine and rehabilitation (PM&R) is the last link in the chain of medical support and the first link in the social and professional reintegration. The PM&R team, the service member and their families work together to provide to the service member the best chance of recovery and return to duty. As part of their rehabilitation, the injured receive care and support based on a historical organization born during the two World Wars. The right to restitution is written in the Constitution since 1790. This right is reflected in practice today by various measures to ensure the gratitude, the restitution and reintegration to the wounded. After a severe injury sustained in a conflict area, the military can count on the support of various national organizations that provide measures such as military disability pensions, retraining and other benefits. The emergence of asymmetrical conflicts in Afghanistan and the increasing number of wounded has improved the organization in place. In 2011, the rehabilitation and reintegration war wounded cell (C2RBO, cellule de réadaptation et réinsertion des blessés en opération) was created, consisting of physiatrists, psychiatrists and representatives of the Army wounded support unit who combine their skills to prepare and facilitate reintegration project monitoring long-term wounded. In addition, this cell can finance many projects for wounded service members. This multidisciplinary and integrative approach puts the wounded and his family at the center of attention of all medicosocial and institutional actors. The “echelon 5” is born.     

Pediatric physiatry in 2000: a survey of practitioners and training programs

OBJECTIVES: To assess the current status and future prospects of the field of pediatric rehabilitation medicine (PRM) physiatry by detailing the demographics, training, research interests, and other characteristics of physicians currently practicing in that field and to determine the availability of training programs in PRM. DESIGN: A printed survey of members of the American Academy of Physical Medicine and Rehabilitation Pediatric Rehabilitation Special Interest Group (PRSIG) and a separate questionnaire directed to departments of physical medicine and rehabilitation (PM&R) concerning their PRM training programs. SETTING: Not applicable. PARTICIPANTS: PRSIG members and PM&R training programs listed by the American Board of Physical Medicine and Rehabilitation. INTERVENTION: Between July 1998 and April 2000, a survey was sent to PRSIG members, with follow-up mailings to nonresponding members. Between April and July 2000, a survey on PRM training practices was sent to 82 PM&R departments with fax and telephone follow-up to nonresponders and to those departments that had discontinued their training program. MAIN OUTCOME MEASURES: Instrument measures of physicians practicing PRM, including demographics, geographic distribution, practice sites, training, academic participation, special interests, and research interests along with willingness to participate in collaborative research, association in other organizations, and communication preferences. Data on training requirements as well as availability of PRM fellowships and combined pediatric and PM&R residencies indicate that the number and scope of these training opportunities are declining. RESULTS: There is little uniformity in the amount of exposure to pediatric rehabilitation required by PM&R residency training programs. There are discrepancies in the reported numbers of PRM fellowships and/or combined pediatric and PRM training programs. Projecting the number of physicians who will be practicing in this subspecialty in the future is difficult because there are no reliable data about the number of graduates or trainees in the field. CONCLUSIONS: The rehabilitation needs of children are met by physiatrists with specialized pediatric training. Our survey provided a demographic overview of the PRSIG membership. Given the decline in PRM training programs, it is imperative that the remaining programs be strengthened through communication and organization among physiatrists who practice PRM. We believe that a national database and an interactive Web site are feasible means with which to facilitate this goal.     

Geriatrics and physical medicine and rehabilitation: common principles,complementary approaches,and 21st century demographics

The demographic changes occurring in the United States transcend the capabilities of any specific medical specialty to provide optimum care for the elderly. This commentary discusses a statement of principles drafted by representatives of the American Academy of Physical Medicine and Rehabilitation who collaborated with members of 9 other medical and surgical specialties. In this commentary, we argue that geriatrics and physical medicine and rehabilitation (PM&R) share common principles and complementary approaches. We urge physiatrists and other rehabilitation professionals to address the needs of elderly patients and recommend that these principles be incorporated into PM&R practice.     

Patient awareness of physical medicine and rehabilitation.

The present study examined the extent to which patients referred to a specialist in physical medicine and rehabilitation (PM&R) could correctly identify the name or essential scope of the specialty the physiatrist practiced. The hypothesis, based on the author's experiences as a staff physiatrist, was that most patients would not be aware of the name and scope of the specialty of physical medicine and rehabilitation. This prospective study involved the administering of a questionnaire to 202 consecutive referrals to a University-affiliated PM&R outpatient clinic. Of the respondents, 19% were able to correctly identify that the physician they were referred to was either a PM&R specialist, a physical medicine specialist, a rehabilitation specialist or a physiatrist. Among the incorrect responses, orthopedist, neurologist and rheumatologist were most prevalent, and 33% of the respondents thought the physiatrist performed surgery. The implications of the findings are discussed. There continues to be a need to educate the public about the scope of practice of physiatry.     

重症康复医学的意义及发展

现代医学发展模式从“治病的科学”逐渐转换为“维护健康的科学”即强调身体功能、日常生活能力及社会参与能力在疾病救治中的重要作用。重症康复医学通过早期康复介入，促进重症患者身体功能的加速恢复及早日回归家庭和社会，因此加强对危急重症和疑难复杂疾病患者的早期临床康复是康复医学发展的重要前景。重症康复与临床其他学科紧密结合，实现“叠加”而不仅仅是“时间的延续”，重症康复工程不断使用新的技术，形成重症康复病房-普通康复病房-社区康复的三级康复网络，康复相关人员知识和技能的提高，以及新医疗管理模式的建立等重要因素都是重症康复发展中面临的挑战和机遇！     

The PM&R Journal Implements a Social Media Strategy to Disseminate Research and Track Alternative Metrics in Physical Medicine and Rehabilitation

Implementation science is an evolving part of translating evidence into clinical practice and public health policy. This report describes how a social media strategy for the journal PM&R using metrics, including alternative metrics, contributes to the dissemination of research and other information in the field of physical medicine and rehabilitation. The primary goal of the strategy was to disseminate information about rehabilitation medicine, including but not limited to new research published in the journal, to health care professionals. Several different types of metrics were studied, including alternative metrics that are increasingly being used to demonstrate impact in academic medicine. A secondary goal was to encourage diversity and inclusion of the physiatric workforce—enhancing the reputations of all physiatrists by highlighting their research, lectures, awards, and other accomplishments with attention to those who may be underrepresented. A third goal was to educate the public so that they are more aware of the field and how to access care. This report describes the early results following initiation of PM&R’s coordinated social media strategy. Through a network of social media efforts that are strategically integrated, physiatrists and their associated institutions have an opportunity to advance their research and clinical agendas, support the diverse physiatric workforce, and educate the public about the field to enhance patient awareness and access to care.     

Use of Geriatrics At Your Fingertips, a pocket guide, to educate physiatrists in geriatric care

OBJECTIVE: To determine whether a geriatric pocket guide, Geriatrics At Your Fingertips, may be a useful tool in educating physiatrists about the care of their older patients. DESIGN: Geriatrics At Your Fingertips was distributed through the American Academy of Physical Medicine and Rehabilitation (AAPM&R) to physical medicine and rehabilitation (PM&R) residents and practicing physiatrists. Two questionnaires evaluated guide use. SETTING: Two academic PM&R departments and physiatrists in the United States. PARTICIPANTS: Two PM&R residency programs, members of AAPM&R's Geriatric Rehabilitation Special Interest Group (GR-SIG), and AAPM&R's membership. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Identification of clinically useful information by residents and GR-SIG members and frequency of guide use among AAPM&R membership. RESULTS: Forty-five PM&R residents and 17 GR-SIG members reported examples of useful information. Geriatrics At Your Fingertips was requested by 483 AAPM&R members. Forty-six percent returned questionnaires (N=223). Seventy percent had used the guide at least once and 49% 4 or more times. CONCLUSIONS: Geriatrics At Your Fingertips is a useful tool with which to educate PM&R residents and physiatrists about geriatric care.     

Academic physiatry. Balancing clinical practice and academic activities.

The need for continued and diversified growth of both scholarly and clinical activities within academic physical medicine and rehabilitation (PM&R) departments is discussed with reference to the demands placed on academic departments by the various components of their mission, such as administration, clinical service, education and research. The expansion and improvement of clinical services should include the following components: program development, resources needed, finances required and marketing. Clinical subspecialization of faculty and solid affiliation with nonacademic hospitals and rehabilitation facilities is essential for academic PM&R. The faculty should include three categories: clinical faculty, clinical-research faculty and research faculty. Adequate financial resources must comprise an appropriate balance of academic funds, clinical income and grant sources. Clinical funds will play a greater role as other sources of funds diminish. Any practice plan must recognize the equality of the differing faculty members' practices, whether their interests are clinical, educational or research-oriented. The expansion and intensification of clinical programs by academy PM&R departments could increase competition in the medical community. Sensitivity to the perceptions of other practitioners and institutions, careful planning and cooperation will help the field grow and improve levels of care for the patients we serve in light of the changing medical care environment.     

Manpower planning for physical medicine and rehabilitation: comment on GMENAC process

Although physical medicine and rehabilitation (PM&R) was not analyzed by the Graduate Medical Education National Advisory Committee (GMENAC) Delphi Adjusted Needs Based Modeling process completed in 1980, a provisional manpower requirement estimate of 3,200 physiatrists was included in the final report. In late 1981 and early 1982, the GMENAC model was used and an official 1990 estimate of 4,060 physiatrists needed, with only 2,400 physiatrists available, was determined. This report summarizes the initial correspondence and the assessment study methods for PM&R utilized to attain these estimates. Considerable variability of the numbers determined by the Delphi Panel is apparent. These estimates have been accepted by the Office of Graduate Medical Education and although no official action has ensued, the results are on record for future manpower planning and may be a factor in the current interest of medical students in the specialty of PM&R.     

The evolution of Medicare financing policy for graduate medical education and implications for PM&R: a commentary

Currently, the only explicit payers for graduate medical education (GME) in the United States are the federal and state governments. Of these, Medicare is by far the largest and most predictable payer. Through the prospective payment system, Medicare reimburses teaching institutions for both their direct and indirect costs associated with their GME programs. Because a well-educated workforce benefits patients covered by private, as well as public insurance, various proposals have been advanced to establish an all-payer pool to distribute the financial burden more equitably. Furthermore, Medicare policy affects physician supply. There is increasing recognition of potential physician oversupply, raising policy questions about the government's longstanding support of GME. In comparison with other specialties, physical medical and rehabilitation (PM&R) may receive more favorable treatment under future GME funding plans, for 2 reasons. First, under the formulas used by Medicare, PM&R training slots typically bring in more indirect revenue to teaching hospitals than is consumed in indirect expenses. This makes PM&R a relatively more attractive program to retain in the face of mandated reductions in training slots. Second, in many parts of the country, PM&R is not threatened by oversupply, making cuts less likely. Nevertheless, the high percentage of non-US medical graduates entering PM&R training may make the specialty vulnerable to future reductions in funded training slots.     

Through the looking glass: a personal view of the field of rehabilitation medicine. The 56th John Stanley Coulter Memorial Lecture

This lectureship reviews the past, present, and future of the field of physical medicine and rehabilitation (PM&R) from the clinical, educational, and research points of view. I make recommendations for the field on how members of the various PM&R associations can make a difference in mapping the future.     

Pain management: What's the more efficient model?

ObjectivesConduct a literature review on the organization models for the chronic neuropathic pain management of spinal cord injury (SCI) patients.MethodsBibliographical research on Medline based on the following keywords: chronic neuropathic pain in spinal cord injury–comprehensive management–multidisciplinary approaches.Results and discussionNo data was found in the literature on this specific topic. We took the option to report the data from the French laws regarding chronic non-cancer pain management. Chronic pain in SCI patients needs a specific and rigorous approach, justifying the role of the physical medicine and rehabilitation (PM&R) physician within specialized pain management centers as a key referent physician and coordinator for this type of patient. Furthermore, SCI pain is a chronic pain and as such requires a global care management; engulfing its emotional, affective, cognitive and behavioral aspects. These particular aspects need to be evaluated within specialized centers dedicated to chronic pain that provide specific therapies such as behavioral and cognitive therapies.ConclusionSpecific pain management centers or hospital units remain the benchmark place for chronic pain in SCI patients. PM&R physicians play a key role in the care management of chronic SCI pain. The partnership PM&R–Pain management center aims to provide the most efficient and coordinated care for SCI patient.     

Academic productivity in physical medicine and rehabilitation.

Academic productivity of faculty members in physical medicine and rehabilitation (PM&R) was evaluated retrospectively by using the numbers of scientific publications as a measurement instrument. This study was completed by examining ten medical peer-reviewed journals that regularly included original articles in the specialty area of PM&R during the years 1988 through 1990. The number of articles was weighted according to the specific journal's impact on the Science Citation Index. Academic productivity of physiatric departments showed wide variation. Ten units published at least 20 articles during the 3-yr period. Eight departments achieved a ratio of at least one article per faculty member based on reports from the Association of American Medical Colleges. Further study will be needed to assess the factors underlying these wide variations in departments' productivity.     

Physical medicine in medical curricula: training primary care physicians and students

The demonstrated need for the education of primary care physicians in the principles of Physical Medicine & Rehabilitation (PM&R) is not matched by the curricula of medical schools and primary care residency programs. This anomaly of medical education is discussed from the standpoint of the hindrances inherent in the medical professional as a whole and more specifically in PM&R itself. Several concepts are suggested to stimulate thought about how PM&R may change perceptions of the specialty. Increased general medical knowledge is an important element of the PM&R learning experience. The emphasis of medical education should be on the students' needs rather than those of the specialty.     

How Prospective Physical Medicine and Rehabilitation Trainees Rank Residency Training Programs

Background

Since the inception of the National Resident Matching Program, multiple studies have investigated the factors applicants consider important to ranking prospective residency programs. However, only 2 previous studies focused on prospective physical medicine and rehabilitation (PM&R) trainees, and the most recent of these studies was published in 1993. It is unknown whether these previous studies are reflective of current prospective PM&R residents.

Reliability of a 360-degree evaluation to assess resident competence

OBJECTIVE: To determine the feasibility and psychometric qualities of a 360-degree evaluation of physical medicine and rehabilitation (PM&R) residents' competence. DESIGN: Nurses, allied health staff, and medical students completed a 12-item questionnaire after each PM&R resident rotation from January 2002 to December 2004. The items were derived from five of the six competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). RESULTS: Nine hundred thirty evaluations of 56 residents were completed. The alpha reliability coefficient for the instrument was 0.89. Ratings did not vary significantly by resident gender. Senior residents had higher ratings than junior residents. A reliability of >0.8 could be achieved by ratings from just five nurses or allied health staff, compared with 23 ratings from medical students. Factor analysis revealed all items clustered on one factor, accounting for 84% of the variance. In a subgroup of residents with low scores, raters were able to differentiate among skills. CONCLUSION: Resident assessment tools should be valid, reliable, and feasible. This Web-based 360-degree evaluation tool is a feasible way to obtain reliable ratings from rehabilitation staff about resident behaviors. The assignment of higher ratings for senior residents than junior residents is evidence for the general validity of this 360-degree evaluation tool in the assessment of resident performance. Different rater groups may need distinct instruments based on the exposure of rater groups to various resident activities and behaviors.