Criteria for selection of physical medicine and rehabilitation residents. A survey of current practices and suggested changes

The growing number of medical graduates seeking residency training in Physical Medicine and Rehabilitation (PM&R) has made the resident selection process increasingly difficult. This circumstance has prompted a search for more efficient selection criteria. Forty-one PM&R residency program directors in the United States and Puerto Rico completed a survey on the way they selected their residents. The results indicate that personal applicant characteristics, as determined by interview, were more important than academic criteria in ranking residency candidates. Of the academic variables presented, participation in a PM&R elective at the program director's hospital and the Dean's letter were rated highest. The interview experience has a major influence on the ranking of an applicant for acceptance into a PM&R training program. Academic criteria should have more influence on applicant selection than they do at present. In addition, early identification and vigorous recruitment of resident candidates with an interest in research is essential for increasing the number of academic physiatrists within our specialty.     

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.     

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.

Musculoskeletal education in physical medicine and rehabilitation residency programs: graduating resident perspective

OBJECTIVES: To characterize graduating physical medicine and rehabilitation (PM&R) residents physicians' perceptions of their current musculoskeletal (MSK) training, to identify barriers perceived by resident physicians to improving MSK education experiences, and to compare the views of resident physicians with those of PM&R residency program directors. DESIGN: Fourth-year PM&R residents graduating in 2004 whose program directors attended the 2004 Association of Academic Physiatrists annual meeting were asked to complete an MSK education survey developed by the authors. Data were compared with a previous MSK education survey that had been completed by PM&R residency program directors. RESULTS: Ninety-three of 156 (61%) fourth-year PM&R residents responded after multiple contacts. According to residents, the most frequently used MSK education formats during residency were MSK lecture series, MSK journal clubs, and MSK workshops. Potential barriers to improved MSK education during residency included staff, money, and time. If given unlimited resources, most residents would greatly increase the use of visiting lecturers, MSK workshops, and MSK lecture series. CONCLUSION: Graduating PM&R residents as well as residency program directors indicated a strong interest in expanding resident MSK education through the use of visiting lecturers. Differences were noted with respect to the use of hands-on learning (i.e., MSK workshops [residents]) vs. passive learning (i.e., CD ROMS/DVDs and videos [program directors]). Both groups described how limited resources including staff, money, and time are barriers to resident MSK education.     

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.     

Pediatric Emergency Medicine Fellowships: Faculty and Resident Training Profiles

The objective of this study was to evaluate the faculty and graduate training profiles of Pediatric Emergency Medicine (PEM) fellowship training programs. An electronic 10-point questionnaire was sent to 57 PEM fellowship directors, with a 70% response rate. Analysis of the individual certification of faculty members in PEM training programs demonstrated that the largest represented training types were general pediatricians and pediatricians with PEM sub-certification (29% and 62% representation, respectively). The remaining faculty types consistently showed < 5% overall involvement. Reported estimates on faculty delivery of clinical training, didactic training, and procedural skills demonstrated that pediatricians sub-board certified in PEM consistently administered the highest percentage of these skill sets (74%, 68%, and 68%, respectively). Emergency Medicine-trained physicians showed a relative increase of involvement in fellowship programs administered by Emergency Medicine departments and in those programs located within adult hospitals. Yet, this involvement still remained substantially lower than that of the pediatric-type faculty. Program directors of fellowships within pediatric hospitals and those administered by Pediatric programs demonstrated a preference for general pediatricians with sub-board certification in PEM to improve their faculty pools. Program directors of fellowship programs located in adult hospitals and those administered by departments of EM demonstrated no preference in training type. Lastly, program directors report that 95% of past graduates received their primary board certification through Pediatrics and only 5% received their primary board certification through Emergency Medicine. There are currently many more pediatric-trained physicians among PEM fellowship faculty and graduates. This survey has demonstrated that there has been a decline in EM-trained physicians involved in PEM fellowships since 2000.     

A survey to determine the prevalence and characteristics of training in Evidence-Based Medicine in emergency medicine residency programs

We conducted a survey to determine the prevalence, training methods, and allotment of time for teaching evidence-based medicine (EBM) skills within accredited Emergency Medicine (EM) residency programs in the United States. A survey was mailed to program directors of all 122 accredited Emergency Medicine residency programs. The survey was also sent to program directors using an e-mail listserv. Responses were obtained from 53% of programs; 80% (95% CI: 68-89) of EM programs reported teaching some EBM. Although respondents believed a median of 10 hours were required to adequately cover this topic, only 22% provided more than 5 hours per year. Sixtey-three percent (95% CI: 50-75) of respondents reported using the JAMA Users' Guides series in journal club and 83% reported efforts to link journal clubs to patient care. Perceived barriers to integrating EBM into teaching and patient care included lack of trained faculty, lack of time, lack of familiarity with EBM resources, insufficient funding, and lack of interested faculty. In summary, academic EM programs are attempting to train residents in EBM, but perceive a lack of trained faculty, time, and funding as barriers. Desired resources include a defined curriculum, on-line training for faculty, and defined strategies for integration of EBM into training and patient care.     

Pediatric emergency medicine fellowships: faculty and resident training profiles

The objective of this study was to evaluate the faculty and graduate training profiles of Pediatric Emergency Medicine (PEM) fellowship training programs. An electronic 10-point questionnaire was sent to 57 PEM fellowship directors, with a 70% response rate. Analysis of the individual certification of faculty members in PEM training programs demonstrated that the largest represented training types were general pediatricians and pediatricians with PEM sub-certification (29% and 62% representation, respectively). The remaining faculty types consistently showed < 5% overall involvement. Reported estimates on faculty delivery of clinical training, didactic training, and procedural skills demonstrated that pediatricians sub-board certified in PEM consistently administered the highest percentage of these skill sets (74%, 68%, and 68%, respectively). Emergency Medicine-trained physicians showed a relative increase of involvement in fellowship programs administered by Emergency Medicine departments and in those programs located within adult hospitals. Yet, this involvement still remained substantially lower than that of the pediatric-type faculty. Program directors of fellowships within pediatric hospitals and those administered by Pediatric programs demonstrated a preference for general pediatricians with sub-board certification in PEM to improve their faculty pools. Program directors of fellowship programs located in adult hospitals and those administered by departments of EM demonstrated no preference in training type. Lastly, program directors report that 95% of past graduates received their primary board certification through Pediatrics and only 5% received their primary board certification through Emergency Medicine. There are currently many more pediatric-trained physicians among PEM fellowship faculty and graduates. This survey has demonstrated that there has been a decline in EM-trained physicians involved in PEM fellowships since 2000.     

Perceived need for emergency medicine training in Pakistan: A survey of medical education leadership

Objective: To assess the perception of leaders of the academic medical institutions regarding the need for specialty training in emergency medicine. Methods: A cross‐sectional survey was conducted in all medical colleges of Pakistan in September 2005. Our sample included all academic leaders of recognized medical colleges in Pakistan. A questionnaire was designed and sent (mailed and faxed) to vice chancellors, deans, principals or medical directors of the institutions. Reminders were sent through faxes and emails wherever available, followed by phone calls if responses were not available after several attempts. Results: At the time of study, there were 39 medical colleges recognized by Pakistan Medical and Dental Council. Of these, responses were received from 26 teaching institutions in the country. A majority of the respondents (85%) were not satisfied with the care provided in the ED of their primary teaching hospital, and three‐fourth (74%) thought that doctors specialized in other disciplines, like internal medicine and family medicine, cannot adequately manage all emergencies. When asked if Pakistan should have a separate residency training programme in emergency medicine, 96% responded in affirmative, and many (85%) thought that they will start a residency programme in emergency medicine if it was approved as a separate specialty. Conclusion: This survey shows significant support for a separate local training programme for emergency medicine in the country.     

Headache in medical education: medical schools, neurology and family practice residencies

Objective.—To explore the extent of headache education received by medical students and residents.
Background.—Headache is a common, often severe, and sometimes disabling problem. However, 49% of sufferers do not seek professional treatment—of those who do, only 28% are very satisfied. One possible reason is limited education of physicians about headache.
Methods.—Surveys were sent to all allopathic and osteopathic medical schools, 200 family medicine residencies, and all 126 neurology residencies. Information requested included the amount and perceived adequacy of headache education and any plans to increase headache education.
Results.—Response rates were 35% to 40%. Medical school lecture hours ranged from 0 (4%) to >5 (24%) with 92% having no plans for an increase in headache education. Family Medicine residency lecture hours ranged from 1–3 (30%) to >5 (34%) and case presentations from 1–5 (23%) to >5 (41%), with 88% of program directors having no plans for increase. Neurology residency lecture hours ranged from 1–3 (11%) to >5 (64%) and case presentations from 1–5 (23%) to >10 (57%), with 80% having no plans for increase.
Conclusion.—Undergraduate medical education in headache is limited. Despite medical schools perceiving their training as adequate, both neurology and family practice residency program directors believe entering residents are inadequately prepared in headache upon entering the program.     

Uniformed Medical Students and Residents in Emergency Medicine

“Uniformed medical students and residents” refers to medical school enrollees and physicians in training who are obligated to serve in the military after graduation or training completion. This is in exchange for 2 forms of financial support that are provided by the military for individuals interested in pursuing a career in medicine. These programs are offered namely through the Uniformed Services University of Health Sciences (USUHS) and the Health Professions Scholarship Program (HPSP). Uniformed medical school graduates can choose to serve with the military upon graduation or to pursue residency training. Residency can be completed at in-service programs at military treatment facilities, at out-service programs, at civilian residency training programs, or via deferment programs for residency training at civilian programs. Once their residency training is completed, military physicians should then complete their service obligation. As such, both USUHS and HPSP students should attend a basic officer training to ensure their preparedness for military service. In this article, we elaborate more on the mission, requirements, application, and benefits of both USUHS and HPSP. Moreover, we expand on the officer preparedness training, postgraduate education in the military, unique opportunities of military medicine, and life after completion of military obligation.     

Relationship Between Dean's Letter Rankings and Later Evaluations by Residency Program Directors

Background: It is not known how well dean's letter rankings predict later performance in residency.

Purpose: To assess the accuracy of dean's letter rankings to predict clinical performance in internship.

Method: Participants were medical students who graduated from the University of Rochester School of Medicine and Dentistry in the classes of 2003 and 2004. In their Dean's Letter, each student was ranked as either “Outstanding” (upper quartile), “Excellent” (second quartile), “Very good” (lower 2 quartiles), or “Good” (lowest few percentile). We compared these dean's letter rankings against results of questionnaires sent to program directors 9 months after graduation.

Results: Response rate to the questionnaire was 58.9% (109 of 185 eligible graduates). There were no differences in response rate across the four dean's letter ranking categories. Program directors rated students in the top two categories of dean's letter rankings significantly higher than those in the very good group. Students in all three groups were rated significantly higher than those in the good group, F (3, 105) = 13.37, p < .001. Students in the very good group were most variable in their ratings by program directors, with many receiving similarly high ratings as students in the upper 2 groups. There were no differences by gender or specialty.

Conclusion: Dean's letter rankings are a significant predictor of later performance in internship among graduates of our medical school. Students in the bottom half of the class are most likely either to underperform or overperform in internship.     

Resident Service Hours in Emergency Medicine

Objective: The number of hours worked by residents in all specialties has become a controversial issue. Residents often are expected to competently conduct patient care activities and to take educational advantage of clinical experiences in spite of frequent fatigue and sleep deprivation. This survey of residency directors was designed to assess the scheduled clinical time for emergency medicine (EM) residents. Methods: A 13-question survey dealing with time commitments of EM residents was sent to the residency directors of all accredited EM residency programs in the United States in the fall of 1991. Residency directors were asked to indicate the number of shifts, hours, and days off per week; and the number of night shifts and weekend days off per month for each postgraduate year of residency training (PGY1-PGY4). Directors also were asked whether shifts were scheduled randomly or predictably with progression from days to nights with time off after nights. Results: Seventy of 71 (98.6% response rate) residency directors responded. Residents were scheduled for an average of 49.1 hours per week. Scheduled hours decreased from an average of 51.9 at the PGY1 level to an average of 44.5 at the PGY4 level. A similar progression with year of training was noted for scheduled night shifts/ month, days off/week, and weekend days off/month. A PGY1 trainee averaged 7.0 night shifts/month, 1.9 days off/week, and 3.0 weekend days off/month; while a PGY4 trainee averaged 5.3, 2.4, and 3.2, respectively. Only 40% of the directors reported predictable scheduling progressing from days to nights. Conclusion: Emergency medicine resident schedules, as reported by residency directors, fall well within current specialty-specific requirements and compare favorably with the reported numbers for other specialties. However, because large ranges in scheduling parameters were reported, the data may be of value to residency directors, residents, and prospective residents. Most programs did not report a predictable schedule progression of shifts.     

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.     

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.     

A profile of faculty development in physical therapy education programs

The purpose of this study was to report on the status of faculty development in physical therapy education programs. A survey questionnaire was sent to the directors of 110 physical therapy programs nationwide. Analysis of responses from respondents (n = 79; 72%) demonstrated 1) criteria used to evaluate faculty members were similar among different institutions, 2) fewer than half of the institutions have a faculty development plan (FDP), 3) the majority of those institutions that have an FDP supported similar areas and activities to facilitate faculty development, and 4) respondents used creative ways to support faculty development. The results appear to indicate that most physical therapy programs do not have a formalized program to assist faculty members in their development of skills in research, teaching, and service. [Rothman J. Rinehart ME: A profile of faculty development in therapy education programs.