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.     

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.     

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.     

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.     

The practice of physical medicine and rehabilitation in sub-Saharan Africa and Antarctica: A white paper or a black mark?

Introduction.?The medical specialty of Physical Medicine and Rehabilitation (PM&R) has had a proven impact on persons with disability and on healthcare systems. Documents such as The White Book on Physical and Rehabilitation Medicine in Europe have been important in defining the scope of practice within various regions. However in some continents the practice has not been well defined.

Objective.?To explore the practice of PM&R in sub-Saharan Africa and Antarctica.

Methods.?Medline searches, membership data searches, fax survey of medical schools, Internet searches and interviews with experts.

Results.?The continents are dissimilar in terms of climate and government. However both Antarctica and sub-Saharan Africa have no PM&R training programs, no professional organisations, no specialty board requirements and no practicing physicians in the field. Since there are no known disabled children in Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However, the 788 000 000 permanent residents of sub-Saharan Africa including approximately 78 million persons with disability are left unserved.

Conclusions.?Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups and policymakers can impact the crisis. However government – specifically national ministries of health – is ultimately responsible for the health and well-being of citizens.     

Impact of a required fourth-year medical student rotation in physical medicine and rehabilitation

This study evaluated the impact of a 2-wk required rotation in Physical Medicine and Rehabilitation (PM&R) on fourth-year medical students' knowledge of PM&R and attitude toward teamwork in patient care. Survey results on attitudes toward a team approach to patient care and knowledge in PM&R were compared prerotation and postrotation. One hundred thirty-eight fourth-year medical students participated in this 2-yr study. The combined response rates for the attitude and knowledge surveys were 62% and 56%, respectively. As measured by a pretest and posttest self-reported knowledge assessment, the rotation increased knowledge of PM&R (P ≤ 0.05). Four aspects of the rotation that were rated higher by students from the second year of the rotation were role and responsibility definition, incorporation of current literature, enhancement of clinical skills, and general rotation satisfaction. The rotation provides an experience for medical students to increase their knowledge of PM&R.     

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.     

The Practice of Physical Medicine and Rehabilitation in subSaharan Africa and Antarctica:A White Paper or a Black Mark?

Objective: To explore the practice of PM&R in subSaharan Africa and Antarctica. Method: Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts. Result:The continents are dissimilar in terms of climate and government. However both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Since there is no known disabled child on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However the 788,000,000 permanent residents of subSaharan Africa including approximately 78 million persons with disability are left unserved.Conclusion:Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However government - specifically national ministries of health - is ultimately responsible for the health and wellbeing of citizens.     

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.     

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.     

Beyond war and military medicine: social factors in the development of prosthetics

Reznick JS. Beyond war and military medicine: social factors in the development of prosthetics.Polytrauma is an immediate outcome of current warfare, and the need to investigate this condition is equally immediate. The value of historical analysis in this endeavor should not be underestimated. It is among the best tools we have to help ensure that current research and practice involve engagement with the social contexts of polytrauma as well as with the medical science of its treatment. This special communication provides historical perspective on certain aspects of the polytraumatic condition—namely, limb loss, prosthetic rehabilitation, and community reintegration after receiving a prosthesis. It discusses the influential role of societal factors in these areas to encourage greater understanding that the care of persons with polytrauma must involve critical thinking about their relationships to and participation in society as well as their treatment by medical science. This special communication also provides historical perspective to enrich appreciation of the value of history for the field of physical medicine and rehabilitation (PM&R), the PM&R clinician, and the PM&R clinical researcher. Readers will learn that historical knowledge puts PM&R research and practice into perspective, reminding us that rehabilitation should involve critical thinking not only about medicine, but also about social roles and the participation of people in society despite physical and psychologic challenges.     

Musculoskeletal and neurologic conditions in rural family practice: implications for physical medicine curriculums

To help determine the educational needs of both students and practitioners, an inventory of musculoskeletal and neurologic disorders was made of eight rural family practices for one year. Data on 54,043 patients representing 152,482 visits was put into an automated information system at the time care was received and coded by diagnosis. Computer listings provided the frequency of 372 diagnoses, the age distribution for diagnoses and the percent of total patients for each diagnosis. Physical medicine and rehabilitation (PM&R) conditions accounted for a minimum of 6.9% of the total visits and 11.7% of conditions that occurred individually in small numbers. PM&R conditions were fairly evenly distributed throughout all age ranges, indicating a need for education in both pediatric and adult areas. The breakdown of PM&R conditions by category provides valuable insight for future curriculum development.     

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.     

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.     

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.     

Rehabilitation recommendations for institutionalized motor-disabled patients

Consultation reports on 142 profoundly retarded and severely motor-disabled patients in a state residential care facility who were seen by physiatrists from an academic department of physical medicine and rehabilitation (PM&R) were reviewed. In all, 168 reasons for consultation were listed: 117 for specific identification or management of disabilities related to gross-motor or fine-motor function, 37 for surgical problems, and 10 for medical problems. The consultants made 314 recommendations altogether: 100 suggested the evaluation or treatment of gross-motor disabilities by a physical therapist, 43 suggested occupational therapy evaluation or treatment, and an additional 73 suggested adaptive equipment involving an orthotist. The recommendations also involved the following problems: medical-33; surgical-37; behavioral-27; further rehabilitation-1. The skills of a consultant knowledgeable in the management of multiply handicapped people include the coordination of medical, surgical, physical and behavioral care. Such knowledge is also a useful adjunct to overall patient care in complex cases with motor involvement. The preliminary association during which these consultations were done served as the basis of a growing affiliation between the state institution and the department of PM&R.     

The 34th Walter J. Zeiter lecture: creating the future of PM&R: building on our past

The founders of the field of physical medicine and rehabilitation (PM&R) took advantage of a confluence of political, technical, and economic opportunities to launch our specialty. In the process, they expressed their values of belief in the importance of function, the team approach to health care, the utility of physical agents and modalities in the management of neuromuscular conditions, the impact of education for our patients and their families, the rights of persons with a disability (PWD), and the responsibility of our field to advocate for public policy issues concerned with the needs of PWD. Advances in the technology of health care delivery and biomedicine will shape our future. Specific trends and factors are addressed. Equally important will be the political dimension, including the aging of our global population, and the economic consequences of health insurance pressures. The field of PM&R should focus on activities that take advantage of emerging trends but are rooted in our traditional values. In particular, the field should look forward to the massive growth of populations in need of our services because of aging and longevity, the emerging global health community, and our increasing technical capacity to impact improvements in health and function. The field is charged to preserve awareness of our core values, to support the common good of research, to keep the use of new and emerging technology in check to serve the needs of our patients, to continue our advocacy for social justice for PWD, and to embrace the emerging global community.     

Physicians' attitudes and practices regarding treatment of HIV-infected patients.

We conducted a statewide survey to identify physicians' experiences, attitudes, and practices related to HIV-infected patients. A random sample, stratified by medical specialty (primary care, surgery, emergency medicine), was drawn. Physicians were concerned about contagion and inadequate knowledge to care for HIV-infected patients; 40% reported refusing or referring new HIV-infected patients. Differences across medical specialty and respondents' interest in various medical education topics to remedy knowledge deficits are discussed.     

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.