Rehabilitation resident academic productivity. Report on 1993 graduates

A survey was designed to explore the relationship among elective time (ET), residency research requirement (RR), mandatory research rotation (MR), and academic productivity for the 1993 graduating residency class. Sixty-seven of the 75 rehabilitation residency program directors listed in the 1993 Directory of Graduate Medical Education Programs responded (89% response rate). Data from 60 programs, representing 283 graduating residents, were analyzed (80% usable response rate). A resident was operationally defined as "active" if that individual submitted either articles (SART) for publication or abstracts (SABS) for oral/poster presentation during the training years; residents with accepted articles (AART) and/or abstracts (AABS) were defined as "productive." Odds ratios and chi 2 statistics were calculated for each study risk variable (ET, RR, MR) and the corresponding outcome variables (SART, SABS, AART, AABS). One hundred and fifty-nine residents (56%) submitted abstracts; 86 (30%) submitted articles; of these residents, 134 (47%) and 54 (19%) had their work accepted, respectively. Research was required by 26/60 (43%) programs. Research elective time was available in 41/60 (68%) programs; only 44/203 (22%) residents used this time for research. Residents who had research required had a 1.9 times greater likelihood of submitting both abstracts (P < 0.008) and articles (P < 0.014). No other study relationship was found to be significant. The study results suggest that implementing a research requirement in the residency training curriculum may lead to an increase in resident research activity.

Methods used in the evaluation of clinical competency of physical medicine and rehabilitation residents

A 17-item questionnaire was designed to determine how physical medicine and rehabilitation (PM&R) training directors assess their residents' clinical competency. A response rate of 83% (62/75) was obtained. Seventy-nine percent (49/62) have a written resident supervision policy, and 73% (45/62) have a written resident probation policy. Ninety-four percent (58/62) believe that their system of evaluating residents' clinical competency is effective, although many commented that it could be improved. 76% (47/62) of the residency training directors made the final decision regarding residents' clinical competency. Fifty-two percent (32/62) have a departmental written examination, and 23% (14/62) have formal oral examinations. Eighteen percent (11/62) use an objective structured clinical examination (OSCE), 8% (5/62) use standardized patients and 3% (2/62) use videotaped patient encounters. Forty percent (25/62) use medical record audits. Fifty percent of the programs have rated at least one resident unsatisfactory during a clinical rotation in the past 3 yr, and 11% (7/62) have reported to the American Board of Physical Medicine and Rehabilitation that the overall clinical evaluation of one resident was unsatisfactory in the past 3 yr. Forty-seven percent (29/62) of the programs have asked at least one resident to leave their program in the past 3 yr. The OSCE is emerging as the state-of-the-art method for assessing clinical skills, although it is expensive. The measurement of clinical competency is important in the certification and recertification process, and our specialty needs better methods to assess these performance skills.

A comprehensive pediatric rehabilitation nurse internship program

A comprehensive internship program was conceived at Mount Washington Pediatric Hospital in Baltimore to recruit and train new nursing employees in pediatric rehabilitation. The Pediatric Nurse Internship Program was designed to provide extensive theory relevant to pediatric rehabilitation nursing, as well as preceptor-based clinical experiences, to ease the transition of new nurses into the pediatric rehabilitation arena. The program incorporated a strong interdisciplinary team approach. The content areas included all the functional parameters of health as well as didactic information about the diagnoses specific to the pediatric population. The goal was to allow the intern to achieve clinical competence in pediatric rehabilitative nursing. Four nursing interns were enrolled in the 12-week program, which involved completing an educational project, taking a written examination, and demonstrating evidence of clinical competencies. On completion of the program, three interns transferred into full-time positions at the hospital and demonstrated an extremely high level of functioning. Partial support for the program was provided through grant money from the Maryland Health Services Cost Review Commission.

Factors used by physical medicine and rehabilitation residency training directors to select their residents

A 17-item questionnaire was designed to assess the relative importance of various factors to physical medicine and rehabilitation (PM&R) training directors when ranking PM&R resident applicants during the National Resident Match. The questionnaire was sent to all PM&R residency training directors. The recipients were asked to grade most selection factors based on a numerical scale: 1, unimportant; 2, some importance; 3, important; 4, very important; 5, critical. The specific factors addressed in the questionnaire were: academic criteria, letters of recommendation, individual applicant characteristics and aspects of the interview process. Twelve yes-or-no questions were also designed to determine the weight that residency training directors place on certain academic criteria. A response rate of 88% (66/75) was obtained. The most important academic criteria were grades in a PM&R clerkship in their facility (4.1 +/- 0.8), followed by grades in a PM&R clerkship in another facility (3.6 +/- 0.9). The most important letters of recommendation were from a PM&R faculty member in the respondent's department (4.0 +/- 0.8), followed by the dean's letter (3.7 +/- 1.0) and the PM&R chairman's letter (3.7 +/- 1.0). The three most important applicant characteristics evaluated during the interview were compatibility with the program (4.4 +/- 0.8), the ability to articulate thoughts (4.2 +/- 0.8) and the ability to work with the team (4.2 +/- 0.8). Most program directors used multiple criteria to complete their rank list, but the most important were based upon the interview (4.5 +/- 0.9), letters of recommendation (3.7 +/- 0.9), medical school transcript (3.6 +/- 0.8) and the dean's letter (3.6 +/- 1.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Rotating stations: an innovative approach to third-year medical student education in physical medicine and rehabilitation

Education of medical students is an important component of physical medicine and rehabilitation training programs. A one-day combined lectures/rotating stations conference was designed to introduce physical medicine and rehabilitation to third year medical students during the academic years 1991 through 1993. Pre- and post-testing allowed objective measurement of student knowledge of physical medicine and rehabilitation. The lectures and rotating stations were evaluated, and the feedback was used to improve subsequent conferences. Pre- and post-tests indicated increased student knowledge, and interest in physical medicine and rehabilitation doubled in each class that participated. This instructional method increases third year medical student exposure to physical medicine and rehabilitation in a cost-effective and efficient manner.

[Social medicine in medical education exemplified by the Witten/Herdecke University]

In 1992 a problem-based curriculum was introduced into the Medical Faculty of the University of Witten/Herdecke (UWH). First experiences with this approach indicate that--for several reasons discussed--community related health issues have not been sufficiently addressed. Therefore, it is recommended to give students access to field experiences in community health. At the UWH this is accomplished by a community-related practicum which connects students with a variety of community health services. A parallel course discusses students' experiences in a problem based manner and population related studies are developed.

Educating primary care physicians in geriatric rehabilitation

This article has reviewed the current status of primary care physician education in rehabilitation and the potential effects of current educational inadequacies on use of rehabilitation. The epidemiologic data regarding disease, development of disability, resource utilization, and its relevance to curriculum selection for rehabilitation were examined. Health care resources are limited, and given the increasingly important role the rehabilitation will play in health care, it is important that our educational efforts promote optimal use of those resources. A variety of teaching methods and their potential utility were discussed. Educating primary care physicians in the proper use of rehabilitation is of immediate importance for the large and growing older population. The use of available data on disease prevalence and impact to direct educational efforts will maximize the beneficial effects of our educational investments. The improved use of geriatric rehabilitation can make a significant impact on the health and quality of life for millions of older Americans.

[Requirements for graduates of training courses from the viewpoint of various specialty fields]

Against the background of rehabilitation as practised within the legal German framework of statutory and compulsory old age pension insurance--this rehabilitation scheme having developed continually, getting more and more differentiated for the last 40 years--we welcome the post-graduates of the specialised training curriculae in Public Health. The post-graduates are expected not only to acquire differentiated knowledge of the various spheres of activities of the different statutory social insurance and welfare bodies, but also to possess so to say a "sixth sense" regarding the "quality" of the individual spheres. Governed by the concepts of economy of means, triftiness and efficiency it is always imperative to ensure that the best possible care is offered to an individual in need and to plan further developments. The postgraduate must therefore be capable of becoming integrated within a team and to appreciate the expectations of members of other professions in order to eventually participate in creating feasible solutions within the framework of the hierarchically preferential demands inherent in the various spheres.

Chief residents in physiatry. Expectations v training

A large majority of physical medicine and rehabilitation residencies have chief resident positions, but little has been written about the expectations of the program directors and the training of the chief resident to fulfill those expectations. A 20-item questionnaire was mailed to 73 program directors in physical medicine and rehabilitation in May 1992. The participants were asked about selection methods, their perception of the duties of the chief resident(s), their concerns about the chief resident(s) position, the training and the evaluation of the chief resident(s). An 85% (62/73) response rate was achieved. There was a chief resident position(s) in 98% of the programs responding. Chief resident selection was made mostly by appointment of the chairman and/or program director and/or the vote of the faculty. The program directors perceived the most important duties of the chief resident to be: act as a liaison between faculty and the residents, act as a role model, do scheduling, build teamwork and give constructive feedback. The most important skills were considered to be leadership and stress management. Causes of concern were time pressure, abuse of power, stress and work overload. Opportunities to develop leadership and administrative/management skills were considered the most exciting aspects of the position. It was surprising, however, that only 15 of 61 (25%) provided some formal training. Only 28 of 61 (46%) had a position description.

Evaluation of the quality of medical practice in rehabilitation medicine

Evaluation of medical institutions, research and teaching in rehabilitation medicine is the prerequisite for planning, improvement and credibility. This article describes methods used in Canada to structure different levels of evaluation and create an atmosphere of positive reinforcement for clinicians.

Rehabilitation services for the Pacific

The Pacific Basin Rehabilitation Research and Training Center was created to help meet the challenges of rehabilitating people in rural remote communities in the United States-associated Pacific. We describe the center, the special region it serves, some of its many programs, and some of the ways it is helping communities in this region provide services that are appropriate and sensitive to the culture, the environment, and the disability.

Physical medicine and rehabilitation residents' educational needs assessment

A study was done to determine how well residents in Physical Medicine and Rehabilitation (PM&R) believe their educational needs are being met in various clinical and didactic areas. Surveys were sent in April 1989 to the 814 persons on the 1989 American Academy of Physical Medicine and Rehabilitation resident physician registry. Residents were asked to rate how much experience they thought they were getting in their residency for each of 22 clinical and didactic topics such as stroke, spinal cord injury, head injury, prosthetics, chronic pain, sports medicine, pediatric rehabilitation, cardiopulmonary rehabilitation, electromyography, and physical modalities. In addition, they were asked to rate how much they believed they should be given with respect to these same topics. The response rate was 532 out of 814 (65%). Residents expected somewhat more than what they were getting overall; however, there were exaggerated discrepancies in a few specific areas. Residents believed they should be getting significantly more clinical and didactic experience in Industrial Medicine, Sports Medicine, Computer Applications, Therapeutic Injections, and Administration. The results should serve as guidelines for residency training and the study should serve as a model for future routine assessments.

[A field assessment of a community 'rehabilitation class' for home handicapped persons--focusing on participant social network]

The purpose of this study is to evaluate a community 'Rehabilitation class' for its effectiveness. A function of the 'Rehabilitation class' is the expansion of a participant's social network, and the following hypothesis was formulated: the reciprocal relationships of participant and class or staff members bring about psychological effectiveness and a change of their awareness, resulting in the expansion of social networks. Actual class activity, psychological aspects and social networks of twenty-six participants and twenty care takers, who responded to a questionnaire survey, were examined with respect to the above hypothesis. Those reporting having changed were compared to those reporting no change. The results were as follows: (1) Class activity was directed at developing relationships among participants, and while most of them were changed positively, it appeared that staff members were not sufficiently involved. (2) There were 23 participants in the 'changed' group. Most of their care takers and family were changed positively. Eleven reported receiving significant emotional support from other 'Rehabilitation class' members, and therefore their social networks appeared to have expanded generally. (3) The 'non changed' group consisted of 3 participants whose social networks did not appear to have expanded. (4) Social networks outside the home were not expanded for all participants, probably due to their reported receiving little social support from others outside family members, and because they had few social roles outside the home. Based on the above results, it is concluded that effective classes involve participants individually, and encourage the independent activity of participants, and that it is necessary to have networking with other organizations in community, and the 'Rehabilitation class' should be provided to smaller local regions.

Ethical considerations in rehabilitation medicine

As the number of patients with chronic illness or disability grows, rehabilitation professionals will face increasingly difficult questions. Traditional concepts of medical ethics can help find solutions to some, but not all of those questions. Rehabilitation medicine needs an expanded vision of informed consent, one that embraces the needs of patients and promotes rehabilitation's educational model. To insure that rehabilitation professionals use this model appropriately, we need to make certain that their education integrates humanistic and caring virtues with medical knowledge and skill.

Geriatrics training in physical medicine and rehabilitation

A survey was conducted to determine the level of training in geriatrics in physical medicine and rehabilitation (PM&R) residency training programs. Questionnaires were sent to 76 accredited programs in 1989 with a 63% (48/76) response rate. Results show that 49% of patients cared for by PM&R residents in inpatient settings are 65 years of age or older, and 42% of patients cared for in ambulatory settings are in the same age group. Of PM&R programs, 30% have physician faculty who are geriatric "specialists." PM&R residents have a significant exposure to elderly patients in the consultation role. Less exposure to elderly patients occurs in distinct geriatric rehabilitation and geriatric medicine programs or units. Among 10 medical specialties, PM&R programs compare well in terms of teaching about the topics and the personnel that are important in geriatrics. This is due in part to an obvious overlap between the content of rehabilitation medicine and that of geriatrics. Furthermore, there is moderate interest in PM&R in developing fellowship training in geriatric rehabilitation. The need for more academic faculty who are geriatric "specialists," as well as the need for increasing PM&R exposure to distinctly geriatric settings as a part of training, is apparent.

A method to assess the trainee profiles of medical students attracted to our physical medicine and rehabilitation residency training program

A 35-item questionnaire was designed to assess the relative importance of various factors to medical students when ranking physical medicine and rehabilitation (PM&R) residency training programs. The questionnaire was used to assess the relative importance of the various factors to three groups of medical students: those who interviewed, those who matched and those who were listed on the match list of the UMDNJ-New Jersey Medical School (NJMS) Department of PM&R, as well as our current residents. Recipients were asked to grade selection factors based on a numerical scale: 1, extremely important; 2, very important; 3, important; 4, minimally important; 5, not important. A response rate of 100% (n = 72 medical students + 25 residents) was attained. The analysis indicates that, overall, there is no significant difference in ranking of the factors by each of the four groups. However, the medical students who recently matched with the UMDNJ-NJMS PM&R program rated the opportunity to conduct research significantly higher than the current house staff or the medical students on the entire match list. This is a desirable result, as the program strives to provide an environment that is conducive to the growth of research and academic physiatrists. This questionnaire could also be used by other residency training directors to guide the development of their program and to gain valuable information regarding the perception of their program among in-coming residents and the importance of various factors to the students interested in their program.