Physical Medicine and Rehabilitation

Goals

This rotation provides the intern an opportunity to become familiar with physical medicine and rehabilitation in both inpatient and outpatient settings. Upon completion, the intern should develop competency in identifying, diagnosing, and treating common rehabilitation disorders in a team environment driven by caring humanistic and professional values.

Objectives

1. Identify appropriate diagnosis or differential diagnosis for the following:

Stroke
Traumatic brain injury
Spinal cord injury
Neuropathy
Myopathy
Cerebral Palsy
Muscular Dystrophy
Osteoarthritis
Low back pain
Osteoporosis
Fibromyalgia and myofascial pain
Rheumatoid arthritis
Seronegative arthropathies
Adhesive capsulitis
Rotator cuff syndrome
Nerve and tendon entrapment syndromes
Coccydynia
Kyphoscoliosis, in the adult
Spondylolysis, spondylolisthesis, in the adult
Herniated disk (lumbar, thoracic, or cervical), with or without nerve deficit
Cervicalgia
Bursitis/Tendonitis
Complex regional pain syndromes/RSD
Neuropathic joint disease
Spinal stenosis
Kyphoscliosis in the adolescent
Internal knee derangement

2. For each of the major diseases listed, describes major therapeutic approaches and discusses the benefits and risks or each.

2.1. Performance of History

Criteria: Resident demonstrates appropriate knowledge base to obtain a thorough history on the patient suspected of having a disorder of the nervous or musculoskeletal system.

Axial Skeletal pain, stiffness, range-of-motion, and instability

Peripheral joint pain, stiffness, range-of-motion, and instability

Soft tissue pain and restriction

Neurological symptoms to include weakness, loss of or altered sensation, sphincter function or coordination

History of other neurological or musculoskeletal disorders, e.g., fractures, polio, stroke, bone or joint surgery

Effects on activities of daily living, e.g., dressing, cooking

Occupational, work, and recreational activities

Social history to include habits, e.g., tobacco use and social support system, e.g., spouse

Past workup and treatments

Family history of nervous system disorders, bone or connective tissue disease

2.2. Performance of Physical Examination

Criteria: Resident demonstrates the ability to perform a physical examination on these patients by noting the following:

Posture, gait, and movement

Local findings to include:

deformity

range of motion

joint crepitus

tenderness

erythema and warmth

swelling or edema

strength

sensibility

reflexes

appropriate provocative maneuvers

cerebellar function

2.3. Orders or performs appropriate diagnostic studies and demonstrates the ability to interpret them, for example:

Radionuclide bone scan

MRI

Myelogram

Arthrogram

CT scan

EMG

2.4. Recognizes the need to and requests appropriate consultation. Ability to call upon and coordinate the care from other health care providers required by patients such as: Physical therapists, Occupational therapists, Speech therapists, Prosthetists, Pathologists, and Psychologists.

3. Attitudes and Professional Behavior

3.1. Attends promptly and assumes responsibility for patient welfare

3.2. Demonstrates effective communication skills

3.3. Demonstrates the effective utilization of case-related clinical learning through availability and appropriate follow-up

4. Teaching and Lifelong Learning

4.1. Models effective teaching skills to house staff when in-patient consults are done

4.2. Demonstrates effective teaching skills with assigned student clerks

4.3. Demonstrates commitment to assigned reading and illustrates independent initiative in case-related reading.

Methods

Admit patients to the inpatient rehabilitation service including thorough and appropriate history, physical examination and initial assessment/rehabilitation plans. Review this with supervising faculty.

Follow assigned patients assuming responsibility for ongoing care including orders and progress notes daily. Be available on-call to assigned patients.

Attend seminars with therapists to understand their role in the rehabilitation process.

Prepare consultations requested of physical medicine and rehabilitation service and review with faculty.

Attend all rehabilitation conferences and medicine core conferences.

Evaluate patients in outpatient clinic.

Be present during electrodiagnostic testing.

Trainees should attend a minimum of 4.5 hours of teaching attending rounds per week.

Evaluation

Residents are evaluated by the attending staff on an ongoing basis. Constructive criticism is given in areas of weakness and residents are given assistance in improving skills. Evaluation documentation is provided by chart audit and end-of-rotation evaluation forms which are shared with each resident personally. Resident's evaluation of their experience is provided by written evaluations as well at the end of the rotation.