Physiatry Residents Research Articles

Trainee Preparedness to Enter Physiatry Residency: Early Findings from a National Cross-Sectional Survey Study

Introduction: This national survey study investigates the transition of PM&R residents from as they transition into residency, aiming to identify associated factors influencing their preparedness. The transition to residency can be stressful, and insufficient preparedness is associated with a higher risk of burnout. While existing research has examined this transition in large specialties like internal medicine and surgery, there is a gap in understanding preparedness for PM&R residency in PGY-2. PM&R residency offers diverse routes, and not all medical schools have PM&R departments, leading to varied exposure and experience among incoming residents. Methods: To address this gap, a voluntary national survey study was conducted, collecting data from 55 residents across the USA from PGY-2 to PGY-4. Results: Participants reported their overall preparedness, with 51% feeling prepared and 49% feeling unprepared for clinical care at the start of residency. The prepared group demonstrated higher emotional and clinical preparedness, particularly in performing neuro/musculoskeletal physical examinations, managing rehabilitation issues, and interpreting imaging. Experience as an intern emerged as the most critical factor influencing preparedness. There were no significant differences between the prepared and unprepared groups in terms of age, gender, medical degree, timing of PM&R exposure, participation in PM&R interest group, type of internship pursued (transitional, medicine, surgery, or categorical), or academic versus community hospital during intern year. Conclusions: Incoming residents who self-identified as unprepared may specifically benefit from early check-ins with residents about wellbeing and early focused education on the neuro/musculoskeletal physical examination, management of common rehabilitation related issues, and interpretation of neuromusculoskeletal imaging, given the differences in responses we observed between prepared and unprepared groups in these domains. Residents trended toward feeling unprepared in handling rapid responses, pediatric rehabilitation patients, and therapy prescriptions and precautions at the start of PM&R residency.

Assessment of the Study Habits of Residents in Physical Medicine and Rehabilitation Programs in Saudi Arabia: A Cross-Sectional Study.

Residents in training must employ a variety of study strategies, as they not only participate in academic studies but also interact with patients. This study aimed to evaluate the study practices and factors affecting those practices among Saudi Arabian physical medicine and rehabilitation residents during their residency program. In this cross-sectional study, a previously used questionnaire was distributed to Saudi Arabian physiatry residents from July 1 to August 15, 2022, via a social media platform and completed using a Google Forms survey. A Microsoft Excel spreadsheet was used to collect, clean, and import the data before IBM SPSS Statistics for Windows, version 22.0 was utilized for statistical analysis. The data of 94.91% of respondents were included in the analysis. Individuals who were female, unmarried or divorced, and without children predominated. Only 17.9% (n = 10) of the residents believed that their training program effectively prepared them to pass the board examination, which was the most strongly motivating factor for studying for 85.7% of respondents. Over two-thirds of the residents mentioned that they regularly exercise. Residents who studied more than 11 hours per week had a significantly lower score in the category of factors that negatively affect examination performance (M = 12.33 ± 2.82, F = 2.794, P < 0.05). Females, final-year residents, and Riyadh residents studied more than their counterparts. Our study is the first to investigate how Saudi physiatrists study, with the finding that current physiatry residents employ a combination of traditional and contemporary learning strategies. This information can help stakeholders to understand current training challenges, improve the quality of training for physiatry residents, and create an ideal learning environment.

Residents' Perceptions of a Novel Virtual Livestream Cadaveric Teaching Series for Musculoskeletal Anatomy Education.

Musculoskeletal anatomy education is essential to many healthcare providers but has consistently been considered difficult for various reasons. Traditional methods have focused on in-person cadaveric teaching, which became inaccessible during the COVID-19 pandemic; therefore, new teaching methods were developed to address this gap in education. This project implemented novel virtual livestream musculoskeletal anatomy teaching methodology with cadaveric prosections and evaluated the efficacy of this modality compared with traditional in-person cadaveric teaching. A targeted musculoskeletal anatomy curriculum was developed and delivered via livestream to 12 Canadian physiatry residents. Upon completing the virtual curriculum, residents completed an anonymous survey assessing this new virtual livestream cadaveric methodology compared with previous experiences with traditional in-person anatomy teaching. The survey response rate was 92%. Most participants (73%) rated the virtual livestream sessions as better than traditional in-person teaching. Reasons included better visualization of cadaveric anatomy and easy discussion among the group. T test analysis comparing both methods demonstrated the livestream method was equivalent or better across several domains. Virtual livestream teaching is a viable method for teaching the important subject of musculoskeletal anatomy. Educators should consider how to best integrate this approach into future anatomy curricula.

Longitudinal Ultrasound-Guided Injection Curriculum for Physical Medicine and Rehabilitation Residents.

Physiatrists are increasingly using musculoskeletal ultrasound for both diagnostic and therapeutic purposes. However, a standardized longitudinal curriculum for instructing physical medicine and rehabilitation residents in performing ultrasound-guided interventional procedures has yet to be established. The purpose of this study is to develop and assess the effectiveness of a longitudinal curriculum in training residents to perform common ultrasound-guided musculoskeletal injections using fresh-frozen cadaveric specimens. The course included six weekly hands-on educational sessions, divided by anatomical region, integrated into an established anatomy and physical examination curriculum. After completion of the curriculum, residents reported improved comfort and confidence and displayed improved competence in performing these injections. Other physiatry residency programs should consider implementing longitudinal, hands-on cadaveric training courses to better prepare trainees to perform ultrasound-guided injections as part of their future clinical practice.

Movement Rx: Improving Physical Activity Education In Physiatry Residency Education

Movement Rx: Improving Physical Activity Education In Physiatry Residency Education

Creating a resident-centric rehabilitation research team

BackgroundThe 36-month Physical Medicine and Rehabilitation (PM&R) or Physiatry residency provides a number of multidisciplinary clinical experiences. These experiences often translate to novel research questions, which may not be pursued by residents due to several factors, including limited research exposure and uncertainty of how to begin a project.Limited resident participation in clinical researchnegatively affects the growth of Physiatry as a field and medicine as a whole. Thetwo largest Physiatry organizations – the Association of Academic Physiatristsand the American Academy of Physical Medicine and Rehabilitation – participate inthe Disability and Rehabilitation Research Coalition (DRRC), seeking to improvethe state of rehabilitation and disability research through fundingopportunities by way of the National Institutes of Health (NIH), the NationalInstitute on Disability, Independent Living and Rehabilitation Research(NIDILRR) and the Patient-Centered Outcomes Research Institute (PCORI). Apaucity of new Physiatry researchers neutralizes these efforts.ResultsThis paper detailsthe creation of a novel, multidisciplinary Rehabilitation Resident Researchprogram that promotes resident research culture and production. Mirroring ourcollaborative clinical care paradigm, this program integrates facultymentorship, institutional research collaborates (Neuroscience Nursing ResearchCenter, Neuroscience Research Development Office) and departmental resources(Shark Tank competition) to provide resident-centric research support.ConclusionsThe resident-centricrehabilitation research team has formed a successful research program that waspiloted from the resident perspective, facilitating academic productivity whilerespecting the clinical responsibilities of the 36-month PM&R residency. Residentresearch trainees are uniquely positioned to become future leaders ofmultidisciplinary and multispecialty collaborative teams, with a focus onpatient function and health outcomes.

Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Physical Medicine and Rehabilitation Residency Training.

A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.

Evidence-Based Medicine Training in United States-Based Physiatry Residency Programs.

Although the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies. However, although most respondents reported using traditional pedagogic methods of training such as journal club, very few reported that their EBM training used a structured and systematic approach. Future work is needed to support and facilitate physiatry residency programs interested in adopting structured EBM training curricula that include recommended EBM core competencies and the evaluation of their impact.

Heterogeneity in Palliative Care Education Across Physiatry Residency Programs (SCI903)

Heterogeneity in Palliative Care Education Across Physiatry Residency Programs (SCI903)

The Physiatry Workforce in 2019 and Beyond, Part 2: Modeling Results.

The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States. A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources. Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030. Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists' use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall.

Factors Influencing Fellowship Decision Making During Physical Medicine & Rehabilitation Residency.

Previous surveys have demonstrated an increasing trend among graduating physiatry residents who desired to pursue a subspecialty fellowship. There has been sparse information on whether residents start their training with a subspecialty interest in mind and what factors influenced them to choose a fellowship. This article describes a prospective survey in the 2019-2020 academic year in which 175 responses were collected representing 65 (78.3%) of the 83 physical medicine and rehabilitation programs with graduating residents. Nearly 3 in 4 (73.7%, 129/175) reported matching into a fellowship, and among those, 79.8% (103/129) had matched into a pain, spine, or sports medicine fellowship. At the start of residency, 62.3% (109/175) were planning to pursue a fellowship, with 54.9% (96/175) planning to focus on either pain, sports, or spine medicine. Most respondents (72.2%) did not change their initial subspecialty focus during their residency training. Forty-six percent agreed that their anticipated subspecialty influenced their choice of residency program. The results of this survey demonstrate that most graduating residents are matriculating into fellowship training with pain, spine, and/or sports medicine being among the top choices. These results underscore the importance of subspecialty interests of trainees at the start of their residency and how training may influence their subspecialty interest.

Subspecialty Training: Hospice and Palliative Medicine.

Physiatrists care for patients and families with complex medical needs, and primary palliative care is an important part of the comprehensive rehabilitation care plan. Palliative care improves patient and family quality of life and reduces healthcare costs. Clinical care guidelines for several physiatry patient populations now include the provision of palliative care.Current Accreditation Council for Graduate Medical Education physiatry residency program requirements include foundational palliative care skills. Similarly, current clinical palliative care practice guidelines enumerate standards that apply to the rehabilitation setting. However, there is a dearth of literature on the current state of palliative care training within physiatry programs, and hospice and palliative medicine remains one of the least subscribed physiatry subspecialties.In this article, we describe palliative care, highlight existing literature on palliative care needs within physiatry patient populations, and identify a core physiatry-palliative care skillset. We look both within physiatry and across other specialties to guide recommendations for palliative care education within physiatry residency programs. We also describe opportunities for post-residency fellowship training in hospice and palliative medicine.

Cancer Rehabilitation Medical Knowledge for Physiatry Residents: Literature Subtopic Analysis and Synthesis into Key Domains.

Cancer Rehabilitation Medical Knowledge for Physiatry Residents: Literature Subtopic Analysis and Synthesis into Key Domains.

Brief Ultrasound-Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation.

Multiple studies demonstrate poor musculoskeletal palpation accuracy of physiatry residents. With the growing use of ultrasound clinically, it could serve as a powerful educational tool. However, there are no published studies examining the efficacy of ultrasound-aided education at the bedside, where much learning takes place during postgraduate training. To determine if brief ultrasound-aided teaching improves residents' accuracy and confidence of musculoskeletal palpation. Before/After Trial. Academic Institution. Ten physical medicine and rehabilitation residents were voluntary participants. Each resident was given a survey to assess confidence in palpating the hook of the hamate and medial calcaneal tubercle. They then attempted to palpate and place a marker over these two structures in a model patient. Marker placement accuracy was verified by ultrasound. Faculty spent less than 1 minute per landmark, sonographically teaching its correct localization. The resident, after moving to a new model patient, was then re-tested on accurate marker placement for both landmarks. A repeat survey to assess confidence was administered. Preintervention and postintervention accuracy and confidence of correct localization of both landmarks. We used McNemar's and Wilcoxon's tests to determine whether the intervention improved the location accuracy and confidence of successful palpation, respectively. Confidence level of correct localization of two landmarks improved on average from 4.3 to 8.15 on a scale of 10 after intervention. Of 20 palpation attempts, 11 correctly placed the marker postintervention after an incorrect placement, 8 made no change, and one changed from correct to incorrect placement. The odds of improvement in accuracy was 11 (95% confidence interval [CI] 1.60-473.47, P < .01). Both tests showed significant improvements after the intervention at the significance level of .05. Brief, ultrasound-aided teaching increases accuracy and confidence of residents' musculoskeletal palpation.

Using a Workshop Format for Physiatry Trainees in the Management of Acute Sports-Related Concussion.

Select residency and medical student training programs have developed and researched skill-based workshops, focusing on mastering a surgical or communication skill; however, they are less frequently studied in physiatry residency programs. Given the importance of concussion care in physiatric practice, this study sought to measure the effectiveness of a novel sports-related concussion workshop. Based on the 5th International Consensus Statement on Concussion in Sport, a 6-hr concussion workshop was developed. Participants were administered a preworkshop and postworkshop questionnaire to gauge level of comfort managing various aspects of concussion, case-based questions to assess participant knowledge, and questions regarding satisfaction with workshop-based training sessions. Sixteen participants, ranging from PGY-2 to PGY-5, were included in the analyses, with significant gains (P < 0.0001 to P = 0.0045) made in all measures of comfort managing sports-related concussion; the study was unable to detect a statistically significant improvement in knowledge as assessed by the patient vignettes (P = 0.17), but participants did report high levels of satisfaction with workshop-based training sessions. Thus, workshop-based physiatry trainee education sessions can be used to teach trainees certain skills or provide comprehensive training in the management of a specific condition. Participants demonstrated improved comfort managing concussion, a trend toward improved knowledge, and a high degree of satisfaction with the content's method delivery.

Poster 121 Musculoskeletal Physical Exam Skills Assessment in Physiatry Residents.

Poster 121 Musculoskeletal Physical Exam Skills Assessment in Physiatry Residents.

Feedback to Supervisors: Is Anonymity Really So Important?

Research demonstrates that physicians benefit from regular feedback on their clinical supervision from their trainees. Several features of effective feedback are enabled by nonanonymous processes (i.e., open feedback). However, most resident-to-faculty feedback processes are anonymous given concerns of power differentials and possible reprisals. This exploratory study investigated resident experiences of giving faculty open feedback, advantages, and disadvantages. Between January and August 2014, nine graduates of a Canadian Physiatry residency program that uses open resident-to-faculty feedback participated in semistructured interviews in which they described their experiences of this system. Three members of the research team analyzed transcripts for emergent themes using conventional content analysis. In June 2014, semistructured group interviews were held with six residents who were actively enrolled in the program as a member-checking activity. Themes were refined on the basis of these data. Advantages of the open feedback system included giving timely feedback that was acted upon (thus enhancing residents' educational experiences), and improved ability to receive feedback (thanks to observing modeled behavior). Although some disadvantages were noted, they were often speculative (e.g., "I think others might have felt …") and were described as outweighed by advantages. Participants emphasized the program's "feedback culture" as an open feedback enabler. The relationship between the feedback giver and recipient has been described as influencing the uptake of feedback. Findings suggest that nonanonymous practices can enable a positive relationship in resident-to-faculty feedback. The benefits of an open system for resident-to-faculty feedback can be reaped if a "feedback culture" exists.

D.07 Clinical electromyography training in Canada: The experience of neurology and physiatry residents

Background: There are currently no national standards for clinical electromyography (EMG) training for residents in neurology and physiatry in Canada. The purpose of this study was to obtain demographic and qualitative data pertaining to EMG residency training in Canada, with the goal of facilitating discourse that could lead to national standards for EMG training. Methods: An online survey was distributed to senior neurology and physiatry residents (post-graduate years 3-5), at seven tertiary Canadian centres. The study authors, who are trainees and consultants with a broad range of EMG expertise (junior and senior resident, clinical neuromuscular fellows, senior physiatrist and neuromuscular neurologists), developed pertinent demographic and qualitative questions. Results: Thirty-eight residents completed the survey (23 neurology, 15 physiatry). There was inter-program variation in quantity of the training experience, content of the curriculum, access to expertise (including technologists) and goals for future training and practice. Similarly, differences were identified between the training experiences of neurology and physiatry residents. Conclusions: Inter-program variability in EMG training was identified. Additionally, differences were identified between neurology and physiatry resident training. This data provides evidence of training discrepancies across the country and can be used to establish national training standards for EMG in Canada.

Residency and Beyond: Subspecialization Trends Among Graduating Physiatry Residents and the Musculoskeletal Curriculum.

Previous studies and informal surveys have demonstrated a trend among graduating physiatry residents who desired to practice in an outpatient musculoskeletal (MSK)- or spine-type setting. However, there has been no updated information on the current trend among graduating residents as well as sparse information on gauging if current trainees feel prepared on graduation to treat patients with such disorders. This article describes a prospective survey of graduating chief residents during the 2013-2014 academic year in which 72% of chief residents planned to pursue a fellowship. A total of 54% of those chief residents planned to pursue a pain, sports, or spine fellowship. Seventy-five percent of the responding chief residents reported that most of the residents in their program felt that the current amount of required rotations in MSK, sports, spine, or pain medicine was adequate and 85% felt comfortable practicing in a noninterventional spine or MSK position after graduation without a fellowship. The results of this survey provide an updated perspective on the current trends among graduating residents as well as how residents perceive their MSK curriculum. These results may prove useful when evaluating MSK curriculums and shaping resident education to maximize career goals.

Resident Accuracy of Electromyography Needle Electrode Placement Using Ultrasound Verification

BackgroundElectromyography (EMG) and musculoskeletal (MSK) ultrasound (US) are core learning objectives during physical medicine and rehabilitation (PM&R) training. However, there have been no prior studies using MSK US to assess the acquisition of EMG procedural skills during residency training. This study aims to demonstrate the differences in skillful needle placement between junior and senior physiatry residents. The integration of both EMG and MSK US may have tremendous potential for additional learning opportunities related to electrodiagnostic education. ObjectiveTo determine the accuracy of anatomic landmark–guided EMG needle electrode placement in commonly used muscles by PM&R resident physicians. DesignCross-sectional study. SettingAn academic PM&R residency program. ParticipantsTwelve (5 postgraduate year [PGY] –3 and 7 PGY-4) PM&R resident physicians participating in a MSK US training course. MethodsTwelve PM&R residents in the eighth month of their third and fourth years of postgraduate training performed anatomic landmark–guided needle placement to the extensor indicis proprius (EIP), pronator teres (PT), peroneus longus (PL), and soleus muscles of live subjects. Once the needle electrode was satisfactorily placed, needle localization was verified with US. Main Outcome MeasuresAccuracy of EMG needle electrode placement. ResultsThe overall accuracy of needle electrode placement for all resident participants was 68.8%. The mean accuracy of the 4 selected muscles was 50% by PGY-3 residents and 82.1% for PGY-4 residents (P = .01). EIP was the most commonly missed muscle, with correct placement performed by 20% of PGY-3 and 42.9% of PGY-4 residents. PGY-3 residents demonstrated 60% accuracy with localizing the PT, PL, and soleus muscles. PGY-4 residents demonstrated 85.7% accuracy for PT, and 100% accuracy for both PL and soleus muscles. ConclusionsSenior residents demonstrated greater accuracy of landmark-guided needle placement than junior residents. EMG procedural skills are important milestones in PM&R training, and MSK US may be a useful tool to enhance resident learning.