Rehabilitation Residency Programs Research Articles

Social media adoption and utilization by Physical Medicine & Rehabilitation residency programs and implications for remote resident recruitment.

We aim to investigate the association of Instagram and Twitter (rebranded X) adoption by Physical Medicine & Rehabilitation (PM&R) residencies with the number of National Resident Matching Program (NRMP) applications received in the 2020-2021 application cycle. Among 88 PM&R residency programs, 67 (77%) had Instagram accounts, 45 (51%) had Twitter accounts, and 41 (47%) had both. Forty (60%) Instagram accounts and 19 (42%) Twitter accounts were opened during the 2020-2021 application cycle, correlating with the introduction of virtual interviews and the COVID-19 pandemic. Residency programs with active Instagram or Twitter accounts had more NRMP applications (F(2,85) = 7.49, P = 0.001). Simple main effects analysis showed that programs with an Instagram account (P = 0.03) or a Twitter account (P = 0.03) received more residency applications. In multivariate linear regression analysis including presence of an Instagram account, program size, program setting, and program region, the presence of a Twitter account (coefficient 37.3, P = 0.04, 95% CI 1.71-72.96) and ≥ 16 residents in the residency program (coefficient 77.9, P < 0.001, 95% CI 44.43-111.31) were positively correlated with the number of residency applications. In conclusion, residency programs that were larger and adopted Twitter had more applicants in 2020-2021. Future research is needed to determine how social media activity impacts residency applicant decision-making.

Shifting the Curve: Mastery Learning to Teach Nerve Conduction Studies in Physical Medicine and Rehabilitation Residency.

Nerve conduction studies are a commonly performed procedure and a core competency for physical medicine and rehabilitation residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across physical medicine and rehabilitation programs. The aims of this study are to standardize training and assessment of resident proficiency in nerve conduction studies skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 physical medicine and rehabilitation residents underwent a pretest, followed by a mastery learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at posttest. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. Thirty-three of 36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing nerve conduction studies. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a physical medicine and rehabilitation residency program and can shift the curve to allow residents to immediately start performing nerve conduction studies at the start of their clinical experience.

Geographic Proximity of Medical Students to PM&R Residency Programs Is Associated With Increased Match Rates Into PM&R.

Despite the growing popularity of physical medicine and rehabilitation as a specialty among medical students, meaningful experiences and mentorship can be challenging to obtain and may significantly vary depending on opportunities available to interact with physiatrists. This study explores the association between the geographic proximity of physical medicine and rehabilitation residency programs to medical schools and the match rate of medical students into physical medicine and rehabilitation from 2019 to 2021. Data on US medical schools, graduates, and physical medicine and rehabilitation residency programs were collected from publicly available sources, and a sample of 1193 physical medicine and rehabilitation residents from US medical schools was analyzed using a one-sample proportion test. The proportion of physical medicine and rehabilitation residents originating from medical schools with physical medicine and rehabilitation residency programs in the same metropolitan area was significantly greater than the corresponding proportion of expected residents based on medical school graduates, even when controlling for medical school affiliations with physical medicine and rehabilitation residency programs. These findings suggest that exposure and opportunities provided by physical medicine and rehabilitation residency programs may influence nearby medical students and that expanding residency programs into geographic regions without existing physical medicine and rehabilitation programs may foster interest and promote growth in the field of physiatry.

Evidence-based practice education in physical medicine and rehabilitation residency programs: A Canadian national survey.

The current extent and quality of evidence based practice (EBP) training for physiatrists is unclear at this time. Training of EBP is also available to residents in Canada. The extent, quality and impact of the training was explored. Cohort study Results: about half of the Canadian programs reported a formal EBP curriculum. The most frequently reported method of providing EBP education were resident participation in journal club. Despite the increasing integration of EBP into residency program education, there remains a critical lack of knowledge and skills for implementation of EBP into clinical practice among Canadian PM&R residency programs.

Diversity, Equity, and Inclusion Curriculum Embedded in a Physical Medicine and Rehabilitation Residency Program.

Diversity, equity, and inclusion initiatives are continuing to have increased importance in medical training, including rehabilitation medicine. Although resident-led curricula have been integrated into medical education in other training programs, to our knowledge, this the first report focusing on integrating these topics into resident education for a physical medicine and rehabilitation program. We created a didactic curriculum for our rehabilitation residents that included: quarterly lectures on diversity, equity, and inclusion topics followed by small group discussions. Each session also included an article that was included in the discussion. The sessions used both anonymous presurvey and postsurvey data to assess the efficacy of our initiative. Our initial data showed that our quarterly sessions created a safe and comfortable environment for discussing diversity, equity, and inclusion topics. In addition, our session specific data supported that increased awareness of diversity, equity, and inclusion disparities with rehabilitation and medicine was achieved. Our committee used the data and feedback to create further iterations of this initiative within our program, and we believe that this is a model that can be adopted by other physical medicine and rehabilitation residencies.

Developing residents as educators: A medical education track within a physical medicine and rehabilitation residency program.

An academic career requires knowledge and skills in providing clinical care, research, and medical education. More medical trainees are now aspiring to become clinician-educators. The objective of this descriptive study was to design and implement an optional 18-month Medical Education Track for Physical Medicine and Rehabilitation (PM&R) residents and assess resident confidence in medical educator knowledge and skills. A survey for trainees to self-evaluate their confidence in teaching skills, mentorship, and educator skills was developed. All resident physicians were surveyed at the start of their PGY3 year as a needs assessment. All residents were surveyed again 18 months later. Twenty-six out of thirty-six residents participated in the optional Medical Education Track (72.2%). All PM&R trainees demonstrated improved confidence in teaching, mentoring, and medical educator skills over an 18-month period. Participants in the Medical Education Track had higher scores in all domains. There was a high degree of satisfaction with the Track amongst participants, with all domains rated between "somewhat satisfied" and "extremely satisfied." A dedicated Medical Education Track may be a useful way to train PM&R resident physicians in medical education knowledge and skills to provide a foundation for future careers in medical education. This article is protected by copyright. All rights reserved.

Palliative Care Education in US Physical Medicine and Rehabilitation Residency Programs: Current Practices, Perceived Needs, and Barriers.

Background: Physical medicine and rehabilitation (PM&R) clinicians commonly care for patients with serious illness/injury and would benefit from primary palliative care (PC) training. Objective: To assess current practices, attitudes, and barriers toward PC education among U.S. PM&R residencies. Design: This is a cross-sectional study utilizing an electronic 23-question survey. Setting/Subjects: Subjects were program leaders from U.S. PM&R residency programs. Results: Twenty-one programs responded (23% response). Only 14 (67%) offered PC education through lectures, elective rotations, or self-directed reading. Pain management, communication, and nonpain symptom management were identified as the most important PC domains for residents. Nineteen respondents (91%) felt residents would benefit from more PC education, but only five (24%) reported undergoing curricular change. Lack of faculty availability/expertise and teaching time were the most endorsed barriers. Conclusion: PC education is heterogeneous across PM&R programs despite its perceived value. PC and PM&R educators can collaborate to build faculty expertise and integrate PC principles into existing curricula.

Survey of global health education in physical medicine and rehabilitation residency programs across the United States

Survey of global health education in physical medicine and rehabilitation residency programs across the United States

A Hybrid Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents-a Multi-center Pilot Program.

The increased use of musculoskeletal ultrasound (MSKUS) in clinical practice warrants achieving competency earlier in physiatrists' careers. Physical Medicine and Rehabilitation (PM&R) residency programs have started incorporating formal MSKUS training in their curricula; however, significant heterogeneity remains in MSKUS education. Numerous barriers contribute to the lack of consensus for MSKUS training during residency, but the COVID-19 pandemic severely disrupted in-person learning. As an adjunct or alternative to in-person learning, teleguided technology is being utilized. This curriculum demonstrates the role of a hybrid MSKUS training with interinstitutional collaboration. Twenty PM&R learners, from two institutions, were divided into a fundamental or advanced track. Virtual didactic sessions alternated weekly with hands-on ultrasonographic scanning sessions. Following a 12-month longitudinal curriculum, an end-of-year practical examination was used for competency assessment, in addition to a survey assessing resident perceptions and feedback. To our knowledge, this is the first collaborative and hybrid MSKUS curriculum for PM&R learners that can be easily reproduced at most training institutions and circumvent some of the barriers amplified by the COVID-19 pandemic. The online version contains supplementary material available at 10.1007/s40141-023-00380-z.

Multi-Institutional Journal Club as a Component of Diversity, Equity, and Inclusion Curricula in Residency Programs.

Topics of diversity, equity, and inclusion (DEI) are an integral component of post-graduate medical education. However, it is currently unclear the extent to which physical medicine and rehabilitation residency programs have incorporated a DEI curriculum into their training programs. Here, a novel, multi-institutional DEI journal club is described. This journal club format can be an important component of the DEI curriculum as it provides non-local perspectives and insights into specific issues and allows for a simple way to introduce DEI training in programs currently without such training. The virtual format also provides further opportunities for discussion and networking.

The State of Palliative Care Education in United States Physical Medicine and Rehabilitation Residency Programs: Heterogeneity and Opportunity for Growth.

Physical medicine and rehabilitation physicians routinely care for patients with serious illness and injury who could benefit from an integrated palliative care approach due to the propensity for high or complex symptom burden. Despite this, it has been unknown whether and how physical medicine and rehabilitation residency programs are equipping residents with a foundational palliative care skillset. We report national survey results characterizing the current status of palliative care education within US physical medicine and rehabilitation residency programs. Programs vary widely in the type and amount of palliative care education provided, with nearly a third of responding programs reporting no palliative care education at all. These findings suggest the need for nationally unifying palliative care education standards for physical medicine and rehabilitation residency programs to ensure that all physical medicine and rehabilitation residents have the opportunity to develop a robust palliative lens that can be applied across rehabilitation practice settings. An articulated set of standards could both facilitate achievement of palliative care-specific objectives and support achievement of foundational physical medicine and rehabilitation residency program objectives.

Reaching underserved domestic and international populations through Physical Medicine & Rehabilitation Residency training: A survey of residents and program directors.

In 2015, the World Health Organization (WHO) reported that over 400 million individuals worldwide lack access to medical care. In addition, clinicians are more likely to treat underserved patients during their careers if they have exposure to these populations during their training. To analyze what forms of didactic experiences are available and which opportunities are the most valuable with domestic/international underserved populations in Physical Medicine & Rehabilitation (PM&R) residency programs in the United States. Cross-sectional survey using REDCap software. PM&R residency programs in the United States. A total of 137 participants in Accreditation Council of Graduate Medical Education (ACGME)-accredited PM&R residencies in the United States (24 program directors and 113 residents). Not applicable. Surveys collected information regarding demographic data, prior global health training experiences, current residency training experiences involving domestic/international underserved populations being offered, participants' perceived importance of training experiences with domestic/international underserved population, barriers that impede these experiences, and if availability of these opportunities affected resident recruitment. Participants reported that their PM&R programs did not offer global health simulations (91.2%), educational tracks (75.2%), international electives (71.5%), or rotations with domestic underserved populations (48.9%). Residents viewed exposure to simulation labs (3.25/5), educational tracks (3.42/5), and electives (4.02/5) more importantly than attending physicians. Conversely, attending physicians viewed lectures (3.92/5), journal clubs (3.58), and rotations treating domestic underserved populations (4.42/5) more favorably. Both residents and attending physicians endorse lack of financial support and mentorship as barriers to these opportunities. Participants from all regions outside the Midwest reported that these educational opportunities would affect residency recruitment (56% vs. 31%). This is the first study assessing the current state of global health training opportunities for PM&R residents as well as the perceived value of such experiences. Many PM&R medical trainees desire exposure to global health medicine curriculum, and many would alter their residency selection based on its availability.

Comparison of State Board Disciplinary Actions in Board-Certified Versus Non-Board-Certified Physical Medicine and Rehabilitation Physicians.

Our goals were to estimate how many physicians who were enrolled in a physical medicine and rehabilitation residency program are licensed to practice medicine without American Board of Physical Medicine and Rehabilitation board certification and to compare risk of state medical board disciplinary action with those who are board certified. We matched physicians who completed training in physical medicine and rehabilitation before 2019 with the Federation of State Medical Boards database. We compared certified versus noncertified physicians registered with Federation of State Medical Boards and frequencies of disciplinary action. There were 14,729 physicians with matched American Board of Physical Medicine and Rehabilitation and Federation of State Medical Boards data. Of these, 13,707 (93.1%) had attained initial American Board of Physical Medicine and Rehabilitation certification and 1022 (6.9%) had not. Certification status predicted a disciplinary action (odds ratio = 2.76; 95% confidence interval = 2.202-3.463; P < 0.001). Compared with the board-certified physicians, those who never passed part I (attempted once or more) were 4.68 times more likely to have a disciplinary action (P < 0.001), and those who passed part I with multiple attempts but failed part II (1 or more times) were 3.26 times more likely to have a disciplinary action (P = 0.013). Absence of American Board of Physical Medicine and Rehabilitation certification is noted in approximately 7% of physicians who undertook physical medicine and rehabilitation residency training and obtained medical licensure. These individuals are at higher risk for state medical board disciplinary action.

Letter to the Editor on "Incorporating Holistic Review in Recruitment in a Physical Medicine and Rehabilitation Residency Program".

Letter to the Editor on "Incorporating Holistic Review in Recruitment in a Physical Medicine and Rehabilitation Residency Program".

Incorporating Holistic Review in Recruitment in a Physical Medicine and Rehabilitation Residency Program.

Traditional residency recruitment practices are vulnerable to unconscious biases, inequity, lack of diversity, and have limited ability to predict future clinical competency. Holistic review and evidence-based strategies, such as structured interviews and situational judgment tests, can mitigate these limitations. A physical medicine and rehabilitation residency program restructured its residency recruitment process using holistic review principles and evidence-based strategies during the 2020-2021 academic year. A subcommittee developed a weighted screening rubric based on Association of American Medical Colleges core competencies and semistructured interview questions targeting specific domains. Formal implicit bias training was provided. Screening scores determined interview invitations. Applicants participated in three different domain-focused semistructured interviews. Screening and interview scores were combined to form the program rank list. A postinterview anonymous questionnaire was sent to interviewees to obtain feedback. Four hundred eighty-nine applicants were screened (82 interview invitations, 80 interviewed, 8 matched). The respondents to the postinterview questionnaire found that interviews evaluated them objectively (90%) and improved their impression of the program (90%). The program's match was consistent with previous matches. Interviewed applicants represented a racially diverse group. Most questionnaire respondents had a positive impression of the interview process. This article demonstrates incorporating holistic review into residency recruitment and provides specific resources to aid other institutions pursuing similar goals.

Virtual Objective Structured Clinical Examination Experiences and Performance in Physical Medicine and Rehabilitation Residency.

Virtual education has been described before and during the COVID-19 pandemic. Studies evaluating virtual objective structured clinical examinations with postgraduate learners are lacking. This study (1) evaluated the experiences of all participants in a virtual objective structured clinical examination and (2) assessed the validity and reliability of selected virtual objective structured clinical examination stations for skills in physical medicine and rehabilitation. Convergent mixed-methods design was used. Participants included three physical medicine and rehabilitation residency programs holding a joint virtual objective structured clinical examination. Analysis included descriptive statistics and thematic analysis. Performance of virtual to previous in-person objective structured clinical examination was compared using independent t tests. Survey response rate was 85%. No participants had previous experience with virtual objective structured clinical examination. Participants found the virtual objective structured clinical examination to be acceptable (79.4%), believable (84.4%), and valuable for learning (93.9%). No significant differences between in-person and virtual objective structured clinical examination scores was found for three-fourth stations and improved scores in one fourth. Four themes were identified: (1) virtual objective structured clinical examinations are better for communication stations; (2) significant organization is required to run a virtual objective structured clinical examination; (3) adaptations are required compared with in-person objective structured clinical examinations; and (4) virtual objective structured clinical examinations provide improved accessibility and useful practice for virtual clinical encounters. Utility of virtual objective structured clinical examinations as a component of a program of assessment should be carefully considered and may provide valuable learning opportunities going forward.

The Hirsch Index and Self-Citation in Academic Physiatry Among Graduate Medical Education Program Directors.

The Hirsch Index is a measure of academic productivity which captures both the quantity and quality of an author's output. A well-accepted bibliometric, the Hirsch Index still may be influenced by self-citation, which has been assessed in other medical and surgical specialties. This study aims to evaluate research output and self-citation in physiatry, establishing a benchmark for the field, in addition to identifying differences between physical medicine and rehabilitation subspecialties. This study identified physical medicine and rehabilitation residency and fellowship program directors and analyzed the number of publications, citations, self-citations, and h-indices. A total of 169 program directors were identified, and the mean number ± SD of publications, citations, and Hirsch Index for the cohort were 16.7 ± 29.5, 348 ± 753, and 5.7 ± 6.7, respectively. When self-citation was excluded, less than 2% of program directors (3 of 169) had changes in Hirsch Index greater than one integer, and none greater than two integers. The Hirsch Index remained unchanged for 90% (152 of 169). Spinal cord injury fellowship directors had significantly higher mean number of publications (28, P = 0.04), mean number of citations (672, P = 0.03), and Hirsch Index (9.2, P < 0.01; 95% confidence interval). Overall, self-citation is infrequent in physical medicine and rehabilitation, and spinal cord injury directors had more robust academic profiles.

Development of a Formalized, Multifaceted Mentorship Program in Physical Medicine and Rehabilitation Residency Education.

Mentorship in medicine has long been a vital component to the training, development, and career advancement of physicians. Although optimal strategies for facilitating mentorship relationships are unknown, it is recognized that establishing a formalized mentorship program within residency training may augment mentor-mentee pairing, improve overall trainee experience, and enhance resident perception of strong mentoring relationships. A formalized mentorship program was successfully developed in a Canadian physical medicine and rehabilitation residency program, including innovations such as near-peer self-matching, a needs assessment survey, a speed dating event, formation of "link groups," and "fireside chats" with faculty members. This approach may serve as a guide for other medical education and residency programs seeking to implement a similar concept.

Virtually Possible: Medical Student Rehabilitation Rotations During a Pandemic.

The novel coronavirus 2019 pandemic has led to new dilemmas in medical education because of an initial shortage of personal protective equipment, uncertainty regarding disease transmission and treatments, travel restrictions, and social distancing guidelines. These new problems further compound the already existing problem of limited medical student exposure to the field of physical medicine and rehabilitation, particularly for students in medical schools lacking a department of physical medicine and rehabilitation, approximately 50% of medical schools. A virtual medical student physical medicine and rehabilitation rotation was created to mitigate coronavirus 2019–related limitations and impact on medical education. Using audiovisual technology, students had the opportunity to participate in clinical inpatient and outpatient care, live-streamed procedures, and virtual didactics, develop and showcase their clinical knowledge and reasoning skills, and become familiar with the culture of the physical medicine and rehabilitation residency program. Adaptive educational approaches, including integration of the flipped classroom model, success, pitfalls, and areas for improvement will be described and discussed. Providing nontraditional methods for physical medicine and rehabilitation education and exposure to medical students is crucial to maintain and promote growth of the field in this unprecedented and increasingly virtual era.

Retrospective Study on the Effect of the Timing of Exposure on Confidence Level in Applying to Physical Medicine and Rehabilitation Residency Programs.

Residency specialty choice, a complex decision-making process, is often influenced by confidence level built upon knowledge, experience, and fit with the specialty. Despite the need for physiatrists with population growth, especially people with disability and older patients, limited growth in the number of residency positions and delayed exposure to the field of physical medicine and rehabilitation potentially contribute to a lack of confidence in pursuing physical medicine and rehabilitation. Early introduction to a specialty has been shown to impact specialty selection. Thus, this study aims to explore the impact of timing of exposure to physiatry on the confidence level of physical medicine and rehabilitation residents in their specialty choice. A survey for current physical medicine and rehabilitation residents was developed and distributed to residency program directors with a request to forward it to all residents. The response rate was low at 13%; however, the results provide a window into the experience of today's medical and premedical students. Interestingly, of the 175 respondents, a similar number reported first exposure to physiatry during third year and before medical school. In addition, earlier exposure was associated with higher confidence levels in specialty choice, the most powerful factor being the exposure to the specialty before starting medical school or during the preclinical years in medical school. These findings highlight opportunities to improve the physiatry workforce by providing earlier exposure to the specialty, even before medical school. Based on the results of the survey and ongoing discussions among medical students, residents, and faculty leaders, the authors review current recruitment efforts and new ideas.