ME553M.27

Introduction to Physical Medicine and Rehabilitation

Credits: 4.00 CREDITS (Clinical Elective)
Sites: SRH
Directors: Chae, Heechin
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month.
Open to Exclerks: Yes (may be restricted for international students)
Description:
Physical Medicine and Rehabilitation (PM&R) physicians provide care for people with a wide range of physical disabilities and musculoskeletal disorders. This four-week introductory clerkship provides exposure to the scope of services PM&R physicians provide.
The first two weeks are spent on an inpatient service (spinal cord injury, brain injury, stroke, or musculoskeletal service), and the following two weeks in clinics and on acute care consults. Clinics include spine, musculoskeletal/sports, pediatrics, spasticity management, and electrodiagnostics.
On the inpatient service, students carry 3-4 patients and follow one selected patient through all aspects of rehabilitation, including physical, occupational, speech, and recreational therapies. In the outpatient setting, students participate in guided patient evaluations and observe interventional spine and spasticity management procedures.
Residents, fellows, and attendings provide small group interactive didactics, clinical guidance and supervision, exposure to patient encounters, and daily feedback regarding clinical and presentation skills. Didactics cover history-taking and physical examination, condition-specific medical treatments, and disability ethics and social medicine.
There is one required 30-minute oral case presentation, based upon the patient closely followed during the inpatient experience. Patient care teams - physicians, therapists, nurses, case managers – provide pertinent information to assist with preparation.
The resident facilitators for the clerkship provide students with the month’s schedule, set of clerkship objectives, and set of recommended readings via e-mail prior to the start of the clerkship. They, along with the course director, then meet with students throughout the clerkship to provide teaching and to give and receive feedback.
Students are expected to attend all resident and medical student didactic sessions and assigned clinical experiences. This includes clinical lectures, interactive sessions, chief rounds, and grand rounds. Students are also expected to be respectful of all patients and staff, and to be committed to learning about disability and its implications. There is no call.
Learning Goals:
1) To become familiar with the patient populations that physiatrists treat.
2) To understand the role of physiatrists in improving function and quality of life for patients.
3) To understand the unique roles physiatrists play as medical specialists in the care of patients with musculoskeletal disorders (including shoulder pain, back pain, knee pain) and severe long-term disabilities (including spinal cord injury, brain injury, stroke, cerebral palsy).
4) To understand the indications for referral of patients to physiatrists.
5) To observe and understand the roles of all members of a rehabilitation team.
6) To become proficient in the examination of the musculoskeletal and neurologic systems.

7) To gain sensitivity to general medical, psychological, social, and functional considerations for a person with a disability and his or her family.
8) To learn the key aspects of running team and family meetings regarding patient care.
9) To become familiar with research in physiatry at Harvard Medical School.

10) To become familiar with physiatry services available for patients at Spaulding, Harvard, and throughout Boston.
11) To be able to present a physical medicine and rehabilitation case, with focus on function, adjustment, and quality of life.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Basic science and evidence-based medicine are incorporated into medical student and resident didactic sessions and journal clubs (approximately seven hours per week). Evidence-based clinical practice guidelines are also provided for students. Laboratory research opportunities are reviewed and participation encouraged.
Evaluation:
The residents, attendings, and staff with whom the students work will evaluate the students daily. They will provide immediate, constructive verbal feedback to students regarding clinical, interpersonal, and presentation skills. They will provide end-of-rotation written feedback as well. The residents, attendings, and staff will also evaluate students on an end-of-clerkship oral patient presentation. They will assess presentation skills, appropriateness of patient evaluation to level of training, sensitivity to disability, and receptiveness to feedback. Verbal and written feedback will be provided on the day of presentation. Course coordinators will also evaluate professionalism, enthusiasm, and commitment to learning based upon ongoing communications beginning prior to the start of the rotation.
Grade Criteria:
High Honors:
Clinical Skills: Exceptional history and physical examination skills, unusual aptitude for patient interaction, sincere commitment to learning, asked appropriate questions, sought assistance when needed. Clearly read appropriate literature and applied lessons learned to patient care.
Sensitivity to Disability: Unusually sensitive to patient circumstances, functional goals, and the implications of disability.
Interpersonal Interactions with Staff: Utmost respect for all members of the care team, an example-setter for the other students. Taught other members of the care team, advocated for patients during team meetings. Incorporated feedback well to improve own skills.
End-of-Clerkship Presentation: Excellent presentation skills, beyond expectations for level of training. Sought guidance and feedback in the process of creating presentation. Clearly spent extra time learning from and about the patient and long-term goal-setting.
Participation: Attended all required didactic and clinical sessions, informed course coordinators in advance of any anticipated absences. Sought to make up time missed.

Honors:
Clinical Skills: Above average history and physical examination skills, clear aptitude for patient interaction, sincere commitment to learning, asked appropriate questions, sought assistance when needed. Occasionally read relevant literature and discussed in the context of patient care.
Sensitivity to Disability: Appropriately sensitive to patient circumstances, functional goals, and the implications of disability.
Interpersonal Interactions with Staff: Respectful of all members of the care team. Taught other members of the care team, advocated for patients during team meetings. Made good effort to incorporate feedback to improve own skills.
End-of-Clerkship Presentation: Above average presentation skills, clearly committed to learning. Demonstrated detailed understanding of patient and goal setting.
Participation: Attended all required didactic and clinical sessions, informed course coordinators in advance of any anticipated absences. Sought to make up time missed.

Satisfactory:
Clinical Skills: Average history and physical examination skills, appropriate to level of training. Fair amount of enthusiasm for rehabilitation. Did not read relevant literature, and not take extra steps to excel.
Sensitivity to Disability: With prompting, attentive to patient circumstances, functional goals, and the implications of disability.
Interpersonal Interactions with Staff: Respectful of all members of the care team, friendly. Did not demonstrate significant leadership skills. Minimal attempt to incorporate feedback to improve own skills.
End-of-Clerkship Presentation: Average presentation skills, appropriate for level of training. Minimal interest in receiving feedback. Minimal time spent with patient and considering appropriate goal-setting.
Participation: Attended most required didactic and clinical sessions, may or may not have informed course coordinators in advance of anticipated absences. Made no attempts to make up time missed.

Unsatisfactory:
Clinical Skills: Deficiencies in basic history and physical examination skills for level of training. Little to no enthusiasm for rehabilitation. Not committed to learning or improving.
Sensitivity to Disability: Little to no attention to patient circumstances, functional goals, and the implications of disability.
Interpersonal Interactions with Staff: Rude, inappropriate, or apathetic.
End-of-Clerkship Presentation: Below average presentation skills. Minimal to no effort in preparation of presentation. Minimal interest in receiving feedback. Little to no effort spent with patient or considering goal-setting.
Participation: Poor attendance without explanation. Did not inform course coordinators of anticipated absences. Made no attempts to make up time missed.
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