Uams department of Physical Medicine and Rehabilitation Residency Program Manual



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UAMS Department of Physical Medicine and Rehabilitation

Residency Program Manual
Rani L. Lindberg, M.D., Residency Program Director

Kevin M. Means, M.D., Residency Associate Director

Linda M. Voyles, Residency Program Coordinator
last reviewed/revised November 2015

TABLE OF CONTENTS


FOREWARD 4

Our History 4

The History of Physiatry
An Overview 5

Physical Medicine and Rehabilitation


Description of Program 7

Overall Goals and Objectives for Residency Training 9

Educational Goals - PGY-1 Resident 11

Educational Goals - PGY-2 Resident 11

Educational Goals - PGY-3 Resident 12

Educational Goals - PGY-4 Resident 13

UAMS Department of Physical Medicine and Rehabilitation
Faculty Roster 14

Department Chairman/Associate Residency Program Director


Kevin M. Means, M.D. 16

Outpatient rotations in PM&R. For each rotation, there are objectives tied to general competencies. These are general and PM&R content specific objectives. Residents use the rotation overviews to UAMS Department of Physical Medicine and Rehabilitation

Resident Roster 17

Introduction for Educational Program 18

PGY-1 Rotation Introduction 19

Physical Medicine and Rehabilitation Fundamental Clinical Skills Rotation 21

Emergency Medicine 24

Medicine Wards-VAH 27

Radiology 29

Neurology 32

Pediatric Wards ACH 34

Geriatric Wards 36

Rheumatology, BMC 39

Sample Residency Rotation Schedules 45

47

Introduction for Rotation Objectives 47


Resident Signs of Fatigue 49

Inpatient Goals & Objectives 51

Outpatient Goals & Objectives 59

Scheduled Educational Activities for PM&R Residents


2015-2016 70

Master Schedule


2015-2016 71

Grand Rounds 72

Resident Seminars 73

Seminar Evaluation 75

Journal Club 76

Suggested Guideline for Review of a Research Article 78

PM&R Resident

Self-Assessment Examination 79

PM&R Resident Scholarly Activity Program 80

Resident Mid-Rotation Evaluation by Faculty 82

Objective Structured Clinical Examination (OSCE) 83

Residency Program Policy - Resident Selection Criteria and Recruitment Process 85

Residency Program Policy - Resident Evaluations 88

Residency Program Policy - Faculty Evaluations by Residents 89

Residency Program Policy - Resident Leave 90

Residency Program Policy - Educational & Administrative Leave 94

Residency Program Policy - Procedure for Leave Request 96

Residency Program Policy – Moonlighting 97

Residency Program Policy - Duty Hours and Work Environment 98

Residency Program Policy - Night Call 100

BHRI PHYSICIAN HOUSESTAFF POLICY 101

BHRI Patient Care Policy/Procedure #D-1 104

Residency Program Policy - Meals for BHRI On-Call Residents 105

Residency Program Policy - Resident Pagers 106

Residency Program Policy - Photocopying for Residents and Medical Students 107

Residency Program Policy - Book Funding 108

Residency Program Policy - Regarding Travel 109

Residency Program Policy - Chief Residents 110

Residency Program Policy - Guidelines for Resident to Resident Supervision in PM&R 112

Residency Program Policy - Criteria and Processes for Academic Actions of Reappointment, Evaluation, Promotion, and Other Disciplinary Actions 113

Residency Program Policy - UAMS/PM&R Library Rules 116

Residency Program Policy - PM&R Housestaff-Fringe Benefits 117

Residency Program Policy - Self-Assessment Examination (SAE) 121

Residency Program Policy - Addressing Resident Concerns 122

Residency Program Policy – Supervision 124

American Board of Physical Medicine & Rehabilitation – Registration of New Residents 125

APPENDIX 126

Semi-Annual Resident Evaluation of Faculty 127

PM&R RESIDENT CHECKOUT FORM 128

Request to Participate in Moonlighting Activities 129

Resident Counseling Form 131


FOREWARD

Our History
We are a young specialty in an organized sense. Under the leadership of Dr. Frank Krusen, we were recognized as the “American Board of Physical Medicine” in 1947 by the Accreditation Council on Graduate Medical Education (ACGME). Two years later, the word “Rehabilitation” was added at the urging of Dr. Howard Rusk.

However, using physical agents, i.e., exercise and heat, may have been the earliest method of medical rehabilitation by our physician forebears.

Many American physicians and philanthropists contributed to the development of the specialty “Physical Medicine and Rehabilitation.”

An account of the maturation of our specialty reflects somewhat the biases of the persons assembling the history, but clearly this narrative presents an objective view of our beginnings and subsequent growth during the past 75 years.

Others may add to or subtract from the story, but this will serve as the consensus for our own album.

Much appreciation to Bradley R. Johns for his thorough investigation and presentation.


Ernest W. Johnson, MD Professor of PM&R

The Ohio State University September 14, 1994
The History of Physiatry
An Overview

Physical means of healing have been practiced since prehistoric times, but Physiatry did not become recognized as a separate medical specialty until 1947. Most widely known as the field of Physical Medicine and Rehabilitation, the medical specialty of modern-day Physiatry comprises the related disciplines of Physical Medicine, Rehabilitation Medicine and Electromyography.

The term Physiatry derives from the Greek word physikos (physical) and iatreia (art of healing). A Physiatrist is a physician who creatively employs physical agents as well as other medical therapeutics to help in the healing and rehabilitation of a patient. Treatment involves the whole person and addresses the physical, emotional and social needs that must be satisfied to successfully restore the patient’s quality of life to its maximum potential.

Since the beginning of time, people have used physical means for treatment of illness and injury. Such physical agents for healing have included water, heat, cold, massage, light, exercise and electricity. Throughout history, water has functioned as a primary means of physical healing. Written accounts of physical techniques for healing can be traced as far back as the writing of Hippocrates in 400 B.C.

Rehabilitation involves the restoration of a diseased or disabled person to optimal physical, psychological and social functioning.


The History of Physiatry

Presented by the Association of Academic Physiatrists Historical Committee
Link to http://www.physiatry.org/?page=History_PMR

Physical Medicine and Rehabilitation


Description of Program

Physical Medicine and Rehabilitation (PM&R) program encourages residents to become competent Physiatrists by having experience in clinical, didactics, and by participating in research curriculum. This program has qualified faculty to implement the program and residents are expected to fulfill the components of this program.

The University of Arkansas for Medical Sciences (UAMS) is the sponsoring institution and several sites participate in this program. The PM&R program is a multi-clinical site utilizing Arkansas Children’s Hospital (ACH), Baptist Health Rehabilitation Institute (BHRI), Central Arkansas Veterans Hospitals in Little Rock (CAVH-LR) and North Little Rock (CAVH-NLR), and the University of Arkansas for Medical Sciences (UAMS). These facilities allow students to have the opportunity to work in a rehab facility and private practice. Arkansas Children’s Hospital (ACH) is the seventh largest pediatric hospital in the country, and the only pediatric medical center in the state.

ACH has a strong pediatric rehab program with a large number of patients and a 20-bed inpatient rehabilitation pediatric unit. In addition to inpatient care, there are regular clinics for myelomingocele, muscular dystrophy, and cerebral palsy. Burn and hemophilia clinics are optional.

BHRI is a free standing institute that allows residents to obtain good clinical training in PM&R. In addition to inpatient care, there are extensive on-site outpatient facilities, as well as multiple satellite therapy centers.

UAMS is an acute care teaching hospital. PM&R residents interact with medical students of different specialties, residents, and faculty from other services such as Neurosurgery, Neurology, Trauma Surgery, Medicine, Geriatrics, Oncology, Rheumatology, Family Practice, and Orthopedics.

CAVH-LR is an acute care hospital with a spacious section devoted to Rehabilitation Medicine Services. It is a tertiary facility that admits complex medical problems from the surrounding district plus the usual mix of patients from the local metropolitan area. The hospital is adjacent to and closely affiliated with University Hospital and the faculty of most services have joint appointments in the hospitals. There is a PM&R consultation service at this hospital. CAVH-NLR is a long-term hospital for patients with psychiatric and chronic medical problems. A 20-bed rehabilitation unit and a 38-bed geriatric unit provide a solid environment for learning and training. There is an extensive consultation service, including diagnostic EMG’s and numerous outpatient clinics (i.e., brace, seating, spinal cord, general rehabilitation, back, amputee clinics, and falls clinics.)

PM&R is a four-year graduate medical education program that requires four years of graduate medical education to complete training for a physician seeking specialization in this field, three years of which must be physical medicine and rehabilitation training. Of these three years, no more than six months can be elective. Three years are spent in the Department of Physical Medicine and Rehabilitation with three month rotations, which provide a wide variety of clinical experience in both neuromuscular and musculoskeletal diagnosis. This includes comprehensive rehabilitation of severe physical disabilities such as spinal cord injury, head injury, stroke, amputation, electrodiagnosis, management of acute and chronic musculoskeletal problems, and management of chronic pain syndromes. No more than one month of this elective time may be taken in a non-ACGME – accredited program, unless prior approval is given by the Residency Review Committee (RRC).

The remaining months of this year may include any combination of accredited specialties or subspecialties. Most or best areas excelled in: Spinal Cord, Geriatrics, and VA (Spinal Cord expanded with VA). Students are going to get a variety of experiences in patient populations at VA-Geriatrics, BHRI-Private Rehab, UAMS and ACH-Pediatrics, which will give students diversity. One year of the four years of training is to develop fundamental clinical skills. This year of training in fundamental clinical skills must consist of an accredited transitional year or include six months or more responsibility in accredited training with inpatient responsibility in family practice, internal medicine, obstetrics-gynecology, pediatrics, or surgery, or any combination of these patient care experiences.

Accredited training in any of these specialties or subspecialties selected must be for a period of at least four weeks. PGY-1 would do six months of inpatient ward medicine at the VA and six months of the following specialty areas: Neurology, Emergency Medicine, Ambulatory Medicine (VA), Radiology/Rheumatology, Orthopedics and PM&R. No more than eight weeks may be in non-direct patient care experiences. Training in fundamental clinical skills must be completed within the first two years of the four-year training program.

This training program may choose either to provide three years of physical medicine and rehabilitation training and appoint residents at the PGY-2 level contingent on satisfactory completion of first year’s accredited training in fundamental clinical skills or to provide four years of training to include twelve months of these fundamental clinical skills in areas other than physical medicine and rehabilitation. It is the responsibility of this program for the quality of the integrated educational experience for the entire training program, including twelve months of training in fundamental clinical skills in areas other than physical medicine and rehabilitation.

Overall Goals and Objectives for Residency Training

It is the intent of the Physical Medicine and Rehabilitation (PM&R) program to develop physicians well trained and able to practice in a competent and independent manner as Physiatrists. This training will be achieved through a) supervised clinical work with increasing responsibility for outpatients and inpatients and b) a foundation of organized instruction in the basic neurosciences. Physicians completing the program will be eligible for certification by the American Board of Physical Medicine and Rehabilitation with an ultimate goal of an eventual 100% pass rate on both the oral and written examinations. This program has training level specific educational goals that must be met to ensure residents are aware of the level of education in this program. They are:



Mastery Level: Competent in all essential knowledge areas; technically proficient in skill areas; minimal input by attending faculty required for subtle or fine points only; capable of unsupervised independent PM&R practice.

Advanced Level: Competent in most essential knowledge areas; basic knowledge areas have been mastered, but some advanced areas may need further improvement; technically proficient in many, but not all skills areas; requires some supervisory input by attending faculty, but less than basic level resident.

Basic Level: Familiar with basic PM&R knowledge areas; competence still improving; familiar with some PM&R technical skills; requires moderate supervisory input by attending faculty, especially for advanced areas.

Residents are also required to develop competencies in the six areas below to the level expected of a new practitioner. Toward this end, the resident is provided through the training program with the appropriate experience to develop and demonstrate the following specific knowledge, skills, and attitudes:


  1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

  2. Medical Knowledge about established and evolving biomedical, clinical and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

  3. Practice-based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvement in patient care.

  4. Interpersonal and Communication Skills that result in effective information exchange and learning with patients, their families, and other health professionals.

  5. Professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

  6. Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value.

Physical Medicine and Rehabilitation residency program must document that it provides an educational experience of such quality and excellence as to offer its graduates the opportunity for attainment of those competencies necessary for entry level independent practice of this specialty. This must include knowledge about the diagnosis, pathogenesis, treatment, prevention and rehabilitation of those neuromusculoskeletal, neurobehavioral, cardiovascular, pulmonary, and other system disorders common to this specialty in patients of both sexes and all ages. This program will provide the opportunity for the graduate to develop the attitudes and psychomotor skills required to:


  1. Modify history-taking technique to include data critical to the recognition of functional abilities and physical and psychosocial impairments that may cause functional disabilities;

  2. Perform the general and specific physiatric examinations, including electromyography, nerve conduction studies, and other procedures common to the practice of physical medicine and rehabilitation;

  3. Make sound clinical judgments; and

  4. Design and monitor rehabilitation treatment programs to minimize and prevent impairment and maximize functional abilities.

In addition, this program must provide the opportunity for the graduate to be able to coordinate effectively and efficiently an interdisciplinary team of allied rehabilitation professionals for the maximum benefit of the patient by:



  1. An understanding of each allied health professional’s role,

  2. The ability to write adequately detailed prescriptions based on functional goals for physiatric management, and

  3. The development of management and leadership skills.

Additionally, this training program will stress the importance of self-evaluation, continuing medical education and continued professional development after graduation. The training program must provide the opportunity for the resident to develop the necessary written and verbal communication skills essential to the efficient practice of physiatry. The organization and philosophy of the residency program must provide the opportunity for development of the clinical competence of the resident. The curiosity and creativity of all residents must be stimulated and must be involved in the critical appraisal of current literature. All provisions of the Institutional Requirements must also be met for accreditation.

Clinical competence requires:


  1. A solid fund of basic and clinical knowledge,
  2. The ability to perform an adequate history and physical exam,


  3. The ability to order and interpret appropriate diagnostic tests,

  4. Adequate technical skills to carry out selected diagnostic procedures,

  5. Clinical judgment to critically apply the above data to individual patients,

  6. Attitudes conducive to the practice of Physiatry, including appropriate interpersonal interactions with patients, professional colleagues, supervisory faculty, and all paramedical personnel,

  7. Personal integrity,

  8. Regular, timely attendance at departmental and divisional educational activities,

  9. Timely dictations and signature of inpatient discharge summaries and outpatient notes, as well as completion of appropriate letters or phone calls to referring physicians,

  10. Recognition of personal limits. Controversial issues require direct and immediate participation of the responsible attending,

  11. Ongoing dedication to critical evaluation of one’s own skills and knowledge and to continuing education through literature review, communication with colleagues, and attendance at society meetings and other educational forums, and

  12. Interaction with other facets of the health care delivery system at large in a comprehensive yet cost-effective manner.

Within the PM&R program, there are educational goals for specific PGY level residents. These goals ensure residents have mastered skills at a certain level before progressing to a higher level. The educational goals for PGY 1-4 are as follows:


Educational Goals - PGY-1 Resident

Upon completion of the first postgraduate year, a PM&R resident should:

  1. Recognize typical clinical problems among patients with physical medicine and rehabilitation problems in various clinical settings and their management.

    (Patient Care, Systems-Based Practice, Medical Knowledge)


  2. Discuss the management of typical clinical problems among patients with physical medicine and rehabilitation problems in various clinical settings.
    (Systems-Based Practice, Medical Knowledge, Practice-Based Learning)

  3. Demonstrate proper history and examination techniques.
    (Patient Care, Communication, Professionalism)

  4. Identify various diseases and conditions that are amenable to rehabilitation efforts.
    (Medical Knowledge)

  5. Describe allied health professionals involved in the rehabilitation team.
    (Systems-Based Practice, Practice Based Learning)

Educational Goals - PGY-2 Resident



Upon completion of the second postgraduate year, a PM&R resident should:
1. Demonstrate proficiency in physiatric assessment, diagnosis and prescription for functional impairments, arising from acute and chronic neurological, musculoskeletal, cardiovascular and pulmonary conditions.
(Patient Care, Medical Knowledge)

2. Perform basic physiatric interventional procedures like trigger point and intra-articular injections, nerve and phenol blocks, botox injections and diagnostic examination, including nerve conduction and electromyographic studies.


(Patient Care, Medical Knowledge)

3. Develop leadership skills to promote the team approach and responsible utilization of consulting services to maximize rehabilitation outcomes.


(Systems-Based Practice, Interpersonal and Communication Skills, Professionalism)

4. Demonstrate a basic level competence in performing the comprehensive and physiatric physical examination and in the analysis of data from pertinent diagnostic tests to achieve the appropriate diagnosis.

(Patient Care, Medical Knowledge)

5. Demonstrate a basic ability to formulate, implement and monitor appropriate PM&R treatment plans to archive maximum physical, psychological, social, vocational, avocational and educational outcomes for patients in the acute hospital setting, the acute rehabilitation unit or hospital, the sub-acute or long-term care environment and the outpatient setting.

(Patient Care, Medical Knowledge)


  1. Demonstrate a basic understanding of the roles of interdisciplinary rehabilitation team members and a basic ability to lead and coordinate their efforts.
    (Patient Care, Medical Knowledge, Systems-Based Practice)

  2. Demonstrate basic communication skills in communicating with patients, families, medical staff, team members, and other personnel.
    (Communication)

  3. Demonstrate a basic level of competency relative to decision-making in the physical medicine and rehabilitation management of adults and children with most of the following conditions: traumatic brain injury, stroke, spinal cord injury, amputations, hereditary, developmental and acquired neuromuscular and musculoskeletal conditions, acute and chronic pain syndromes, cardiovascular and pulmonary disorders, soft-tissue disorders including burns and ulcers.
    (Patient Care, Medical Knowledge)

  4. Demonstrate basic familiarity with journals that constitute the medical literature relevant to PM&R and in the basic components of research papers.
    (Practice Based Learning)

  5. Demonstrate basic familiarity with common cost containment issues in physical medicine and rehabilitation practice,
    (Systems-Based Practice)

Educational Goals - PGY-3 Resident



Upon completion of the third postgraduate year, a PM&R resident should:


  1. Demonstrate an advanced level competence in performing the comprehensive and physiatric physical examination and in the analysis of data from pertinent diagnostic tests to achieve an appropriate diagnosis.
    (Patient Care, Medical Knowledge)
  2. Demonstrate an advanced ability to formulate, implement and monitor appropriate PM&R treatment plans to achieve maximum physical, psychological, social, vocational, avocational, and educational outcomes for patients in the acute hospital setting, the acute rehabilitation unit or hospital, the sub-acute or long term care environment and the outpatient setting.

    (Patient Care, Medical Knowledge, Systems-Based Practice, Communication)


  3. Demonstrate advanced ability to lead and coordinate the efforts of an interdisciplinary rehabilitation team.
    (Systems-Based Practice, Professionalism, Communication)

  4. Demonstrate advanced communication skills to be an effective communicator with patients, families, medical staff, team members, and other personnel.
    (Interpersonal and Communication Skills)

  5. Demonstrate an advanced level of competency relative to decision-making in the physical medicine and rehabilitation management of adults and children with most of the following conditions: traumatic brain injury, stroke, spinal cord injury, amputations, hereditary, developmental and acquired neuromuscular and musculoskeletal conditions, acute and chronic pain syndromes, cardiovascular and pulmonary disorders, soft-tissue disorders including burns and ulcers.
    (Patient Care, Medical Knowledge)

  6. Demonstrate advanced technical skill in the performance of common PM&R procedures (and in the prevention and management of associated complications) including: Electrodiagnosis (electromyography and nerve conduction studies), joint and soft tissue injections.
    (Patient Care, Medical Knowledge)

  7. Demonstrate advanced knowledge of the biomedical research process and demonstrate advanced knowledge of the components of research papers and what journals constitute the medical literature relevant to PM&R.
    (Practice-Based Learning)

  8. Take an active role in common cost containment issues in physical medicine and rehabilitation practice when making choices in types of procedures and management.
    (Systems-Based Practice)

Educational Goals - PGY-4 Resident

Upon completion of the fourth postgraduate year, a PM&R resident should:

  1. Recognize Physical Medicine and Rehabilitation conditions, address the natural history, and anticipate nature of conditions when providing care.

    (Patient Care, Medical Knowledge)


  2. Demonstrate competence in performing comprehensive physical examination and analysis of pertinent data from diagnostic tests to achieve an appropriate diagnosis.
    (Patient Care, Medical Knowledge) (OSCE)

  3. Continue to demonstrate the ability to formulate, implement and monitor appropriate PM&R treatment plans to achieve maximum physical, psychological, social, vocational, avocational and educational outcomes for patients in the acute hospital setting, the acute rehabilitation unit or hospital, the sub-acute or long term care environment and the outpatient setting.
    (Patient Care, Medical Knowledge)

  4. Demonstrate ability to lead and coordinate the efforts of an interdisciplinary rehabilitation team with minimal supervision.
    (Systems-Based Practice, Communication)

  5. Demonstrate excellent communication skills to be an effective communicator with patients, families, medical staff, team members, and other personnel.
    (Communication)

  6. Continue to demonstrate a level of competency to be able to independently make decisions regarding appropriate physical medicine and rehabilitation management of adults and children with all of the following conditions: traumatic brain injury, stroke, spinal cord injury, amputations, hereditary, developmental and acquired neuromuscular and musculoskeletal conditions, acute and chronic pain syndromes, cardiovascular and pulmonary disorders, soft tissue disorders including burns and ulcers.
    (Patient Care, Medical Knowledge, Systems-Based Practice)

  7. Continue to demonstrate technical skill in the performance of common PM&R procedures and in the prevention and management of associated complications including: Electrodiagnosis (electromyography and nerve conduction studies), joint and soft tissue injections.
    (Patient Care, Medical Knowledge)
  8. Completion of research project.
    (Practice Based Learning)

  9. Demonstrate the ability to supervise and guide junior residents in PM&R activities.
    (Practice Based Learning)

UAMS Department of Physical Medicine and Rehabilitation
Faculty Roster




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