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Physical Medicine and Rehabilitation

Curriculum


PGY 2

Inpatient rotation Rehab Unit at AMCH

 

GOAL

The goal of this rotation is for PM&R residents to learn to care for hospital inpatients with functional impairments stemming from a wide variety of disease conditions including orthopedic fractures; multiple trauma; general deconditioning after prolonged hospitalization; status post organ transplants; and spinal disorders. The resident will become well versed and familiar in the role and function of each discipline as a unique entity in addition to each member’s role in the rehabilitation team.  The resident will develop and utilize the skills to organize and coordinate the team to optimize patient rehabilitation.  The resident will also learn to manage medical issues and understand how these issues may impact on a patient’s rehab potential.

 

The rehab team consists of the following members: 

  • Physicians – attending and resident
  • Nursing
  • Occupational therapy
  • Physical Therapy
  • Speech Language Pathology
  • Psychology
  • Social Work
  • Recreational Therapy

OBJECTIVES

Patient Care

 

PMR residents must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health in patients.   Residents are expected to:

 

  • Determine the appropriateness of patients for the inpatient rehab unit.
  • Perform appropriate physiatric history including psychosocial, educational, functional, vocational and recreational, and physical exam.
  • Develop knowledge about the diagnosis, pathogenesis, treatment, prevention and rehabilitation of those neuromuscular, cardiovascular, pulmonary and other system disorders common to the field of PMR in patients of both genders, and of all ages.
  • Develop skills in the evaluation and  management  of
    • generalized or focal weakness, 
    • balance or coordination deficits
    • mobility/ADL deficits
    • Sensory and/or motor deficits
    • Skin integument issues
    • Cognitive rehab
    • Use of prosthetic and/or orthotics
    • Swallowing dysfunction
    • Neurogenic bowel and bladder 
  • Prescription writing including exercise, modalities, precautions, adaptive equipment, prosthetics, orthotics.
  • Evaluation and management of above issues as they relate to the diagnoses of CVA, TBI, SCI, orthopedic trauma, total joint arthroplasty, inflammatory arthritis, cardiac and/or pulmonary dysfunction, PVD, cancer. 

Medical Knowledge

PMR residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices.  Residents are expected to: 

  • Demonstrate an investigatory and analytic thinking approach to clinical situations
  • Know and apply the basic and clinically supportive sciences which are appropriate to Physical medicine and rehabilitation.
  • Manage complex medical programs
  • Have knowledge of the principles of physiatry and be able to integrate into the practice of medicine. 

Practice Based Learning and Improvement

  • PMR residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.
  • Residents are expected to be able to utilize evidence based medicine and integrate it into the practice of physiatry.
  • Understand how to apply research and statistical methods.
  • Be able to appropriately use information technology. 

Interpersonal and Communication Skills

  • Communicate clearly and accurately to patients, families, faculty, residents  and other healthcare personnel.
  • Complete medical records, discharge summaries, in a timely and legible manner
  • Work effectively with others.
  • Facilitate education of students and other professionals. 

Professionalism

  • Maintains a professional demeanor.
  • Is reliable and punctual.
  • Is cooperative and promotes teamwork and mutual respect.
  • Establishes a therapeutic and ethically sound relationship with patients.
  • Demonstrates compassion, sensitivity to and respect for the dignity of patients, families and colleagues as persons regardless of age, culture, disability, ethnicity, gender or sexual orientation.
  • Respects patient confidentiality.

Systems-Based Practice

PMR residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.  Residents are expected to:

  • Understand how their patient care and other professional practices affect other health care professionals, the health care organization and the larger society and how these elements of the system affect their own practice.
  • Be able to evaluate the risk, benefit, limitations and cost of available resources.
  • Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources .
  • Advocate for quality patient care and assist patients in dealing with system complexities.
  • Know how to partner with health care managers and health care providers to assess, coordinate and improve health care and know how these activities can affect system performance. 

PGY3

Pediatrics - Outpatient and Consultation Practice

OBJECTIVES:

  • Perform appropriate history and physical examination.
  • Explore possible issues of hereditary disorders, congenital birth defects.
  • Explore prenatal, perinatal and early postnatal potential health issues as they may relate to the child
  • Learn to look for potential issues of abuse and reporting mechanisms. 

Develop competency in the evaluation and management of the pediatric patient.

  • Cerebral Palsy
  • Spinal cord injury
  • Muscular dystrophies
  • Spinal muscular atrophies
  • Congenital deformities
  • Spasticity
  • Mobility and ADL deficits
  • Down's Syndrome
  • Prosthetics and orthotics, wheelchair evaluations
  • Injury pediatric athlete

Develop the competencies to discuss with the parents or guardians implications of findings, diagnosis and potential management issues.

 

EMG Clinic at AMCH and VA Medical Center

OBJECTIVES:

Perform appropriate history and physical examination as an element of the electrodiagnostic consultation. Develop knowledge about common disorders seen in an EMG laboratory, including:

  • Neuropathy - acquired, hereditary, focal compression
  • Myopathies - acquired, hereditary
  • Radiculopathy
  • Plexopathy
  • Neuromuscular junction disorders.

Develop knowledge and skills in performing routine electrodiagnostic techniques.

  • Nerve conduction techniques
  • Needle EMG
  • Repetitive stimulation studies
  • F wave, H reflex and sacral reflex testing
  • Sphincter studies - urethral and anal.

Develop the knowledge to interpret EMG data and modify a study as data is obtained.

Develop the skills to convey the findings of a study and their diagnostic significance in a concise format.

 

Sunnyview/St. Peter's Nursing and Rehabilitation Center

The PGY3 resident will spend 4 weeks at Sunnyview and 2 weeks at St. Peter's Rehabilitation Center. 

GOALS:

  • Learn the difference in organization, staffing and patient care between acute and subacute rehabilitation facility.
  • Gain an introduction to inpatient pediatric rehabilitation.
  • Gain an introduction to brain injuries in children.
  • Gain an introduction to cognitive remediation.
  • Be able to manage behavioral problems in children and adults

OBJECTIVES:

  • Learn appropriate physiatric history, including the premorbid psychosocial, educational, functional, vocational, recreational components, in addition to accident history, acute and  post-acute hospitalization history.
  • Learn appropriate physiatric physical examination.
  • Develop knowledge about the diagnosis, pathogenesis, treatment and prevention of the disease for pediatric and adult populations.
  • Develop knowledge in assessing the impact of TBI on:
    • Generalized or focal weakness
    • Balance/coordination deficits
    • Cognitive deficits
    • Receptive and expressive dysfunctions
    • Swallowing dysfunction
    • Skin integrity issues
    • Spasticity and heterotopic bone function
    • Endocrine/hormonal dysfunction
    • Pain
    • Associated orthopedic  trauma
    • Rehab goals
  • Learn prescription writing to include exercise modalities, precautions, adaptive equipment, cognitive rehab, counseling, vocational and vocational rehab.
  • Evaluation and management of issues of spasticity.  Use of chemoneurolytic procedures, botulinum toxin injections, motor point blocks, tone reducing techniques including physical agents, modalities and orthoses.
  • Learn classification systems for traumatic brain injury in children and adults.
  • Learn predictors of outcome in traumatic brain injury in children and adults.

Outpatient Rotation at AMCH/Bone and Joint Center and VA Hospital

OBJECTIVES: (Pediatric & Adult Populations)

  • Perform appropriate physiatric history and physical examination in an outpatient milieu.
  • Develop knowledge about common disorders seen in an outpatient physiatry practice, including:
    • Neuromuscular disorders – acquired and congenital
    • Peripheral neuropathies – acquired and hereditary
    • Orthotics and prosthetics
    • Wheelchair evaluations
    • Chronic pain
    • Spasticity
    • Mobility and/or ADL deficits
    • Total joint arthroplasty
    • Myopathies
    • Injured worker
    • CNS dysfunction – CVA, TBI, SCI, MS, inherited and congenital disorders
  • Learn prescription writing to include exercise, modalities, precautions and goals as part of the management plan.
  • Learn the role of medication and the families of medications that may be used to manage various issues.
  • Learn the role of diagnostic studies such as MRI, EMG, X-RAY, ultrasound, etc.  in the evaluation of the outpatient.
  • Learn about the interplay of the medico-legal system in the care of the injured worker or MVA patient.

Prosthetics and Orthotics clinic - Albany Medical Center

OBJECTIVES:

  • Perform appropriate physiatric history, including psychosocial, educational, functional, vocational and recreational, and physical exam.
  • Develop knowledge about the diagnosis, pathogenesis, treatment and prevention of disease and injuries that relate to the field of prosthetics and orthotics, involving all ages regardless of gender.
  • Develop knowledge and skills in the evaluation of common gait deviations seen in below knee and above knee amputates.
  • Develop knowledge in prosthetic and orthotic components and their impact on lower and upper extremity function.
  • Develop knowledge of the functional capacity and limitations of prosthetic and orthotic devices.
  • Develop knowledge in prescription writing for lower extremity prostheses and orthoses, as well as upper extremity prostheses and orthoses.
  • Develop knowledge in the evaluation of prosthetic and orthotic devices for specific patients in term of fit, function and workmanship (i.e., prosthetic/orthotic checkout).

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