Group peer mentoring to improve faculty connections and enhance mentoring networks.

BACKGROUND: Difficulty finding mentors and forging connections in academic departments can be challenging and became even more so when the COVID-19 pandemic reduced opportunities for informal networking. Even as restrictions on in-person meetings eased, many faculty preferred meetings to remain virtual. Because some of the most powerful predictors of faculty vitality are positive professional relationships and feelings of inclusion and belonging to an institution, attending to faculty needs in this area is important to mitigate undesired lingering consequences. APPROACH: We created structured peer mentoring groups for our department's physicians and psychologists that meet virtually. Groups span career stages, academic appointments and clinical interests. The purpose was to establish a deeper culture of mentoring, increase feelings of connection to a supportive community within the department, facilitate career planning and enhance the development of skills necessary in academic medicine such as teaching skills, scholarly productivity and personal wellness. EVALUATION: A survey conducted after the first year of the programme was completed by 70% of eligible faculty (31/45). Ninety-six percent felt the programme had created an inclusive and appreciative culture, 86% met faculty members they had never met before and 79% sought mentoring advice from a colleague they would not usually have interacted with in that manner. All participants appreciated hearing their colleagues' perspectives on topics they do not typically discuss. IMPLICATIONS: Departmentally based group peer mentoring that spans career stages and interests can facilitate faculty connections and enhance a supportive culture of mentorship.

"Hot Seat" Simulation to Teach Conflict Management Skills to Residents.

BACKGROUND: Conflict management is an important leadership skill for residents to develop, yet it is a challenging skill to practice. OBJECTIVE: We developed and evaluated a workshop that teaches conflict resolution skills to physical medicine and rehabilitation residents in a group setting with real-time faculty coaching and peer feedback. METHODS: A 4-step model for handling work-related conflicts was taught, and then residents practiced their skills during a realistic simulated conflict with a trained actor. A faculty coach supported the participant, and peers gave feedback and suggestions in real time as the scripted conflict unfolded. Immediate post-session survey results were analyzed. RESULTS: Workshops were conducted in 2015, 2017, and 2019. A total of 36 residents participated and completed evaluations out of a possible 40 residents in the cohort (90% participation rate). Post-session surveys showed that 100% of participants agreed the session content was relevant to their training and they would use the skills in the future. Ninety-seven percent (35 of 36) felt prepared to manage conflict following the session. CONCLUSIONS: This experiential workshop helped cultivate an appreciation of the importance of conflict management skills in residents' professional development and confidence in their ability to apply a conflict management framework to real-world situations.

Electrodiagnosis in the Patient with Metabolic Syndrome: Adding Value to Patient Care.

Patients with metabolic syndrome are at increased risk of peripheral neuropathy; entrapment neuropathies, such as carpal tunnel syndrome; and spine disease that can lead to radiculopathy or spinal stenosis. Electrodiagnostic studies are a valuable part of patient care in this population. They can confirm suspected diagnoses, uncover additional conditions, and lead to the diagnosis of other causes of neuropathy that require treatment. By assessing the severity of neuropathy, patients at high risk for falls, functional decline, and foot ulcers are identified to guide prevention, treatment, and patient education.

New challenges for the graduate medical educator: implementing the milestones.

Physical medicine and rehabilitation residency programs will face new challenges as they implement the Milestones and establish a Clinical Competency Committee, new requirements in the Accreditation Council of Graduate Medical Education's Next Accreditation System. The milestones require programs to measure the capabilities of individual residents, and programs will be expected to show how residents progress to successively higher levels of behavior during the course of the residency. Program directors will be assisted by a committee of faculty whose role is to assess each individual resident's attainment of milestones and assist in the early identification of residents not making the expected progress. Programs will need to evaluate their assessment programs and will need to create a coherent mix of instruments to evaluate all of the milestones. Because the milestones are based on observable behaviors, a key component of this system will be direct observation by faculty of residents during patient care. However, many faculty are not trained in this skill. Faculty development in observational skills, workplace-based assessment skills, and providing formative feedback will be a very important aspect if the milestones are to be successfully used to help residents make developmental progress in their clinical competence.

Review of upper and lower extremity musculoskeletal pain problems.

This article reviews common causes of upper and lower extremity pain problems, including bone pain, osteoarthritis, tendinopathy, and muscle pain problems. These common conditions affect many areas of the body; knowledge of their diagnosis and treatment guides the rehabilitation of many patients who have musculoskeletal complaints.

Lumbar stabilization: a review of core concepts and current literature, part 2.

Lumbar-stabilization exercise programs have become increasingly popular as a treatment for low-back pain. In this article, we outline an evidence-based medicine approach to evaluating patients for a lumbar-stabilization program. We also discuss typical clinical components of this type of program and the rationale for including these particular features based on the medical literature.

Evidence-based treatment of foot and ankle injuries in runners.

Foot and ankle injuries are common in runners. Treatment is becoming more evidence-based for the most common of these conditions; however, further research is needed to determine the best treatments for injuries that are encountered less commonly.

Lumbar stabilization: core concepts and current literature, Part 1.

The factors that affect lumbar stability have been an area of extensive research. The clinical application of this research in the form of lumbar stabilization exercise programs has become a common treatment of low back pain and is also increasingly used by athletes to improve performance and by the general public for health and the prevention of injury. This article includes a review of the key concepts behind lumbar stabilization. The literature regarding how those with low back pain differ in their ability to stabilize the spine from those without low back pain is discussed, and an overview of current research that assesses the benefits of a lumbar stabilization program to treat low back pain is provided.

Whiplash: pathophysiology, diagnosis, treatment, and prognosis.

We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.

Rotator cuff disease.

Rotator cuff disease is a complex condition. It includes a variety of pathologies, ranging from tendinosis to complete tear. The cause seems to be multifactorial and is most likely a combination of major trauma, microtrauma from daily wear and tear, and age related degeneration. When establishing a program for the patient with rotator cuff dysfunction, the rehabilitation specialist should consider biomechanical factors, the patient's functional goals, and issues beyond the shoulder that may affect the course of the disease.