Association of Academic Physiatrists Residency and Fellowship Program Directors' Resident Recruitment Subcouncil Position Paper on Residency Recruitment.

ABSTRACT: Residency recruitment practices have undergone significant changes in the last several years. Interviews are now conducted fully virtually leading to both positive and negative downstream effects, including decreased cost to applicants and programs, decreased time away from clinical activities, flexibility in scheduling, and increased applications for applicants and program directors. In response to these changes, the Association of Academic Physiatrists Residency and Fellowship Program Directors Council convened a workgroup consisting of program directors, program coordinators, residents, and medical students who reviewed the available literature to provide an evidence-based set of best practices for program leaders and applicants. Available data from the Association of American Medical Colleges and its relevance to future recruitment cycles are also discussed.

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.

Longitudinal Ultrasound-Guided Injection Curriculum for Physical Medicine and Rehabilitation Residents.

ABSTRACT: Physiatrists are increasingly using musculoskeletal ultrasound for both diagnostic and therapeutic purposes. However, a standardized longitudinal curriculum for instructing physical medicine and rehabilitation residents in performing ultrasound-guided interventional procedures has yet to be established. The purpose of this study is to develop and assess the effectiveness of a longitudinal curriculum in training residents to perform common ultrasound-guided musculoskeletal injections using fresh-frozen cadaveric specimens. The course included six weekly hands-on educational sessions, divided by anatomical region, integrated into an established anatomy and physical examination curriculum. After completion of the curriculum, residents reported improved comfort and confidence and displayed improved competence in performing these injections. Other physiatry residency programs should consider implementing longitudinal, hands-on cadaveric training courses to better prepare trainees to perform ultrasound-guided injections as part of their future clinical practice.

Creating a Resident Research Track in Synergy With the Rehabilitation Medicine Scientist Training Program.

ABSTRACT: Physician scientists play an important role in the translation of research findings to patient care; however, their training faces numerous challenges. Residency research track programs represent an opportunity to facilitate the training of future physician scientists in physical medicine and rehabilitation, although optimal program organization and long-term outcomes remain unknown. The Rehabilitation Medicine Scientist Training Program is a National Institutes of Health-funded program aimed at addressing the shortage of physician researchers in the field of physical medicine and rehabilitation by providing instruction, mentorship, and networking opportunities for a successful research career. While the opportunities provided through the Rehabilitation Medicine Scientist Training Program provide critical education and guidance at a national level, trainees are most successful with availability of strong local support and mentorship. The purpose of this article was to present a realistic and easily applicable structure for a physical medicine and rehabilitation residency research track that can be used in concert with the Rehabilitation Medicine Scientist Training Program.

Improving the Assessment of Resident Competency: Physical Medicine and Rehabilitation Milestones 2.0.

ABSTRACT: In 2015, the Accreditation Council for Graduate Medical Education published the Physical Medicine and Rehabilitation Milestones 1.0 as part of the Next Accreditation System. This was the culmination of more than 20 yrs of work on the part of the Accreditation Council for Graduate Medical Education to improve graduate medical education competency assessments. The six core competencies were patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. While providing a good foundation for resident assessment, the Physical Medicine and Rehabilitation Milestones 1.0 was not without faults. With input from program directors, national organizations, and the public, the Physical Medicine and Rehabilitation Milestones 2.0 strives to further advance resident assessment, providing improvements through the integration of the harmonized Milestones and the addition of a supplemental guide.

Electrodiagnostic Evaluation of Individuals Implanted With Extracellular Matrix for the Treatment of Volumetric Muscle Injury: Case Series.

BACKGROUND: Electrodiagnosis can reveal the nerve and muscle changes following surgical placement of an extracellular matrix (ECM) bioscaffold for treatment of volumetric muscle loss (VML). OBJECTIVE: The purpose of this study was to characterize nerve conduction study (NCS) and electromyography (EMG) changes following ECM bioscaffold placement in individuals with VML. The ability of presurgical NCS and EMG to be used as a tool to help identify candidates who are likely to display improvements postsurgically also was explored. DESIGN: A longitudinal case series design was used. METHODS: The study was conducted at the McGowan Institute for Regenerative Medicine at the University of Pittsburgh. Eight individuals with a history of chronic VML participated. The intervention was surgical placement of an ECM bioscaffold at the site of VML. The strength of the affected region was measured using a handheld dynamometer, and electrophysiologic evaluation was conducted on the affected limb with standard method of NCS and EMG. All measurements were obtained the day before surgery and repeated 6 months after surgery. RESULTS: Seven of the 8 participants had a preoperative electrodiagnosis of incomplete mononeuropathy within the site of VML. After ECM treatment, 5 of the 8 participants showed improvements in NCS amplitude or needle EMG parameters. The presence of electrical activity within the scaffold remodeling site was concomitant with clinical improvement in muscle strength. LIMITATIONS: This study had a small sample size, and participants served as their own controls. The electromyographers and physical therapists performing the evaluation were not blinded. CONCLUSIONS: Electrodiagnostic data provide objective evidence of physiological improvements in muscle function following ECM placement at sites of VML. Future studies are warranted to further investigate the potential of needle EMG as a predictor of successful outcomes following ECM treatment for VML.

The Rehabilitation Medicine Scientist Training Program: impact and lessons learned.

Physician scientists are seen as important in healthcare research. However, the number of physician scientists and their success in obtaining National Institutes of Health funding have been declining for many years. The shortage of physician scientists in Physical Medicine and Rehabilitation is particularly severe and can be attributed to many of the same factors that affect physician scientists in general, as well as to the lack of well-developed models for research training. In 1995, the Rehabilitation Medicine Scientist Training Program was funded by a K12 grant from the National Center for Medical Rehabilitation Research, as one strategy for increasing the number of research-productive physiatrists. The Rehabilitation Medicine Scientist Training Program's structure was revised in 2001 to improve the level of preparation of incoming trainees and to provide a stronger central mentorship support network. We describe the original and revised structure of the Rehabilitation Medicine Scientist Training Program and review subjective and objective data on the productivity of the trainees who have completed the program. These data suggest that Rehabilitation Medicine Scientist Training Program trainees are, in general, successful in obtaining and maintaining academic faculty positions and that the productivity of the cohort trained after the revision, in particular, shows impressive growth after about 3 yrs of training.

Acute inpatient rehabilitation of 55 patients after liver transplantation.

OBJECTIVE: Acute rehabilitation for patients who have had liver transplants is often necessary to restore functional mobility, but no studies, except for case reports, have documented the complications, outcomes, or predictors of success of an acute inpatient rehabilitation program. Our objective was to examine each of these areas related to rehabilitation after liver transplantation. DESIGN: We performed a chart review of 55 patients who received a liver transplant and were treated on our acute rehabilitation service. We examined several factors, including age, reason for transplant, length of acute hospital stay, length of acute inpatient rehabilitation stay, FIMtrade mark scores, albumin levels, medical complications, and discharge disposition. RESULTS: Patients undergoing rehabilitation after liver transplantation required multiple medical interventions, including liver biopsy, ultrasound, blood transfusions, and dialysis. Several patients (15%) were transferred to the acute care hospital for medical problems. Both a low albumin and a long length of stay in the acute care hospital correlated with a longer stay in rehabilitation and less efficient rehabilitation. Longer rehabilitation stays correlated positively with FIM gain (P < 0.001, r = 0.534). Significant improvements in FIM scores (P < 0.001) during acute inpatient rehabilitation were noted in patients who were discharged to home. We also found that age, albumin level, and length of stay in the hospital did not predict discharge disposition. CONCLUSION: Patients who have had liver transplants can achieve significant functional gains in acute rehabilitation. Rehabilitation professionals should be aware of potential complications and factors that may affect the rehabilitation of this patient population.

Autonomic dysreflexia: incidence in persons with neurologically complete and incomplete tetraplegia.

BACKGROUND: Autonomic dysreflexia (AD) is a common problem in patients with spinal cord injury (SCI) above the T6 neurologic level and may cause serious medical complications if untreated. Previous studies have focused on patients with complete SCI. DESIGN: Prospective analysis of a historic cohort. A retrospective review of a subset of the cohort also was performed. OBJECTIVES: To examine the percentage of persons with complete and incomplete tetraplegia who developed AD and determine whether patients with incomplete injuries were at risk for developing AD; and to study the onset of AD and determine the time period that patients are at risk for developing AD. METHODS: Data were collected prospectively on 332 patients with tetraplegia to determine American Spinal Injury Association (ASIA) impairment score, neurologic level, presence of AD, and length of hospital stay. The charts of 34 patients who developed AD were then reviewed retrospectively for further data such as onset and contributing factors of AD. Also obtained were data from the National SCI Statistical Center database for comparison of percentage of patients with complete and incomplete injuries who developed AD. RESULTS: Patients with motor-complete SCI (ASIA A or ASIA B) had a higher percentage of AD (P = 0.001) during their initial hospitalization than did patients with motor-incomplete SCI. However, patients with motor-incomplete injuries also were at risk for developing AD. The onset of AD occurred between 1 and 6 months after injury. CONCLUSION: Patients with incomplete tetraplegia are at risk for developing AD. As hospital lengths of stay decrease, patients may be discharged before onset of symptoms. Patient and family education about AD is, therefore, increasingly important for all patients with tetraplegia.