A call for improving of musculoskeletal education on physical medicine and rehabilitation studies: a systematic review with meta-analysis.

BACKGROUND: The incidence of musculoskeletal diseases is increasing in clinical practice, leading to a growing demand for rehabilitation medicine. However, education in musculoskeletal education is lacking in the training of physical medicine and rehabilitation students. This study aims to evaluate the impact of musculoskeletal education on medical students' learning of rehabilitation medicine and analyze the correlation between influencing factors and education. OBJECTIVES: The primary objective of this study is to evaluate the impact of musculoskeletal education on medical students' learning of rehabilitation medicine. Furthermore, the authors aim to analyze the correlation between various influencing factors and the effectiveness of this education, with the goal of informing future educational interventions and enhancing student outcomes. METHODS: A comprehensive search was conducted across the Pubmed, Ovid, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for relevant articles published from January 2012 to September 2024. The search focused on medical students as the research subjects and musculoskeletal education as the intervention method. Both randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were included. The selected studies underwent a systematic review, and meta-analysis was performed using R 3.4.4 software. RESULTS: After a thorough search, 41 studies were included. The retrospective study indicated that the most common impacts were knowledge acquisition, self-confidence, and satisfaction. The subsequent meta-analysis revealed significant increases in students' knowledge acquisition [standardized mean differences (SMD) = 2.15, 95% confidence interval [CI] (1.36, 2.94), I2 = 97%, random effect model] and self-confidence [SMD = 5.81, 95% CI (2.88, 8.75), I2 = 97%, random effect model]. Compared with the general teaching control group, the knowledge acquisition of students in the observation group improved [SMD = 0.25, 95% CI (0.00, 0.51), I2 = 83%, in the random effect model]; However, no significant difference in satisfaction occurred [SMD = 0.27, 95% CI (-0.47, 1.01), P > 0.05, I2 = 89%, in the random effects model]. CONCLUSION: Musculoskeletal education primarily impacts knowledge acquisition self-confidence, and satisfaction among physical medicine and rehabilitation students. The meta-analysis further establishes that musculoskeletal education significantly enhances knowledge acquisition and confidence in these students. TRIAL REGISTRATION: CRD42024563899 (completed on July 17, 2024).

Is Competency-Based Medical Education being implemented as intended? Early lessons learned from Physical Medicine and Rehabilitation.

Background: As competency-based medical education (CBME) curricula are introduced in residency programs across Canada, systematic evaluation efforts are needed to ensure fidelity of implementation. This study evaluated early outcomes of CBME implementation in one Canadian Physical Medicine and Rehabilitation program that was an early adopter of CBME, with an aim to inform continuous quality improvement initiatives and CBME implementation nationwide. Methods: Using Rapid Evaluation methodology, informed by the CBME Core Components Framework, the intended outcomes of CBME were compared to actual outcomes. Results: Results suggested that a culture of feedback and coaching already existed in this program prior to CBME implementation, yet faculty felt that CBME added a framework to support feedback. The small program size was valuable in fostering strong relationships and individualized learning. However, participants expressed concerns about CBME fostering a reductionist approach to the development of competence. Challenges existed with direct observation, clear expectations for off-service training experiences, and tracking trainee progress. There was trepidation surrounding national curricular change, yet the institution-wide approach to CBME implementation created shared experiences and a community of practice. Conclusions: Program evaluation can help understand gaps between planned versus enacted implementation of CBME, and foster adaptations to improve the fidelity of implementation.

Contexte: À mesure que les programmes d'approche par compétences (APC) en formation médicale sont introduits dans les programmes de résidence au Canada, des efforts d'évaluation systématiques sont nécessaires pour assurer la fidélité de la mise en œuvre. Cette étude a évalué les premiers résultats de la mise en œuvre de l'APC en formation médicale dans un programme canadien de médecine physique et réadaptation, qui a été un des premiers à adopter l'APC, dans le but d'orienter les initiatives d'amélioration continue de la qualité et de la mise en œuvre de l'APC à l'échelle nationale. Méthodes: En utilisant une méthodologie d'évaluation rapide, fondée sur le cadre des composantes de base de l'APC en formation médicale, les résultats escomptés de l'APC ont été comparés aux résultats réels. Résultats: Les résultats suggèrent qu'une culture de la rétroaction et de l'encadrement existait déjà dans ce programme avant la mise en œuvre de l'APC, mais le corps professoral a estimé que l'APC en formation médicale a ajouté un cadre pour soutenir cette rétroaction. La petite taille du programme a permis de favoriser des relations solides et un apprentissage individualisé. Cependant, les participants ont exprimé des inquiétudes quant au fait que l'APC favorise une approche réductionniste du développement des compétences. L'observation directe, les attentes claires en matière d'expériences de formation hors de l'environnement clinique et le suivi des progrès des résidents posent problème. Le changement de programme national a suscité des inquiétudes, mais l'approche institutionnelle de la mise en œuvre de l'APC a permis de partager des expériences et de créer une communauté de pratique. Conclusions: L'évaluation des programmes peut aider à comprendre les écarts entre la mise en œuvre planifiée et effective de l'APC en formation médicale, et de favoriser les adaptations pour améliorer le respect des conditions de mise en œuvre.

[WHAT IS "PHYSICAL MEDICINE" - THE FIELD OF PHYSICAL MEDICINE AND REHABILITATION IN ISRAEL?]

BACKGROUND: The field of Physical Medicine and Rehabilitation is as diverse and broad as any field in medicine. The two, seemingly different, fields developed separately and over time (as later presented) merged into one specialty. This resulted in an initial asymmetry of focus amongst training programs - and indeed countries. In Israel, although rehabilitation medicine is on par with the highest levels in the world, its partner, physical medicine (PM) has suffered to the extent that it is practically invisible in some of the training hospitals in our country. OBJECTIVES: We will define PM, explain why it is less developed in Israel, and present the methods being employed to rectify the training imbalance. METHODS: A systematic literature review was performed for prior descriptions and issues in PM in Israel. The search was conducted using four databases (PubMed, Google Scholar, ScienceDirect and the Cochrane Library). Searches were not limited by language or date, reflecting all available data. RESULTS: No articles were identified. This was anticipated as the field of PM is in the process of development in Israel. CONCLUSIONS: Whereas PM has been an official partner of rehabilitation medicine in Israel and prominently featured in academic syllabi, the reality has been otherwise. Our article delineates why this developed and the plans and methods on how it is changing, allowing Israel to be a world leader in all aspects of Physical Medicine and Rehabilitation.

Artificial Intelligence in Medical Education and Mentoring in Rehabilitation Medicine.

ABSTRACT: Artificial intelligence emerges as a transformative force, offering novel solutions to enhance medical education and mentorship in the specialty of physical medicine and rehabilitation. Artificial intelligence is a transformative technology that is being adopted in nearly every industry. In medicine, the use of artificial intelligence in medical education is growing. Artificial intelligence may also assist with some of the challenges of mentorship, including the limited availability of experienced mentors, and the logistical difficulties of time and geography are some constraints of traditional mentorship. In this commentary, we discuss various models of artificial intelligence in medical education and mentoring, including expert systems, conversational agents, and hybrid models. These models enable tailored guidance, broaden outreach within the physical medicine and rehabilitation community, and support continuous learning and development. Balancing artificial intelligence's technical advantages with the essential human elements while addressing ethical considerations, artificial intelligence integration into medical education and mentorship presents a paradigm shift toward a more accessible, responsive, and enriched experience in rehabilitation medicine.

Setting the European standards for training in Physical and Rehabilitation Medicine.

The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the "Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula" published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.

[The National Competency-Based Catalogue of Learning Objectives for Medicine 2.0 for the subject Physical and Rehabilitative Medicine, Naturopathic Medicine. Consensus of Scientific Medical Societies]. / Der Nationale Kompetenzbasierte Lernzielkatalog 2.0 für das Fach "Physikalische und Rehabilitative Medizin, Naturheilverfahren". Konsentierte Ergebnisse beteiligter Fachgesellschaften der AWMF.

BACKGROUND: The learning objectives in the current cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject "Physical and Rehabilitative Medicine, Naturopathic Medicine" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper. MATERIAL AND METHODS: The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For "PRM-NHV", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective. RESULTS: From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject "PRM-NHV" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform. CONCLUSIONS: In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject "PRM-NHV" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.

Shifting the Curve: Mastery Learning to Teach Nerve Conduction Studies in Physical Medicine and Rehabilitation Residency.

ABSTRACT: Nerve conduction studies are a commonly performed procedure and a core competency for physical medicine and rehabilitation residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across physical medicine and rehabilitation programs. The aims of this study are to standardize training and assessment of resident proficiency in nerve conduction studies skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 physical medicine and rehabilitation residents underwent a pretest, followed by a mastery learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at posttest. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. Thirty-three of 36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing nerve conduction studies. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a physical medicine and rehabilitation residency program and can shift the curve to allow residents to immediately start performing nerve conduction studies at the start of their clinical experience.

Geographic Proximity of Medical Students to PM&R Residency Programs Is Associated With Increased Match Rates Into PM&R.

ABSTRACT: Despite the growing popularity of physical medicine and rehabilitation as a specialty among medical students, meaningful experiences and mentorship can be challenging to obtain and may significantly vary depending on opportunities available to interact with physiatrists. This study explores the association between the geographic proximity of physical medicine and rehabilitation residency programs to medical schools and the match rate of medical students into physical medicine and rehabilitation from 2019 to 2021. Data on US medical schools, graduates, and physical medicine and rehabilitation residency programs were collected from publicly available sources, and a sample of 1193 physical medicine and rehabilitation residents from US medical schools was analyzed using a one-sample proportion test. The proportion of physical medicine and rehabilitation residents originating from medical schools with physical medicine and rehabilitation residency programs in the same metropolitan area was significantly greater than the corresponding proportion of expected residents based on medical school graduates, even when controlling for medical school affiliations with physical medicine and rehabilitation residency programs. These findings suggest that exposure and opportunities provided by physical medicine and rehabilitation residency programs may influence nearby medical students and that expanding residency programs into geographic regions without existing physical medicine and rehabilitation programs may foster interest and promote growth in the field of physiatry.

An evaluation of physical medicine and rehabilitation accredited sports medicine fellowship websites.

BACKGROUND: Due to the virtual format of fellowship applications, prospective physical medicine and rehabilitation (PM&R) sports medicine fellowship applicants commonly rely upon fellowship website content to make decisions about applications. Studies have shown that information available to fellowship applicants on program websites is inadequate, and there is no standard for important components of sports medicine fellowship websites. OBJECTIVE: To determine what sports medicine fellowship program features PM&R residents, fellows, and attending physicians consider the most important to be listed on fellowship websites, as well as to assess the scope of information available on fellowship websites. DESIGN: We developed a 30-item list of criteria that fell into categories of general information, fellowship education, recruitment, experience, and academic research. Survey participants were asked to rank the importance of those various items. We then assessed the 21 PM&R accredited sports medicine fellowship websites for the presence of these criteria. PARTICIPANTS: Ninety-six survey respondents composed of PM&R residents, current sports medicine fellows, and attendings. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Not applicable. RESULTS: Items ranked as most important were those in the categories of general information, fellowship experience, and fellowship recruitment. The most valued items were program location, program coordinator contact information, program length, specific requirements for applying, number of positions, types of procedures taught, and specific sites covered. Academic research items were ranked as least important. CONCLUSIONS: Survey respondents identified many fellowship website items as important factors when applying to programs. Many of these items were not listed on fellowship websites, suggesting that adding these criteria to fellowship sites might benefit applicants. Our findings can be used to develop standardized criteria for important components of sports medicine fellowship websites to improve the application and recruitment process.

Student-Led Workshop on Disability Advocacy.

ABSTRACT: Medical students can be powerful advocates for and in partnership with the disability community, yet opportunities for targeted advocacy training are sparse. In February 2023, a medical student-led workshop on disability advocacy for trainees took place at the Association of Academic Physiatrists' Annual Conference. The aims of this session were for trainees to (1) identify existing gaps in disability education at their institution and in policy around disability-related issues; (2) improve perceived ability to engage in disability-related education and policy-based advocacy; and (3) apply an intersectional lens to identify opportunities for intersectionality in disability advocacy. Presession and postsession responses were anonymously submitted via Qualtrics. Of 31 presurvey respondents, 18 responded to the postsurvey, and 12 were identified as having matching unique identifiers. After the workshop, participants overall were more likely to report being very/somewhat confident about their ability to identify gaps in disability education at their institution (75.0% vs. 100.0%, P = 0.011), policy around disability-related issues (41.7% vs. 100.0%, P < 0.006), and opportunities for intersectionality in disability advocacy (33.3% vs. 91.7%, P < 0.015). Participants were more likely to report being very/somewhat confident in engaging in education-based advocacy (58.3% vs. 100.0%, P = 0.006), policy-based advocacy (16.7% vs. 91.7%, P < 0.002), and intersectional disability advocacy (41.7% vs. 91.7%, P < 0.006). All attendees strongly/somewhat agreed with the statements "I hope that this session will continue in future years" and "I think that other trainees would benefit from a similar course." This session was shown to effectively meet the intended goals of the program.

Developing an Inclusive Training Environment: Accommodations in Physical Medicine and Rehabilitation Residency Training for Residents With a Disability.

ABSTRACT: This study examines the challenges and accommodations for medical residents with disabilities within physical medicine and rehabilitation training programs. Medical residency presents unique stressors and responsibilities, with the potential for added complexities for residents with disabilities. Few data exist regarding the prevalence and experiences of people with disabilities as medical trainees and the limited studies available highlight an underrepresentation of individuals with disability in medical training and practice. Through cross-sectional surveys administered to physical medicine and rehabilitation residents, this research assesses disability prevalence, characterizations, barriers to training, and accommodations provided. Of 140 respondents, 9.3% identified as having disabilities, with varying prevalence among genders and disability types. Results revealed distinct challenges for residents with mobility and nonmobility disabilities, spanning learning environments, standardized testing, procedural skills, and accessibility. Self-provided accommodations exceeded program-provided ones, indicating room for improvement in program support. These findings underscore the need for proactive dialog between residents and leadership to address barriers, enhance accommodations, and create an inclusive training environment. The study's insights emphasize the importance of advocating for equal opportunities and cultivating supportive conditions to enable individuals with disabilities to thrive in medical residency programs, ultimately contributing to more diverse and inclusive medical communities.

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.

Inadequacies in Undergraduate Musculoskeletal Education-A Survey of Nationally Accredited Allopathic Medical Programs in Canada.

OBJECTIVE: The aim of the study is to document the current state of musculoskeletal (MSK) medicine education across nationally accredited undergraduate medical programs. DESIGN: A cross-sectional survey design was used to gather curricular data on the following three musculoskeletal themes: (1) anatomy education, (2) preclinical education, and (3) clerkship education. RESULTS: The survey had a 100% response rate with all 14 English-language medical schools in Canada responding. The mean time spent teaching musculoskeletal anatomy was 29.8 hrs (SD ± 13.7, range = 12-60), with all but one program using some form of cadaveric-based instruction. Musculoskeletal preclinical curricula averaged 58.0 hrs (SD ± 53.4, range = 6-204), with didactic lectures, case-based learning, and small group tutorials being the most common modes of instruction. Curricular content varied greatly, with only 25% of "core or must-know" musculoskeletal topics being covered in detail by all programs. Musculoskeletal training in clerkship was required by only 50% of programs, most commonly being 2 wks in duration. CONCLUSIONS: Results document the large variability and curricular inadequacies that exist in musculoskeletal education across nationally accredited allopathic programs and highlight the need for the identification and implementation of more consistent musculoskeletal curricular content and educational standards by all nationally accredited medical programs.

Traditional Lecture Versus Procedural Video Randomized Trial: Comparative Analysis of Instructional Methods for Teaching Baclofen Pump Management.

OBJECTIVE: This study compared the effectiveness of traditional lectures and microvideos in teaching baclofen pump programming and refilling to physicians who have completed less than 10 refills for the previous 2 yrs. DESIGN: A mixed-method approach was used with 60 participating physicians specializing in physical medicine and rehabilitation or pain management. Preintervention and postintervention assessments were conducted using a rubric, and the participants' perceptions and preferences were gathered through focus group sessions. RESULTS: Two thirds of the participants specialized in physical medicine and rehabilitation. No significant differences in the preintervention, postintervention, or knowledge retention scores were found between the traditional lecture and microvideo groups. Both methods demonstrated comparable effectiveness in improving the baclofen pump refilling and programming skills. Qualitatively, participants perceived both approaches as equally helpful, but those in the microvideo group raised concerns because of instructors' unavailability and online platform navigation. Nevertheless, they preferred the convenience, accessibility, and time efficiency of the microvideos. CONCLUSIONS: The study concluded that microvideos are an effective alternative to traditional lectures for acquiring knowledge on baclofen pump programming and refilling. Further research should consider learners' characteristics and investigate the benefits of blended learning in medical education.

Current practice focus trends in physical medicine and rehabilitation.

BACKGROUND: Physical medicine and rehabilitation (PM&R) is a diverse specialty, growing and evolving over a variety of subspecialty and practice focus areas. Accurate data regarding practice patterns of physiatrists are essential for updating requirements in training and certification, particularly as the Accreditation Council for Graduate Medical Education begins its process to update of the PM&R core residency training requirements. This study analyzes practice trends for nearly 98% of physiatrists in active practice, the largest study to date. OBJECTIVE: To update current demographics of physicians specializing in PM&R, including current areas of practice focus, to analyze the alignment of practice focus with subspecialty certification, and to determine the extent that electromyography is a component of current physiatric practice. DESIGN: Retrospective analysis of deidentified responses from American Board of Physical Medicine and Rehabilitation (ABPMR) board-certified PM&R physicians (diplomates) on annual enrollment in the ABPMR Continuing Certification program. PARTICIPANTS: A total of 9543 ABPMR diplomates. MAIN OUTCOME MEASURES: Demographics - age, gender, years in practice, practice setting(s) and area(s). Practice focus, subspecialty certifications. RESULTS: The majority of practicing physiatrists are men (62%) although the percentage of women in the field is growing (38%). Nearly 80% of physiatrists report more than one practice focus area, with pain medicine and sports medicine/musculoskeletal practices most commonly reported. CONCLUSIONS: This study confirms the growth trends in PM&R in pain and sports medicine but also highlights the substantial number of physiatrists focusing their practices in areas related to neurorehabilitation and medical rehabilitation. The large majority of physiatrists incorporate multiple focus areas into their practices. Electromyography is a focus for a declining percentage of practicing physiatrists.