Factors Influencing Physical Medicine and Rehabilitation Trainee Research Engagement.

ABSTRACT: Research engagement during physical medicine and rehabilitation residency and fellowship training is essential for advancing evidence-based medicine and fostering the development of clinician-scientists. Current Accreditation Council for Graduate Medical Education guidelines regarding research requirements during physical medicine and rehabilitation training are ambiguous, and it is unknown whether physical medicine and rehabilitation trainees receive adequate support to pursue research at the level they desire. This anonymous survey study aimed to identify perceived barriers and facilitators to research engagement among US physical medicine and rehabilitation residents and fellows. Our findings suggest that physical medicine and rehabilitation trainees value research engagement. However, research productivity during physical medicine and rehabilitation residency is limited, with many trainees reporting inadequate support and time to participate in research in a meaningful way. Additional support from residency and fellowship programs, including protected time for research, as well as research-specific education and mentorship should be considered to enhance physical medicine and rehabilitation trainee research engagement.

Infusing intellectual and Developmental disability training into Medical School curriculum: a Pilot intervention.

PURPOSE: Despite the rising prevalence of developmental disabilities (DD) in the US, there remains insufficient training for healthcare professionals to care for this medically underserved population - particularly adults. The National Inclusive Curriculum for Health Education (NICHE) aims to improve attitudes and knowledge towards people with intellectual and developmental disabilities (PWIDD); herein we describe one such intervention. METHOD: The intervention integrated didactic, panel presentation and clinical skills components into a 2nd year medical school curriculum.  The didactic session, covering  health and assessment of PWIDDs, history of IDD, stigma, etc., was co-taught by a developmental pediatrician, family medicine physician and social worker.  A panel of 3 adult self-advocates (SAs) with DD and a parent of a child with DD spoke about their lived experiences.  One week later, students practiced taking clinical histories of SAs within small group settings with adult PWIDDs, facilitated by medical school faculty. Students completed the NICHE Knowledge(49 items) and Attitudes (60 items) surveys. The evaluation analyzed pre/post intervention differences in a) knowledge and attitude scores overall and b) by student age, gender, intended medical specialty, and prior experiences with PWIDDs. Open-ended comments were analyzed with content analysis. RESULTS: Overall Knowledge scores increased from pre-to posttest (n = 85; 65[19] vs. 73[17], p = 0.00), while Attitudes score improved (i.e., decreased) (n = 88; 0.55 [.06] vs. 0.53 [0.06]); p = 0.00).  Higher pretest knowledge was found among female identified students (vs. others; p = 0.01) and those knowing > = 5 PWIDD (vs < 5; p = 0.02).  Students characterize their IDD training and experience prior to intervention as 'lacking' and described the sessions as effective. CONCLUSIONS: A brief (4 hours total) intervention was associated with modest but significant improved knowledge and attitudes towards PWIDDs. Replication and sustainability of this and other NICHE interventions are needed to fill gaps in PWIDDs' health care.

Caregivers evaluate independence in individuals with Down syndrome.

Independence is both a sense of autonomy and self-reliance coupled with the skills to complete tasks without assistance. Questionnaire of caregivers of individuals with Down syndrome asked about factors related to independence on six topics: safety, communication, self-care, daily living, social/leisure, and vocational/employment. Responses from 408 caregivers to an independence questionnaire were received, and summarized using means and frequencies. Top goals by topic were safety from sexual abuse, communicating wants and needs, toileting independently, living independently/semi-independently, engaging in leisure time appropriately, and reading and writing. Independence is a complex, multifactorial phenomenon which varies among individuals with DS.

Opportunities, barriers, and recommendations in down syndrome research.

BACKGROUND: Recent advances in medical care have increased life expectancy and improved the quality of life for people with Down syndrome (DS). These advances are the result of both pre-clinical and clinical research but much about DS is still poorly understood. In 2020, the NIH announced their plan to update their DS research plan and requested input from the scientific and advocacy community. OBJECTIVE: The National Down Syndrome Society (NDSS) and the LuMind IDSC Foundation worked together with scientific and medical experts to develop recommendations for the NIH research plan. METHODS: NDSS and LuMind IDSC assembled over 50 experts across multiple disciplines and organized them in eleven working groups focused on specific issues for people with DS. RESULTS: This review article summarizes the research gaps and recommendations that have the potential to improve the health and quality of life for people with DS within the next decade. CONCLUSIONS: This review highlights many of the scientific gaps that exist in DS research. Based on these gaps, a multidisciplinary group of DS experts has made recommendations to advance DS research. This paper may also aid policymakers and the DS community to build a comprehensive national DS research strategy.

COVID-19 pandemic: Early effects on pediatric rehabilitation medicine training.

PURPOSE: The COVID-19 pandemic hastened the need for graduate medical education (GME) innovation, resulting in the creation of multiple pediatric rehabilitation medicine (PRM) e-learning initiatives. There has been a paucity of data regarding trainee perceptions regarding quickly developed new methods of learning during the pandemic. This study explored PRM trainee perceptions of e-learning and effects of the pandemic on education. METHODS: Questionnaire study with data collected via REDCap. RESULTS: Greater than half of PRM trainees (56.6%, 30/53) responded. Most respondents reported that the virtual lectures series (79.3%), journal club (78.9%), and virtual arts initiatives (75.0%) were valuable to their education. Common benefits noted included access to subject experts, networking, lecture recording, and location flexibility. Common concerns included lack of protected time, virtual platform fatigue, and decreased engagement. Most respondents were not redeployed. Relative to before the pandemic, less satisfaction with clinical education (70.0%) and greater satisfaction with non-clinical education (60.0%) was reported. The majority of graduating trainees felt positively (83.3%) and 16.7% were neutral regarding confidence to graduate. CONCLUSION: Trainees perceived national e-learning as valuable to their education, especially due to the access to expert leaders around the nation. Future work should explore ways to overcome barriers and optimize benefits of GME and PRM e-learning.

Integrated Case Management: Does It Reduce Health Service Disparities Across African American and White Medicaid Beneficiaries?

Evidence of persistent racial and ethnic disparities in health service use is substantial. Even among Medicaid beneficiaries, minority individuals may have lower use of specific health services relative to Whites due to varying degrees of trust in the health system, beliefs about the usefulness of medical treatment, provider stereotyping, or geographic service availability. Prior research demonstrated that a Florida Medicaid disease management program led to reductions in service disparities between Whites and African Americans. We study a Medicaid Integrated Case Management program implemented in Virginia, which shares disease management program objectives but can be applied to a broader range of patients. Two versions of the program are assessed, the latter of which incorporated more patient-focused and targeted approaches in identifying client needs and structuring patient interaction. Both versions of the program were associated with reductions in disparities, especially for physician services and when more targeted, patient-centered approaches were adopted.

The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees.

BACKGROUND: Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seek tools to effectively manage enrollees and improve access to quality care while containing costs. OBJECTIVES: The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care plan on health service use and spending for nonelderly, nonpregnant adults. RESEARCH DESIGN: We estimate the relationship between intensity of ICM program involvement and changes in utilization and spending for patients who participated in ICM. We examine whether effects differ between high-risk and lower-risk individuals and between the early and late stages of the program, given that the latter relied on more targeted and patient-centered approaches. Specifically, we estimate linear regressions modeling changes in utilization and spending outcomes as a function of number of program contacts, conditional on number of days over which contacts occurred, as well as individual-level covariates and case manager fixed effects. RESULTS: In the late ICM program period, we observe significant decreases in outpatient utilization associated with program involvement intensity among high-risk ICM participants. We also observe decreases in spending associated with program involvement intensity among the lower-risk group in the late period, although there is no significant impact on spending among high-risk enrollees. CONCLUSIONS: ICM can be a successful strategy for impacting health services use and spending. Our findings suggest that careful program targeting, well-structured client engagement, and direct one-on-one contact are vitally important for achieving program objectives.

Colitis after polytrauma: case report.

Across the medical literature, delayed diagnosis and treatment leads to more costly and worse outcomes. Rehabilitation patients, especially those with polytrauma, often have a complex mixture of medical, social, and psychological health problems that can impair effective diagnosis and treatment. The case presentation describes the procession toward the diagnosis of ulcerative colitis in a preinjury asymptomatic male, suggesting a potential mechanism for its emergence and describing the effect of delayed diagnosis on the efficiency of rehabilitative care. As such, the differential diagnosis for early posttraumatic diarrhea should remain broad, particularly if unexplained or ineffectively controlled.

HealthyME HealthyU(©2010UCPGB): a collaborative project to enhance access to health information and services for individuals with disabilities.

In response to the limited information about health information and training needs among persons with disabilities, a collaborative group of Alabama researchers, educators, and clinicians was formed to implement a statewide needs assessment with support provided by the Alabama Council for Developmental Disabilities and the National Network of Libraries of Medicine. Educational and assessment activities were guided by the Systems Model of Clinical Preventive Care and Health Information National Trends Survey (HINTS) methodology. Four constructs from the 2007 HINTS Annotated Version were identified as relevant to the concepts of local interest. Results of printed and online surveys administered to 251 family and other caregivers, 87 individuals with disabilities, 110 clinical service providers, and 570 health professions students revealed outstanding health communication needs to improve access to reliable consumer information and clinical services. HealthyME HealthyU(©2010UCPGB) developed new educational materials that address issues identified from the needs assessment, specifically (a) accessibility of health care facilities; (b) patient-provider communication; (c) personal health management by consumers and families/caregivers; and (d) sources of trustworthy electronic health information. Six brief digital video training modules were developed for consumers, families, and professionals featuring as speakers health care providers, health professions students, and individuals with cognitive disabilities. Following field testing, video modules were revised and then widely distributed to consumers, family caregivers, and service providers. Preliminary evaluation indicates content is relevant and comprehensible to individuals with disabilities.