Guidelines for neuromuscular ultrasound training.

Neuromuscular ultrasound has become an essential tool in the diagnostic evaluation of various neuromuscular disorders, and, as such, there is growing interest in neuromuscular ultrasound training. Effective training is critical in mastering this modality. Our aim was to develop consensus-based guidelines for neuromuscular ultrasound training courses. A total of 18 experts participated. Expert opinion was sought through the Delphi method using 4 consecutive electronic surveys. A high degree of consensus was achieved with regard to the general structure of neuromuscular ultrasound training; the categorization of training into basic, intermediate, and advanced levels; the learning objectives; and the curriculum for each level. In this study, a group of neuromuscular ultrasound experts established consensus-based guidelines for neuromuscular ultrasound training. These guidelines can be used in the development of the specialty and the standardization of neuromuscular ultrasound training courses and workshops.

Relationship Between Using Clinical Practice Guidelines for Pain Treatment and Physicians' Training and Attitudes Toward Patients and the Effects on Patient Care.

AIMS: To determine the use of clinical practice guidelines (CPGs) for chronic pain (CP) management; analyze the effects of training in pain and the attitudes of physicians toward pain and CP patients on the adherence to these CPGs; and assess the impact of adherence to CPGs on patient care. METHOD: This was a cross-sectional study in a sample of physicians involved in CP patient management. Information on the use of CPGs for CP management, their training in pain, and their attitudes toward pain, patients, and patient care was collected. Descriptive and bivariate analyses were performed, and a multinomial logistic regression model was constructed to analyze factors associated with the use of CPGs. RESULTS: Of the 257 physicians surveyed, 46.6% were physiatrists, 26.7% were general practitioners, and 26.7% were medical oncologists. Although 96.5% claimed to have received training in pain, only 10.1% had received college training, and 76.3% expressed having gaps in their knowledge; 53.9% stated they applied CPGs often/always, and 12.5% rarely/never. Limited knowledge on pain, reduced involvement in training activities, more negative attitudes toward patients, and having experienced CP were the factors related to reduced adherence to CPGs, especially among the youngest respondents. The greater the use of CPGs, the better the patient care was. CONCLUSIONS: Access to scientific information and specialized training are factors related to the use of CPGs for pain treatment. Therefore, the inclusion of CP training in university and during medical specialty training will be essential measures to improve adherence to CPG, thereby improving patient care and pain control.

Interventional Pain Procedures in Physical Medicine and Rehabilitation Residencies.

Exposure to interventional pain procedures is now a required component of training in physical medicine and rehabilitation residencies as mandated by the Accreditation Council for Graduate Medical Education. Data regarding resident exposure and competency in these procedures remain limited. Objectives were to determine the volume and type of exposure physical medicine and rehabilitation residents have to interventional pain procedures and to obtain faculty-perceived opinions regarding competency of incoming fellows as it pertains to interventional pain management. Online surveys were sent to program directors of physical medicine and rehabilitation residencies and fellowship directors of interventional spine, sports medicine, and pain medicine fellowships. Surveys inquired about educational methods, the volume of procedures in which residents actively participate, and faculty-perceived competency of trainees performing procedures. Thirty-nine residency programs and 27 fellowships responded to the surveys. Of the 39 residencies that responded, there was great variation in the exposure residents receive. Most programs reported that residents have moderate exposure to common procedures such as ultrasound-guided knee injections and lumbar epidural injections. In addition, while most residency program directors report graduates to be "fairly prepared" (33%) to "well prepared" (20.5%) with regard to spine procedures, most fellowship directors (63%) describe incoming fellows to be at the "beginner" level.

Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003 to 2015.

BACKGROUND: Pediatric rehabilitation medicine (PRM) physicians enter the field via several pathways. It is unknown whether different training pathways impact performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of Certification (MOC) Examination. OBJECTIVES: To describe the examination performance of candidates on the ABPMR PRM Examination according to their type of training (physiatrists with a clinical PRM focus, accredited or unaccredited fellowship training, separate pediatric and physical medicine and rehabilitation residencies, or combined pediatrics/physical medicine and rehabilitation residencies) and to compare candidates' performance on the PRM Examination with their initial ABPMR certification and MOC Examinations. DESIGN: A retrospective cohort study. SETTING: American Board of Physical Medicine and Rehabilitation office. PARTICIPANTS: A total of 250 candidates taking the PRM subspecialty certification examination from 2003 to 2015. METHODS: Scaled scores on the PRM Examination were compared to the examinees' initial certification scores as well as their admissibility criteria. Pass rates and scaled scores also were compared for those taking their initial PRM certification versus MOC. MAIN OUTCOME MEASUREMENTS: Board pass rates and mean scaled scores for initial PRM Examination and MOC. RESULTS: The 250 physiatrists who took the subspecialty PRM Examination had an overall first-time pass rate of 89%. There was no significant difference between first-time PRM pass rates or mean scaled scores for individuals who completed an Accreditation Council for Graduate Medical Education-accredited fellowship versus those who did not. First time PRM pass rates were greatest among those who were also certified by the American Board of Pediatrics (100%). Performance on Parts I and II of the initial ABPMR Certification Examination significantly predicted PRM Examination scores. There was no difference in mean scaled scores for initial PRM certification versus taking the PRM Examination for MOC. CONCLUSIONS: Several pathways to admissibility to the PRM Examination afforded similar opportunity for diplomates to gain the knowledge necessary to pass the PRM Examination. Once certified, physicians taking the PRM Examination for MOC have a high success rate of passing again in years 7-10 of their certification cycle. LEVEL OF EVIDENCE: III.

Time for food - training physiatrists in nutritional prescription.

INTRODUCTION: Sub-optimal nutrition is a leading factor in all-cause mortality, the preponderance of non-communicable chronic diseases, and various health conditions that are treated by physiatrists, such as stroke and musculoske-letal disorders. Furthermore, patients with chronic pain have a high prevalence of nutritional deficiencies, and malnutrition has been associated with limited rehabilitation outcomes in elderly patients with hospital-associated deconditioning. Thus, physiatrists may find it valuable to include nutrition in their patient services. However, discussion of nutritional counselling in the physiatry literature is rare. OBJECTIVE: To inform physiatrists about including nutritional counselling as part of the treatment they provide. METHODS: The paper reviews recommended communication skills, behavioural change strategies, and opportunities for inter-professional collaboration. Further resources to educate physiatrists both in nutritional prescription and in improving their own personal health behaviours are provided. CONCLUSION: Training physiatrists to address nutrition is a step-wise process, described here.