Percepción de residentes de Medicina Física y Rehabilitación del Perú sobre su residencia médica durante la pandemia por COVID-19 / Peruvian Physical Medicine and Rehabilitation residents’ perception about their medical residency during the COVID-19 pandemic

Introducción y objetivos: La pandemia por COVID-19 ha afectado los programas de residencia médica (RM) a nivel mundial. Sin embargo, pocos reportes se han centrado en la RM de Medicina Física y Rehabilitación (MFyR). Por ello, nuestro objetivo fue describir las percepciones de los residentes de MFyR del Perú sobre su RM durante la pandemia por COVID-19. Materiales y métodos: Estudio trasversal. Durante junio de 2021, se buscó abordar a todos los residentes de MFyR del Perú, usando una encuesta virtual, anónima y voluntaria de 13 preguntas elaborada en Google Forms, que evaluó la percepción que tenían sobre la RM. Resultados: De 142 residentes de MFyR del Perú, 60 (42,3%) respondieron la encuesta. Entre estos, 21,7% consideró que su sede de residencia médica (SRM) cumplía poco o nada con los requisitos mínimos para serlo, 50% que su SRM se preocupó poco o nada por él/ella desde iniciada la pandemia por COVID-19, 35% que los médicos asistentes de su SRM se preocuparon poco o nada por lo académico, y 71,7% que la falta de médicos subespecialistas de MFyR afecta mucho a su formación. Además, 71,7% y 81,7% refirieron haber aprendido poco o nada de ecografía musculoesquelética y de estudios electrodiagnósticos, respectivamente. Finalmente, 18,3% refirieron arrepentirse de haber elegido la especialidad. Conclusiones: Encontramos una importante percepción negativa sobre la RM y una baja autopercepción de haber aprendido sobre ecografía musculoesquelética y estudios electrodiagnósticos. Resulta importante profundizar en las causas y buscar alternativas para mejorar la formación de los residentes de MFyR MFyR en el Perú.(AU)

Introduction and objectives: The COVID-19 pandemic has affected medical residency (MR) programs worldwide. However, few reports have focused on the MR of Physical Medicine and Rehabilitation (PM&R). Therefore, our objective was to describe the perceptions of PM&R residents in Peru about their MR during the COVID-19 pandemic. Materials and methods: Cross-sectional study. During June 2021, we sought to address all PM&R residents in Peru, using a virtual, anonymous and voluntary survey of 13 questions elaborated in Google Forms, which addressed their perception of RM. Results: Of 142 PM&R residents in Peru, 60 (42.3%) responded to the survey. Among these, 21.7% considered that their residency training site (RTS) met little or nothing with the minimum requirements to be one, 50% that their RTS cared little or notthing for him/her since the start of the COVID-19 pandemic, 35% that the physicians attending their RTS cared little or nothing about academics, and 71.7% that the lack of subspecialist physicians in PM&R greatly affects their training. In addition, 71.7% and 81.7% reported having learned little or nothing about musculoskeletal ultrasound and electrodiagnostic studies, respectively. Finally, 18.3% reported regretting to have chosen the specialty. Conclusions: We found an important negative perception about MR and a low self-perception of having learned about musculoskeletal ultrasound and electrodiagnostic studies. It is important to delve into the causes and look for alternatives to improve the training of PM&R residents.(AU)

Development and Implementation of an International Virtual Didactic Series for Physical Medicine and Rehabilitation Graduate Medical Education During COVID-19.

ABSTRACT: Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education.Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation.Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries.The Association of Academic Physiatrists-led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures.

Perceived Benefits of a Cadaver-Based Ultrasound Procedure Workshop for Physical Medicine and Rehabilitation Trainees.

ABSTRACT: Ultrasound-guided musculoskeletal and spasticity injections have become common procedures in physical medicine and rehabilitation practices, but there are currently no guidelines for teaching these procedures in residency and fellowship training programs. As part of a quality improvement initiative, the authors aimed to assess the educational value of a hands-on cadaver-based workshop for enhancing these skills in residents and fellows. Twenty-seven physical medicine and rehabilitation trainees in a single institution were asked to complete surveys before and after the workshop to assess self-perceived benefits. After the workshop, the overwhelming majority felt improvement in their overall knowledge of ultrasound-guided musculoskeletal (93%) and spasticity (78%) procedures. In addition, the workshop improved the level of comfort of trainees both in planning (70%) and performing (59%) the procedures independently. Improving these skills is especially important considering most trainees plan to incorporate ultrasound-guided musculoskeletal (81%) and spasticity (74%) procedures into their future practices. The framework for this workshop can serve as a template for other programs to incorporate into their own training.

Assessing the learning needs of physical medicine and rehabilitation residents to develop a geriatric medicine and rehabilitation curriculum.

BACKGROUND: Older adults with functional impairment are cared for by physiatrists in rehabilitation, but physiatrist training in geriatric-related competencies remains suboptimal. To develop a geriatric rehabilitation (GR) curriculum and explore opportunities for improvement, a needs assessment of stakeholders was conducted to understand physical medicine and rehabilitation (PMR) residents' comfort levels and learning needs in geriatrics. METHODS: A mixed-methods design was employed. PMR residents (n = 18) and practicing physiatrists (n = 40) completed a questionnaire; and PMR residents, physiatrists and key informants (n = 9; n = 4; n = 6) participated in focus groups and semi-structured interviews to explore geriatric experiences of trainees and educational needs in geriatrics and rehabilitation. Data were qualitatively analyzed using constructivist-grounded theory. RESULTS: Residents and physiatrists highlighted similar topics as areas of low comfort in knowledge. Interviews prioritized critical geriatric topics (gait assessment, falls, cognitive impairment, movement disorders, and polypharmacy) and highlighted disposition planning and end-of-life care as areas needing further curriculum support. Challenges in delivering geriatric education were also identified. CONCLUSION: What emerged from the needs assessment was a series of critical geriatric educational priorities for the development of a GR curriculum for physiatry trainees - arising at an opportune time given the shift toward competency-based residency education.

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.

Evidence-Based Medicine Training in United States-Based Physiatry Residency Programs.

ABSTRACT: Although the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies. However, although most respondents reported using traditional pedagogic methods of training such as journal club, very few reported that their EBM training used a structured and systematic approach. Future work is needed to support and facilitate physiatry residency programs interested in adopting structured EBM training curricula that include recommended EBM core competencies and the evaluation of their impact.

Now Is the Time: A Primer on How to Be a Disability Education Champion in Your Medical School.

ABSTRACT: One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity. However, training in the lived experience of disability is not always included in medical education. Physiatrists make excellent disability champions in medical schools, given their training and experience in the care of individuals with disabilities. Here, we describe strategies for physiatrists to increase disability education in medical schools and an overview of standards and tools (Liaison Committee on Medical Education standards; Commission on Osteopathic College Accreditation standards; International Classification of Functioning, Disability and Health language; and the Core Competencies on Disability for Health Care Education published by the Alliance for Disability in Health Care Education) physiatrists can use to facilitate interactions with medical school educational leadership. Specific examples are provided along with a framework to guide the development of disability champions in medical schools.

Musculoskeletal Ultrasound as a Motivator for Selecting a Physical Medicine and Rehabilitation Residency Program in the United States: A Multicenter Survey Study.

ABSTRACT: This study aimed to determine the influence of musculoskeletal ultrasound (MSKUS) curriculum on applicants during the residency-selection process. A survey of 666 applicants for the Johns Hopkins University, Mayo Clinic, and Harvard/Spaulding Rehabilitation Physical Medicine and Rehabilitation programs was conducted in June 2020. A total of 180 respondents scored the influence of a MSKUS curriculum on their decision making for residency selection. In addition, applicants were asked to rank specific areas of physical medicine and rehabilitation that influenced their decision making. Participants most commonly included MSKUS in their top three areas of interest when constructing their rank order list. When asked whether MSKUS presence within a program had an effect during the interview-selection process, 71% responded with "very important" or "absolutely essential" (P < 0.001). For 74% of applicants, exposure to MSKUS in residency was an important factor when creating their rank order list (P < 0.001). More than 92% of applicants stated that they are "likely" or "very likely" to use MSKUS in their future practice and 83% would recommend a program with MSKUS to future candidates (P < 0.001). Based on these results, a large percentage of physical medicine and rehabilitation applicants intend on using MSKUS in their future practice. Therefore, MSKUS may be an important factor for residency selection.

Development of a Cadaver Laboratory Curriculum for Interventional Spine Procedures for Physical Medicine and Rehabilitation Residents.

ABSTRACT: There is no standardized curriculum for teaching interventional spine procedures during residency. The objective of this protocol was to share a curriculum using a cadaver laboratory for teaching Physical Medicine and Rehabilitation residents interventional spine procedures, which can be an effective and safe medium to train residents. This protocol provides a checklist that can guide the residents while they are in the cadaver laboratory with a focus on some of the most common lumbar procedures. Twelve physical medicine and rehabilitation resident's confidence in their ability to maneuver the x-ray image intensifier (C-arm), identify spine anatomy under fluoroscopy, and drive the needle improved after the training curriculum (P < 0.005). Although the cadaver laboratory curriculum is not a replacement for the required Accreditation Council for Graduate Medical Education training, it may serve as a tool to improve resident preparedness for spine procedures.

Development of a Formalized, Multifaceted Mentorship Program in Physical Medicine and Rehabilitation Residency Education.

ABSTRACT: Mentorship in medicine has long been a vital component to the training, development, and career advancement of physicians. Although optimal strategies for facilitating mentorship relationships are unknown, it is recognized that establishing a formalized mentorship program within residency training may augment mentor-mentee pairing, improve overall trainee experience, and enhance resident perception of strong mentoring relationships. A formalized mentorship program was successfully developed in a Canadian physical medicine and rehabilitation residency program, including innovations such as near-peer self-matching, a needs assessment survey, a speed dating event, formation of "link groups," and "fireside chats" with faculty members. This approach may serve as a guide for other medical education and residency programs seeking to implement a similar concept.

Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Physical Medicine and Rehabilitation Residency Training.

ABSTRACT: A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.

Virtually Possible: Medical Student Rehabilitation Rotations During a Pandemic.

ABSTRACT: The novel coronavirus 2019 pandemic has led to new dilemmas in medical education because of an initial shortage of personal protective equipment, uncertainty regarding disease transmission and treatments, travel restrictions, and social distancing guidelines. These new problems further compound the already existing problem of limited medical student exposure to the field of physical medicine and rehabilitation, particularly for students in medical schools lacking a department of physical medicine and rehabilitation, approximately 50% of medical schools. A virtual medical student physical medicine and rehabilitation rotation was created to mitigate coronavirus 2019-related limitations and impact on medical education. Using audiovisual technology, students had the opportunity to participate in clinical inpatient and outpatient care, live-streamed procedures, and virtual didactics, develop and showcase their clinical knowledge and reasoning skills, and become familiar with the culture of the physical medicine and rehabilitation residency program. Adaptive educational approaches, including integration of the flipped classroom model, success, pitfalls, and areas for improvement will be described and discussed. Providing nontraditional methods for physical medicine and rehabilitation education and exposure to medical students is crucial to maintain and promote growth of the field in this unprecedented and increasingly virtual era.

Role of Telerehabilitation in the Rehabilitation Medicine Training Program of a COVID-19 Referral Center in a Developing Country.

ABSTRACT: This article describes the impact of the pandemic on physical medicine and rehabilitation in a COVID-19 referral center of a developing country. It describes how telerehabilitation can be leveraged to fill in the gaps in service, training, and research arms of the physical medicine and rehabilitation specialty. The ITAWAG ("to call") telerehabilitation program is the response of the Department of Rehabilitation Medicine at Philippine General Hospital, which is the country's national university hospital, to the ongoing COVID-19 crisis that continues to limit face-to-face access to physical medicine and rehabilitation services throughout the country. With the significant decline in the number of patients served since the start of the pandemic, the ITAWAG program aimed to bridge the physical distance between patients and clinicians after a set of eligibility criteria for teleconsultation or teletherapy and a step-by-step process used before, during, and after each virtual encounter. However, because many physical medicine and rehabilitation consultants, residents, and therapists were not trained for the virtual approach to patient care, a telerehabilitation curriculum was developed to help in providing quality and competent services. Finally, despite the growing awareness of telerehabilitation throughout the country, several research gaps about this emerging technology are identified to determine its acceptance, applicability, and cost-effectiveness among others.

Quantity and Quality of Physical Medicine and Rehabilitation Clerkships in US Medical Schools.

OBJECTIVE: The purpose of this study was to address two underreported issues in undergraduate physical medicine and rehabilitation medical education: quantity and quality of physical medicine and rehabilitation clerkships in US medical schools. DESIGN: A multimethod sequential design was used to evaluate the curricula of US medical schools. Quantity (N = 154) of physical medicine and rehabilitation clerkships was assessed by counting the number of required, selective, and elective clerkships in each medical school. Quality (n = 13) was assessed by conducting a thematic analysis on physical medicine and rehabilitation clerkship curricula to identify learning objectives. These objectives were then compared with learning objectives in a model standard. RESULTS: Whereas few medical schools required a physical medicine and rehabilitation clerkship, most offered elective rotations in physical medicine and rehabilitation. Most medical schools only included 6 of the 12 model standard learning objectives. Medical schools also included 29 learning objectives not present in the model standard. CONCLUSIONS: Physical medicine and rehabilitation clerkships are not underrepresented but are underemphasized, in undergraduate medical schools. Furthermore, these clerkships use inconsistent learning objectives. Thus, findings suggest the need to draw attention to physical medicine and rehabilitation clerkships by offering them as selectives and to develop a list of standardized learning objectives. This exploratory study developed such a groundbreaking list and invites the physical medicine and rehabilitation community to test it.

Physical Medicine and Rehabilitation Program Directors' Perspectives on US Medical Licensing Examination Step 1 Scoring Changes.

ABSTRACT: In response to increasing dependence on US Medical Licensing Examination Step 1 scores for resident selection, and to improve medical student well-being and education, the Federation of State Medical Boards and the National Board of Medical Examiners announced that no sooner than 2022, Step 1 score reporting would change from numeric to pass/fail. To gauge the impact that this change will have on the residency application process in physical medicine and rehabilitation, an anonymous survey was electronically distributed to program directors of all accredited physical medicine and rehabilitation residency programs in the United States. A response rate of 49% was obtained. In total, 13% of program directors agreed that the scoring change was a good idea. Eighty percent of program directors felt that the change would increase emphasis on Step 2 clinical knowledge in the application process and that it will be more difficult to objectively compare applicants. Among free-text responses to the survey, 70% disapproved, 10% approved, and the remaining 20% were neutral to the change. The results of this survey show that many physical medicine and rehabilitation program directors are concerned about the implications of the Step 1 score reporting change. These data can serve as a helpful guide to program directors and students preparing for a pass/fail Step 1.

Extending the Depth and Breadth of Physiatry Care: Five Strategies for Residents to Develop a Foundation in Hospice and Palliative Medicine.

ABSTRACT: Hospice and palliative medicine is one of seven accredited fellowship subspecialties available to graduates of physical medicine and rehabilitation residency programs. Hospice and palliative medicine and physical medicine and rehabilitation share many of the same principles and practices, and physical medicine and rehabilitation residency training can be excellent preparation for hospice and palliative medicine fellowship. However, unlike the other six physical medicine and rehabilitation subspecialties, there is currently no requirement for hospice and palliative medicine training during physical medicine and rehabilitation residency. As a result, physical medicine and rehabilitation residents may encounter limited hospice and palliative medicine exposure or education, and lack explicit opportunities to develop the basic set of palliative care symptom management and communication tools that can be applied across the spectrum of physiatry care. Here, we provide five strategies that residents can use within their own programs to develop knowledge and experience in hospice and palliative medicine.

Evaluation of Diversity and Inclusion Presence Among US Physical Medicine and Rehabilitation Residency Program Websites.

ABSTRACT: The primary aim of this study was to evaluate the presence of diversity and inclusion promotion among US physical medicine and rehabilitation residency program Websites. A list of physical medicine and rehabilitation residency programs was obtained from the Fellowship and Residency Electronic Interactive Database. The program Website links were obtained from the Fellowship and Residency Electronic Interactive Database or Google. Two reviewers evaluated the presence of 11 predetermined diversity and inclusion metrics. The presence of individual resident and faculty photos and biographies was also evaluated. Cross-sectional and descriptive analyses were performed. A total of 90 physical medicine and rehabilitation residency program Websites were reviewed. Only 15 (17%) Websites met at least 1 of the 11 predetermined criteria. Nine (10%) Websites mentioned diversity in their program mission statement, whereas 7 (8%) included a separate diversity statement. Eight (9%) Websites had a dedicated diversity page/section. Of Websites that included information on their residents and faculty, 62 (85%) had completed 100% of resident photos and 41 (47%) Websites had completed 100% of faculty photos. A total of 30 (41%) Websites had completed 100% of resident biographies, and 15 (17%) Websites had completed 100% of faculty biographies. Less than 20% of all residency program Websites promoted diversity and inclusion. Residency Websites lack key information that prospective applicants use to evaluate diversity.

How to One Up a Pandemic: University of Minnesota's Physical Medicine and Rehabilitation Virtual Clerkship-A Model for Alternative Clinical Training and Preliminary Validation Study.

ABSTRACT: Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.