Rotation: Physical Medicine and Rehabilitation                Site(s): SSM Rehabilitation   

                                                                                    Institute, St. Mary’s Health Center

 

Course Director:                                                                     Duration:

 

General description and goals:

The goals of this rotation are to provide residents with an experience in physical and rehabilitation medicine which equips them with the knowledge, skills and attitudes necessary to care for patients with rehabilitation problems and to recognize when referral to a physiatrist may be necessary. Residents are expected to achieve a competence level appropriate for a competent internist in the fields of physical medicine and rehabilitation.   The educational purpose is for residents to understand the principles and modalities of rehabilitative medicine with the intent to maximize independence and improve functional outcomes. The strength of this rotation lies in the multi-disciplinary approach to patient care which is demonstrated through the cooperative patient care efforts of physiatrists, neurologists, physical, speech and occupational therapists.

 

Resident responsibilities:

Residents will be assigned patients to manage on the inpatient rehabilitation medicine floors under supervision of the attending physician. They will attend rounds with their designated attending on the floors and in the occupational/physical/speech therapy units. They will perform inpatient rehabilitation medicine consults under the direction of their attending. They will actively participate in patient care and engage in self directed and problem based learning.

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Objectives:

1. Obtain a pertinent history with special attention to any motor, sensory or cognitive impairments, pain syndromes and ability to perform ADL’s. Assess the effects of musculoskeletal impairment on a patient’s daily function. 

2. Recognize the complications of prolonged bed rest (contractures, pressure sores, deep venous thrombosis, osteoporosis, muscular deconditioning and others).

3. Understand the health care team approach for rehabilitative medicine and the roles of allied health professionals (physical therapist, occupational therapist, psychologist, speech and language pathologist, prosthetist, orthotist and others).

4. Learn about various physical medicine treatment modalities, including diathermy, ultrasound, electrical stimulation, as well as various types of therapeutic exercises.

5. Develop an understanding of the use of the various assistive devices that may reduce disability including wheelchairs, prosthetics, orthotics and others.

6. Know the principles of evaluation and management of chronic pain.

7. Recognize problems that may require referral to a rehabilitation specialist.

8. Diagnose and manage common musculoskeletal and neuromuscular disorders including fibromyalgia, myofascial pain, repetitive motion disorders, paraparesis/plegia, quadriparesis/plegia, falls and gait disorders, weakness secondary to deconditioning from systemic illnesses/ prolonged ICU or hospital stay, prolonged immobilization post- surgery or trauma, chronic pain and overuse syndromes.

9. Recognize the differences among impairment, disability, and handicap. 

            

Learning venues:

1. The primary learning venue for these objectives will be the SSMRI at St. Mary’s Health Center. A noon conference series will include talks on topics listed above.  

2. The required rheumatology and geriatric rotations, the inpatient ward and unit rotations, the emergency medicine rotations, and the continuity clinic will reinforce learned concepts and provide examples of interdisciplinary care.   

3. The ambulatory and ward syllabi have several articles on the topics listed above.  

4. Many elective experiences include aspects of occupational and rehabilitative medicine – specifically the minor medical rotation, the office-based general internal medicine clinics, and the office rheumatology/orthopedics rotation.