GOALS FOR THE CLERKSHIP GOALS - The goal of the Phase 3 Physical Medicine and Rehabilitation clerkship is to prepare the student to interact with and medically manage patient with all levels of ability and disability. Specifically, the overarching goals are: Learn to focus on function and the functional consequence of illness Improve comfort level and experience working with patients with disabilities Participate in a comprehensive and interdisciplinary approach to clinical care Improve medical knowledge in the following domains: Attention to biomechanics and kinesiology Secondary prevention of medical complications in the rehabilitation setting Unique medical issues in the disabled population Page 1 of 7
CLERKSHIP OBJECTIVES PHYSICIANSHIP OBJECTIVES - Complementary to specific knowledge and skills objectives, students are expected to demonstrate ongoing growth in the area of interpersonal and communication skills, medical ethics and moral reasoning, practice-based learning and improvement and professionalism. During the clerkship, the student will: Participate as a member of the rehabilitation team and effectively communicate with allied health staff, nurses, social workers, consulting physicians, dieticians, respiratory therapists, and psychologists. (SATBC-2a, ECIS-3) Participate in one ethics conference and be able to participate in a discussion of ethical principles as they apply to rehabilitation. (PBMR-1) Demonstrate professional behavior by attending required conferences and completing electronic log. (PBMR-5, PBMR-7) Develop a comfort level in interacting with and providing care for those with disabilities (PASC-1, PBMR-3 Summarize clinical learning opportunities that are relevant to his/her future practice. (CLQI-2, PBMR-7) Demonstrate the ability to manage stress and balance personal & professional demands for time. Maintain professional dress. (PASC-1) Demonstrate professional interactions with health-care team, staff, patients and families at all times (PBMR-3, SATBC-2a) Manage patient care responsibilities in a reliable and efficient manner (PBMR-7) Page 2 of 7
HISTORY AND PHYSICAL EXAM OBJECTIVES HISTORY and PHYSICAL OBJECTIVES During the two week clerkship students will perform a full history and physical on a new inpatient rehabilitation patient. At the completion of the clerkship each student will be expected to be able to focus on the relevant psychosocial history and the neuromuscular physical examination in patient assessment. History/Physical Exams Rehabilitation History Taking Specific Physical Examination Objectives Create comprehensive written history & physicals, specifically targeted to identify impairments that impact a patient s level of function (PCMC-1, PCMC-2, MKS-1c) Summarize a complex medical course for a patient being admitted to the rehabilitation unit from acute care. (PCMC- 3) Resources Where in the Clerkship it is Taught Didactics Spasticity discussion Inpatient Rounds How Assessed Direct Observation CPE Passport Neuromusculoskeletal Physical Examination Perform neurologic examination on a patient with a neurologic condition. (PCMC-2) Determine if spasticity exists during physical examination. (PCMC-2) Page 3 of 7
SKILLS OBJECTIVES SKILLS OBJECTIVES - During the two week clerkship students will perform the following skills as assessed on the CPE. SKILL Specific Knowledge Objectives Resources Where in the How Assessed Clerkship it is Taught Oral presentation skills Give accurate and concise oral presentations of patients on the inpatient rehabilitation unit. (PCMC-3, Inpatient Rounds Didactics CPE Direct Observation ECIS-3) Effective documentation skills Write updated and appropriately thorough daily progress notes for patients on the inpatient rehabilitation unit. (PCMC-3) Construct daily management plans, incorporating patient preferences and values (PCMC-3, MKS-1c) Functional reflection Passport Patient management List and describe various methods to assess and measure neuromuscular function. (PCMC-2, MKS-1d) Assist with creating individualized discharge plans that promote safe transitions of care. (SATBC-3) Identify additional opportunities and ways to advocate for patients and patient access within the current complex health care system. (CES-2) Page 4 of 7
Communicate effectively with patients and their families at the bedside, including counseling & education about health conditions. (ECIS-3, PCMC-6) Communicate effectively with primary care physicians and other members of the rehab team. (ECIS-3, SATBC-2a) Communication skills Communicate with consultants, therapists, nurses, discharge planners and social workers. (ECIS-3, SATBC- 2a) General Knowledge Objectives TOPIC Specific Knowledge Objectives Resources Where in the Clerkship it is Taught Tools and team for functional assessment Define and describe the Functional Independence Measure (FIM score). (MKS-1d, MKS-1c) Braddom's Physical Medicine & Rehabilitation Fifth Edition (2016). Didactics Articles How Assessed Test CPE Page 5 of 7
Write a therapy prescription. (PCMC-3) List and describe the members of a rehabilitation team. (SATBC-2b) Define and describe the terms impairments, disabilities, and community limitations. (MKS-1b, MKS-1c) Discuss the relationships between common clinical disease entities, physical disability, psychosocial issues, quality of life, and maximizing functional outcomes. (MKS-1c) Philadelphia, PA: Elsevier. Chapter 1, 3-8. Braddom's Physical Medicine & Rehabilitation Fifth Edition (2016). Philadelphia, PA: Elsevier. Chapter 5, 85-87. Passport Clerklog Self-identify limitations & knowledge deficits and show a commitment to making improvements (CLQI-1a, CLQI- 2, PBMR-7) Compare and contrast the various levels and locations of rehabilitation care and describe the role of a physiatrist (SATBC-1, SATBC-2b) List common adaptive equipment used in rehabilitation. (MKS-1e) Define, classify, diagnose and manage spasticity. (MKS-1b, MKS-3a, MKS-3b) Describe neuroplasticity. (MKS-1b) Page 6 of 7
Unique medical issues in the disabled population Secondary prevention and management of medical complications Define the appropriate stage for a pressure ulcer. (MKS-1b) Define and manage autonomic dysreflexia. (MKS-1b, MKS-3b) List five medical complications seen after acute stroke. (MKS-1b) Define and manage neurogenic bowel and neurogenic bladder. (MKS-1b, MKS- 3b) Discuss functional consequences of immobility. (MKS-1c) Ivanhoe CB. Spasticity: the misunderstood part of the upper motor neuron syndrome. Am J Phys Med Rehabil. 2004 Oct;83 (10 Suppl):S3-9. Roth E. Lovell L, et al. Incidence of and Risk Factors for Medical Complications during Stroke Rehabilitation. Stroke 2001; 32 (2): 523-9. Kortebein P. Rehabilitation for hospital-associated deconditioning. Am J Phys Med Rehabil 2009; 88:66-77. Page 7 of 7