Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from the impacts of the COVID‐19 pandemic on graduate medical education

Abstract

Physical medicine and rehabilitation (PM&R) residency training may be the broadest of the 24 medical specialties in the United States, as it includes hospital, long-term acute care, and skilled nursing based consultations; inpatient care of individuals with disabling conditions from pediatrics to adults in both freestanding rehabilitation hospitals and hospital-based rehabilitation units; outpatient care involving neuromuscular and musculoskeletal conditions across the life span and procedures including (but not limited to) axial and joint injections, spasticity management including programmable pump refills and motor point injections, and electrodiagnostic studies. Further, over a billion people worldwide, or 15% of the world’s population, are thought to have a disability. The rates of disability are increasing in part due to aging populations and an increase in chronic health conditions. PM&R physicians are integral to the care and treatment for people with disabilities and chronic conditions. Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship programs available for PM&R trainees include spinal cord injury, pain, sports medicine, pediatrics, brain injury medicine, and neuromuscular medicine. Additional (nonaccredited) fellowships include comprehensive spine/musculoskeletal fellowships, electrodiagnosis, stroke, and neurorehabilitation. Historical challenges in PM&R residency training include providing adequate exposure to the breadth and depth of the specialty, as well as developing competence in delivering a broad range of procedures. Before the COVID 19 pandemic, the biggest “disruption” to U.S. medical residency training occurred in 2007 when the ACGME began implementing the first Milestones for internal medicine and later for all specialty areas. Although this implementation was not technically disruptive to the medical trainees directly, it markedly affected program directors and later fellowship directors in relation to how residents were evaluated. Residents in PM&R programs were provided more objective feedback regarding required achievements in specific areas such as procedures, electrodiagnosis, and rehabilitation management. In the years before the implementation of the Milestones 1.0 program, directors met multiple times to learn from each other about this new resident evaluation methodology. It became apparent that there were many areas of uncertainty; thus, in 2019 and 2020, the PM&R Residency Review Committee (RRC) through the ACGME was working on finalizing Milestones 2.0 to inform expectations for training. These are scheduled to be implemented effective July 1, 2021. This means that the clinical competency committees that meet in December 2021 will use these milestones. No other historical events, including the 9/11 attacks, have truly disrupted residency and fellowship Disclosure: Dr Gittler serves on the American Academy of Physical Medicine and Rehabilitation Board of Governors and participates on the Bundled Payments for Care Improvement Advanced advisory board for Sinai Chicago. Dr Hamilton discloses consulting fees from 2nd.MD and serves on the Association of Spinal Cord Injury Professionals Program Planning Committee. Received: 16 April 2021 Accepted: 16 April 2021