David W. Musick

Service Learning in the Medical Curriculum: Developing and Evaluating an Elective Experience.

Background: Medical educators are seeking ways to nurture the service commitments of their medical students while promoting interactions with the communities they serve. Service learning is a pedagogy that links community service with academic experience. Description: The University of Kentucky College of Medicine has developed and implemented an experiential service learning elective. The elective is based in local community agencies where small groups of students perform an asset-needs assessment and design a service project based on their findings. The elective is linked to a behavioral science course that provides accompanying biopsychosocial instruction. Evaluation: Over the 2-year project period, we used multiple methods (i.e., surveys, interviews, reflection questionnaires, evaluations of student performance, and course evaluations) to gather information on the motivations, observations, and assessments of students, faculty preceptors, and community agency partners. Conclusion: Linking a service learning elective to a pre-existing course worked well, achieved its objectives, and will be continued.

Pilot study of a 360-degree assessment instrument for physical medicine & rehabilitation residency programs.

Musick DW, McDowell SM, Clark N, Salcido R: Pilot study of a 360-degree assessment instrument for physical medicine and rehabilitation residency programs. Am J Phys Med Rehabil 2003;82:394-402. Objective To perform a pilot test on a new format for multidisciplinary assessment of resident physicians’ professionalism and clinical performance in acute inpatient rehabilitation settings. Design In this pilot study, a 26-item ratings instrument was developed for use by therapists, nurses, social workers, case managers, and psychologists to rate inpatient residents. Results A total of 421 ratings forms were returned over four academic years. Alpha reliability coefficient for instrumentation sample was 0.99. &khgr;2 and analysis of variance procedures examined item mean differences. Significant differences (P ≤ 0.05) were found based on resident sex (17 items) and rotation setting (20 items). No significant differences were found based on rater profession; mean ratings by profession ranged from 6.67 (physical therapists) to 7.46 (case managers). Conclusions Psychometric properties of this new ratings format are encouraging. The tool was a useful way to provide formative feedback to residents regarding professionalism and performance. Residency program directors can use this approach to fulfill Accreditation Council for Graduate Medical Education mandates to use a variety of assessment methods regarding resident education. However, potential sex bias and other issues affecting performance ratings should be considered in interpreting results and warrant further study.

The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors?

BackgroundProfessionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior.MethodsDuke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions.Results76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork.ConclusionDefining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

How we implemented a service-learning elective.

This paper describes the process used to introduce a service-learning course into the medical curriculum at the University of Kentucky College of Medicine. The rationale for taking the initiative to begin such a project is outlined and curriculum planning considerations are reviewed, including how to identify project team members, choose community agency partners, develop the instructional plan, and define roles and responsibilities of the participants. The importance of understanding the philosophy of service learning and taking time for reflection are underscored. Also discussed are program evaluation issues and strategies are suggested for evaluating service learning, obtaining information relevant to the continuation of the project, and disseminating information about the service learning outcomes.

Implementing a multidimensional geriatric curriculum in a physical medicine and rehabilitation residency program.

ABSTRACTResidency training in physical medicine and rehabilitation may not contain a formal curriculum in geriatric patient care. A multidimensional geriatric curriculum to third and fourth year physical medicine and rehabilitation residents was implemented to enhance their knowledge in and attitude toward geriatrics. The curriculum consisted of a 12-wk clinical rotation at various sites of geriatric care including outpatient geriatric clinic, skilled nursing facility, continuing care retirement community, and home visits. Six online self-learning modules and multiple didactic sessions were also created. The residents’ knowledge and attitude were assessed by pretest and posttest design using the Geriatric Knowledge Test, the Geriatric Attitude Scale, and the Attitudes Toward Teamwork in Healthcare Scale. In addition, the residents completed rotation evaluations to rate their learning experiences. Ten postgraduate year 3 and 4 physical medicine and rehabilitation residents participated in the geriatric curriculum, which included a required rotation. The Geriatric Knowledge Test score at baseline was 67.2%. With the completion of the curriculum, the Geriatric Knowledge Test scores showed improvement to 72.7%, although not statistically significant. The residents showed more favorable attitudes toward the geriatric population and interdisciplinary teamwork as measured by the Geriatric Attitude Scale and the Attitudes Toward Teamwork in Healthcare Scale. Overall, they rated the learning experiences highly on a 1–9 rating scale, with 9 being the highest rating; the residents assigned an average rating of 7.06 to specific learning activities within the rotation and an average rating of 6.89 to the organizational aspects of the rotation itself. The implementation of this geriatric curriculum allowed for improved geriatric training in physical medicine and rehabilitation residents.

An exploratory examination of an academic PM&R inpatient consultation service

Purpose : This study sought to examine an inpatient consultation service delivery system at an academic teaching hospital. Method : Descriptive; retrospective; exploratory. Data from a 33 month period were analysed. Demographic profiles of patients receiving consultation were examined. A comparison was also made between alternate methods of delivering physiatric consultation. Results : Only 80% of patients admitted to a teaching hospital during the study period received consultation. Referrals increased by 75% with the institution of a full-time consultation practice model. Conclusions : The utilization of an inpatient consultation service appears to be dependent upon the service delivery format. Further studies are needed to understand referral patterns and specific challenges to consultation services in an academic setting. Future research should focus on comparing clinical outcomes for patients in diagnostic categories who do and do not receive physiatric consultation.

Impact of a required fourth-year medical student rotation in physical medicine and rehabilitation.

ABSTRACTThis study evaluated the impact of a 2-wk required rotation in Physical Medicine and Rehabilitation (PM&R) on fourth-year medical students’ knowledge of PM&R and attitude toward teamwork in patient care. Survey results on attitudes toward a team approach to patient care and knowledge in PM&R were compared prerotation and postrotation. One hundred thirty-eight fourth-year medical students participated in this 2-yr study. The combined response rates for the attitude and knowledge surveys were 62% and 56%, respectively. As measured by a pretest and posttest self-reported knowledge assessment, the rotation increased knowledge of PM&R (P ⩽ 0.05). Four aspects of the rotation that were rated higher by students from the second year of the rotation were role and responsibility definition, incorporation of current literature, enhancement of clinical skills, and general rotation satisfaction. The rotation provides an experience for medical students to increase their knowledge of PM&R.

Reliability of the Physical Medicine and Rehabilitation Resident Observation and Competency Assessment Tool: A Multi-Institution Study

Musick DW, Bockenek WL, Massagli TL, Miknevich MA, Poduri KR, Sliwa JA, Steiner M: Reliability of the physical medicine and rehabilitation resident observation and competency assessment tool: A multi-institution study. Objectives:To assess the psychometric qualities of a method of resident physician evaluation by faculty. Design:Multicenter study by seven Physical Medicine and Rehabilitation training programs. Faculty physicians observed residents in brief patient encounters or teaching sessions, rated specific competencies, and provided residents with immediate feedback. The resident observation and competency assessment form included competencies in patient care, professionalism, interpersonal and communication skills, systems-based practice, and practice-based learning and improvement. Residents and faculty rated satisfaction with the process. Results:Three hundred sixty-two ratings were completed on 88 different residents. Each resident received an average of 3.8 ratings across two academic years. Overall internal consistency reliability was high (0.98); reliability of the individual competencies ranged from 0.74 to 0.76. Item means were correlated with year of training for two skill sets, with higher means for more experienced residents. The majority of participants gave high ratings of satisfaction; correlation between satisfaction ratings of attending and resident physicians was 0.63 (P < 0.01). Conclusions:The resident observation and competency assessment is a reliable method to assess resident skills in five of six general competencies. Construct validity of the tool is supported by the fact that faculty rated two skill sets higher for senior residents.

The Erdman therapy: a treatment utilizing hot and cold therapy.

Applying therapeutic heat and cold is a common practice in physical medicine and rehabilitation. Despite its widespread use, however, relatively little is understood empirically or theoretically about why certain patients benefit from either hot or cold therapy for acute ailments or chronic conditions. Lacking an evidence base, hot and cold therapy is mostly a trial-anderror process. The medical literature reveals that therapeutic heat and cold has been used to treat a variety of clinical conditions, most notably with patients suffering sports-related injuries and arthritic conditions (e.g., rheumatoid arthritis) and joint disorders (e.g., neck, back pain). Recognizing in advance who would benefit from which modality, and who might be harmed, would represent a major step forward in understanding the mechanism and efficacy of therapeutic heat and cold. An obscure, virtually unknown therapy in use for almost a century— known as the Erdman therapy—may yield insight into why some patients are helped by therapeutic heat and cold modalities. The basic premise of the Erdman therapy hypothesizes that patient groups respond to heat vs. cold therapy on the basis of arterial “tone”—the elastic qualities of the smooth muscles in the vessel walls. Arterial tone, in turn, heavily influences the rate of blood flow, and practitioners of this therapy consider blood flow the primary factor in maintaining good health. Using measurements of the rate of blood flow and arterial tone, the Erdman therapy suggests that the use of therapeutic heat and cold can be used to relieve discomfort and even reverse certain illnesses and conditions. Based on use of this therapy by trained practitioners, it is estimated that between 5% and 10% of the general population responds best to cold therapy and the rest to heat therapy. Practitioners have developed an indicator device—the Erdman indicator—to identify the two classes of patients. The theory supporting the categorization structure and its practical application has not been scientifically proven using traditional strength of