Sudesh Sheela Jain

Factors used by physical medicine and rehabilitation residency training directors to select their residents.

A 17-item questionnaire was designed to assess the relative importance of various factors to physical medicine and rehabilitation (PM&R) training directors when ranking PM&R resident applicants during the National Resident Match. The questionnaire was sent to all PM&R residency training directors. The recipients were asked to grade most selection factors based on a numerical scale: 1, unimportant; 2, some importance; 3, important; 4, very important; 5, critical. The specific factors addressed in the questionnaire were: academic criteria, letters of recommendation, individual applicant characteristics and aspects of the interview process. Twelve yes-or-no questions were also designed to determine the weight that residency training directors place on certain academic criteria. A response rate of 88% (66/75) was obtained. The most important academic criteria were grades in a PM&R clerkship in their facility (4.1 ± 0.8), followed by grades in a PM&R clerkship in another facility (3.6 ± 0.9). The most important letters of recommendation were from a PM&R faculty member in the respondents department (4.0 ± 0.8), followed by the deans letter (3.7 ± 1.0) and the PM&R chairmans letter (3.7 ± 1.0). The three most important applicant characteristics evaluated during the interview were compatibility with the program (4.4 ± 0.8), the ability to articulate thoughts (4.2 ± 0.8) and the ability to work with the team (4.2 ± 0.8). Most program directors used multiple criteria to complete their rank list, but the most important were based upon the interview (4.5 ± 0.9), letters of recommendation (3.7 ± 0.9), medical school transcript (3.6 ± 0.8) and the deans letter (3.6 ± 1.1). Knowledge of the specialty, personal statements and research interest were the least important candidate criteria. The majority of respondents believed that clinical and preclinical honor grades were more important than honor status on the United States Medical Licensing Examination steps 1 and 2.

One program's experience of OSCE vs. written board certification results : A pilot study

The objective structured clinical examination (OSCE) has been the focus of a lot debate with respect to reliability and validity. Much of the controversy surrounding these components lies in a lack of comparison with a “gold standard.” Further work is needed to improve the evaluation of clinical skills to the point that a gold standard can truly be said to exist.

Measuring professionalism in a physiatry residency training program.

DeLisa JA, Foye PM, Jain SS, Kirshblum S, Christodoulou C: Measuring professionalism in a physiatry residency training program. Am J Phys Med Rehabil 2001;80:225–229.A 12-item questionnaire modeled after the one prepared by the American Board of Internal Medicine dealing with professionalism was distributed to 122 physiatry residents representing six training programs, of whom 59% (72) responded. The mean item score on the survey was 7.7 (SD = 1.0) on a scale from 1 to 10, where 10 represents the highest level of professionalism. The internal reliability of the questionnaire was found to be satisfactory (Cronbach’s &agr; = 0.75). A factor analysis of the questionnaire items resulted in three factors explaining 64% of the variance. These factors were: excellence, honor/integrity, and altruism/respect; Eigen values were 3.35, 2.37, and 1.31, respectively. These factors are similar to those obtained in the American Board of Internal Medicine survey. This similarity is a positive feature in ongoing efforts to develop a reliable tool for measuring professionalism in physiatry residency training.

Evidence-based medicine in physiatry : The experience of one department's faculty and trainees

Evidence-based medicine is regarded by many as the new paradigm in medical practice. Sixty-seven medical school faculty and trainees in a physical medicine and rehabilitation department were surveyed with regard to training and competence in the use of evidence-based medicine techniques. The majority of subjects in the present study supported the use of evidence-based medicine techniques, although a number of the respondents indicated that they lacked adequate training or competence in their use. It is suggested that medical schools and physiatry residency programs provide a greater emphasis on training in evidence-based medicine. Recommendations are provided that individuals can use to develop a systematic strategy to keep up with the rapidly expanding medical literature.

Chronic fatigue syndrome: a literature review from a physiatric perspective.

To examine the literature on chronic fatigue syndrome (CFS), especially as it relates to cognitive deficits and exercise, more than 200 articles related to CFS were selected from computer-based research as well as pertinent articles noted in the references of individual articles. All were relevant articles on CFS, although articles in a foreign language were excluded. CFS is a controversial diagnosis of exclusion, but certain subgroups do appear to exist. It may represent multiple diseases or multiple stages of the same disease. Although cognitive deficits are commonly reported, the measured impairments are relatively subtle and are in the area of complex information processing speed, or efficiency. Magnetic resonance imaging, single-photon emission computer tomography, and neuroendocrine studies present preliminary evidence suggestive of the cerebral involvement primarily in the white matter. The weakness and fatigue may be the result of alterations in the central nervous system, not in the peripheral muscles. However, it is hard to separate the documented weakness and endurance deficits from deconditioning. Autonomic symptoms such as orthostatic intolerance and a predisposition to neurally mediated syncope may be explained by cardiovascular deconditioning, a postviral idiopathic autonomic neuropathy, or both. The review points out the need for more carefully designed studies of CFS that focus on the relationship between neuropathology, psychopathology and neuropsychologic functioning. The role of exercise as a stimulus for exacerbation or in treatment needs to be further studied using clear diagnostic criteria as well as control groups that carefully match the activity level.

Postoperative transcutaneous oxygen measurement in the prediction of delayed wound healing and prosthetic fitting among amputees during rehabilitation: a pilot study

Postoperative assessment of amputation wound healing remains largely subjective in nature, being based on the physicians clinical judgement. These considerations significantly impact on the rehabilitation course, as premature prosthetic fitting may result in wound breakdown. Alternatively, delayed healing may result in prolonged hospital length of stay. Few attempts have been made to correlate objective parameters of limb perfusion with amputation wound healing or prosthetic fitting outcome during the rehabilitation phase of treatment. A pilot study was conducted, in which the transcutaneous oxygen monitor, a noninvasive device measuring transcutaneous partial pressure of oxygen (tcpO2), was applied to the stumps of 11 consecutive above-or below-knee amputees admitted for rehabilitation after amputation. All patients were tested within 1 wk of admission and 45 days of amputation. The treatment team was blinded as to the test results. A direct correlation was observed between wound healing outcome and tcpO2 results (Fishers exact test [FET], P=0.03), and no patient with a tcpO2 of <15 mm Hg healed during their rehabilitation stay (FET,P = 0.006). TcpO2 of <15 mm Hg was significantly correlated with prolonged length of stay (Point Biserial Correlation Coefficient [rpbi],=-0.835; P=0.01), delayed prosthetic fitting (rpbi=0.742; p=0.01), and poorer wound healing at admission (rpbi = 0.932; P=0.001). Postoperative tcpO2 measurement may have use in objectively identifying patients at greater risk of delayed wound healing and prosthetic fitting, although further study is warranted.

Improving resident research in physical medicine and rehabilitation: impact of a structured training program.

Abstract Objective: This study describes a research training program that implemented several processes and structures with the aim of increasing the quality and quantity of resident research in physical medicine and rehabilitation. Another aim of the program was to address the Accreditation Council for Graduate Medical Education (ACGME) Practice-Based Learn ing and lmprovement competency. Design: Educational program. Results: Data on resident research activity for 11 years before the implementation of the research program were compared with 4 years of data after implementation. There were statistically significant increases in both the total number of publications (P = 0.03) and the number of empirical, data-based publications after implementation of the program (P = 0.03). Conclusions: The findings from this study suggest that a structu red research training program may have a salutary effect on increasing the quality and quantity of resident research.

Chief residents in physiatry: expectations v training

A large majority of physical medicine and rehabilitation residencies have chief resident positions, but little has been written about the expectations of the program directors and the training of the chief resident to fulfill those expectations. A 20-item questionnaire was mailed to 73 program directors in physical medicine and rehabilitation in May 1992. The participants were asked about selection methods, their perception of the duties of the chief resident(s), their concerns about the chief resident(s) position, the training and the evaluation of the chief resident(s). An 85% (62/73) response rate was achieved. There was a chief resident position(s) in 98% of the programs responding. Chief resident selection was made mostly by appointment of the chairman and/or program director and/or the vote of the faculty. The program directors perceived the most important duties of the chief resident to be: act as a liaison between faculty and the residents, act as a role model, do scheduling, build teamwork and give constructive feedback. The most important skills were considered to be leadership and stress management. Causes of concern were time pressure, abuse of power, stress and work overload. Opportunities to develop leadership and administrative/ management skills were considered the most exciting aspects of the position. It was surprising, however, that only 15 of 61 (25%) provided some formal training. Only 28 of 61 (46%) had a position description.

Factors influencing the specialty choice of the physical medicine and rehabilitation graduating class of 1994 and the entering class of 1995.

To understand better how career choices are made by physiatrists, a 16-item, 7-page questionnaire was sent to all 1994 graduating physical medicine and rehabilitation (PM&R) resident physicians in the United States. Of the 343 senior residents, 202 completed the questionnaire for a response rate of 59%. The questionnaire focused on the following areas: timing of the decision to enter PM&R; and how the medical school curriculum, certain groups of people, and certain specific factors influenced their choices. There were 130 factors modeled after the American Association of Medical Colleges (AAMC) annual medical student questionnaire that the recipients were asked to grade on a numerical scale: 1 = unimportant to 5 = very important. Of the graduating residents, 60.1 % (119/198) made the decision to enter PM&R in their 3rd or 4th yr of medical school, 13.1% (26/198) in the first 2 yr, and 11.1% (22/198) after starting another residency. The five factors ranked most important in the decision were (mean rank score): sufficient time/flexibility for family obligations (4.60); opportunity to make a difference in peoples lives (4.57); interest in helping people (4.55); types of patient problems encountered (4.50); and consistency with personality (4.49). We also obtained the AAMCs 1993 annual data on medical students choosing PM&R. Their top five factors were the same as those listed by the graduating residents, but in a slightly different rank order. Profiles have also been derived on those graduating PM&R residents who chose an academic career (n = 68) v nonacademic (n = 133) and fellowship (n = 34) v nonfellowship (n = 163).

Successful Prosthetic Fitting of a Patient with Epidermolysis Bullosa Dystrophica: Case Report

A patient with recessive dystrophic epidermolysis bullosa developed a squamous cell carcinoma of the right foot resulting in a below the knee amputation. Despite the multiple real and potential skin problems of the stump, she was successfully fitted with a simply designed prosthesis and rehabilitated.