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Kansas City University of Medicine and Biosciences
College of Osteopathic Medicine
Department of Family Medicine
FMED 410/410s
Physical Medicine & Rehabilitation
Course Description:This clerkship will provide students with exposure to many areas of rehabilitation either in an acute inpatient unit or through outpatient services. Students will be exposed to a variety of experiences and may be able to customize the clerkship depending upon interests.
Experiences may include physical therapy, occupational therapy, speech therapy, recreational therapy, psychology, wound care, and other rehabilitation related components.
5 semester credits Repeatable Credit: no
Prerequisites: Successful completion of FMED 301 and FMED 302
Expectations:
Emphasis will be placed on:
• History and physical examination of the rehabilitation patient
• Knowledge of rehabilitation principles relative a patient’s presentation
• Application of OPP and OMT to the management of the patient’s disease process
• Knowledge of current evidence-based medicine within the field of PM&R
Course Structure
The rotation will consist of daily interaction with patients within either the rehabilitation unit and/or an outpatient practice specializing in physical medicine and rehabilitation. The student will be expected to participate in daily inpatient rounds, outpatient encounters, team treatment discussions, journal clubs and didactic lectures. The student may be assigned specific readings by the preceptor relevant to patients seen in the practice.
Competencies & Objectives
The KCUMB educational program has identified specific broad areas that students should develop during their training. These help ensure that the students are able to demonstrate and/or develop specific skills. This overarching competencies and objectives specifically addressed in the Elective in Physical Medicine and Rehabilitation course are denoted in bold:
1. Demonstrate basic knowledge of osteopathic philosophy and practice and osteopathic manipulative treatment;
2. Demonstrate medical knowledge through one or more of the following: Passing of course tests, standardized tests of the NBOME, end of clerkship tests, research activities, presentations, and participation in directed reading programs and/or journal clubs; and/or other evidence based medical activities;
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3. Demonstrate interpersonal and communication skills with patients and other health care professionals;
4. Demonstrate knowledge of professional, ethical, legal, practice management, and public health issues applicable to medical practice;
5. Demonstrate the ability to effectively treat patients, provide medical care that incorporates the osteopathic philosophy, patient empathy, awareness of behavioral issues, the incorporation of preventive medicine, and health promotion.
6. Demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based medicine into patient care, show an understanding of research methods, and improve patient care practices.
7. Demonstrate an understanding of health care delivery systems, provide effective and qualitative patient care with the system, and practice cost-effective medicine.
Course Objectives:
Osteopathic Philosophy and Practice/Osteopathic Manipulation
• Demonstrate understanding and implementation of the integration of manipulative treatment into the overall management of the patient relative to the patient’s presentation.
Patient Care
• Demonstrate the appropriate history and physical examination skills of a patient on a Rehabilitation service.
• Demonstrate understanding of the proper documentation of a rehabilitation unit admit history and physical examination and outpatient SOAP note, inclusive of a differential diagnosis and a treatment plan.
• Demonstrate the consideration of sequelae relevant to the rehabilitation patient and their diagnosis.
• Demonstrate the ability to order and interpret laboratory and imaging studies relevant to a rehabilitation patient presentation.
Medical Knowledge
• Demonstrate the understanding of the rehabilitation team members and their function
• Demonstrate understanding of the normal musculoskeletal examination
• Demonstrate the understanding of the continued follow up of a rehabilitation patient
• Demonstrate knowledge of potential sequelae the rehabilitation patient may face.
Professionalism
• Demonstrate professionalism in performing the duties as assigned within the elective rotation.
Interpersonal and Communication Skills
• Demonstrate appropriate use of communication skills during patient encounters. Practice-Based Learning and Improvement
• Demonstrate the understanding of effectively and efficiently providing care to the rehabilitation patient
3 • Demonstrate the integration of evidence based medicine in developing a treatment plan
for the rehabilitation patient.
Detailed Objectives
Osteopathic Philosophy and Practice/Osteopathic Manipulation
• Demonstrate competency in the application of manipulative treatment modalities appropriate for patients in need of rehabilitation because of a disease process or injury; addressing the structural model, respiratory-circulatory model, neurological model, metabolic model, and the behavioral model
• Demonstrate fundamental integration and implementation of relevant osteopathic
• manipulative medicine treatment techniques during encounters with the rehabilitation patient.
• Demonstrate the ability to integrate osteopathic principles and practice into management of all rehabilitation patient presentations.
Patient Care
• Perform evaluation and appropriate documentation of gait, tone, reflexes, sensation, coordination and station.
• Demonstrate appropriate documentation and interpretation of patient history including quality of life functions, physical exams, allied health (lab procedures, radiography, etc), social, occupational, and familial data.
• Demonstrate, evaluate and appropriately document range of motion and manual muscle examination for extremities and spine.
• Understand the need for readjusting individualized patient treatment plans based on acute and long term goals, and possible treatment reactions and interactions.
• Demonstrate a fundamental understanding of the presentation and management of additional complaints or diseases that could be encountered: neurogenic bowel, neurogenic bladder, heterotopic ossification, autonomic dysreflexia, spasticity, amputation, tracheostomy management.
• During this elective rotation, the student is expected to develop competencies in the following clinical skills. The expected level of student engagement in the skills being developed:
Observe (O), Assist (A), Master (M).
• Ordering and interpretation of basic laboratory tests and diagnostic studies (O, A)
• Clinical indications and components of electrodiagnostic testing (O, A)
• Ordering and interpretations of appropriate radiographic studies (O, A)
• Mental status and cognition assessment tools and their use (O, A)
• Physiatric prescriptions and how they are written (O, A)
• Correct use of reflex hammer, ophthalmoscope, otoscope, sphygmomanometer; stethoscope
• tongue depressor; tuning fork ( M)
• Assess normal gait and perform elementary analysis of gait (M)
• Perform & document appropriate OMM examination (A, M)
Medical Knowledge
• Understand the roles of the physiatrist and the interdisciplinary management of the disabled patient (rehabilitation nurse, physical therapist, occupational therapist, speech or hearing therapist, dietician, orthotic/prosthetic technicians, and vocational
4 • Demonstrate a basic understanding of physical examination deficiencies and their
classification as impairments, disabilities or handicaps.
• Understand pathophysiology and treatment for spinal cord injury; and demonstrate fundamental understanding of spinal cord injuries and rehabilitative requirements.
• Demonstrate fundamental understanding of stoke syndromes and rehabilitative requirements.
• Demonstrate a fundamental understanding of the presentation and management of additional complaints or diseases that could be encountered: neurogenic bowel, neurogenic bladder, heterotopic ossification, autonomic dysreflexia, spasticity, amputation, tracheostomy management.
Professionalism
• Demonstrate professionalism by being prompt to required components of the rotation, and being dressed professionally.
• Demonstrate professionalism in the interactions with all members of the rehabilitation team.
Interpersonal and Communication Skills
• Understand the importance of communicating with the patient and family regarding the education for acute and long term goals of the treatment plan.
Practice-Based Learning and Improvement
• Demonstrate a fundamental understanding of cost effective medical management to include primary prevention, healthcare delivery and patient social-economic status.
Systems-based Practice
• Demonstrate appropriate use of clinical practice guidelines where appropriate for the rehabilitation patient’s diagnosis.
General Information about Clerkship
The student is expected to have the appropriate physical diagnostic tools necessary to perform a thorough neuromusculoskeletal examination.
Assignments:
1. Review clinical practice guidelines for the management of concussion/mild traumatic brain injury, Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. A national clinical guideline and early acute management in adults with spinal cord injury: a clinical practice guideline for health-care
professionals.
2. Attend all didactic sessions, journal clubs (inclusive or presentation of one current PM&R research article).
Recommended Resources.
1. DeLisa, JA; Gans, BM; Welsh, NE; Bochenek, WL; Frontera, WR. Physical
Medicine and Rehabilitation: Principals and Practices, 4th ed. Lippincott, Williams
& Wilkins, 2004
2. Tan, JC. Practical Manual of Physical Medicine and Rehabilitation: Diagnostics, Therapeutics and Basic Problems, 2nd ed. Moseby, 2005
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3. National Guideline Clearing House (http://www.guideline.gov/)
4. Chila, A. Foundations for osteopathic medicine (3rd ed.), Lippincott Williams & Wilkins, 2010.
5. DiGiovanna, E. An Osteopathic Approach to Diagnosis and Treatment, Lippincott, Williams & Wilkins. 2005
Evaluation
This elective clerkship is graded Satisfactory/Unsatisfactory.
POLICIES Dress Code
Students are expected to wear clean, pressed, white lab coats, required identification badges and dress in a professional manner on all clinical experiences. Professional dress for males includes a shirt, tie and slacks. For female students, this includes a professional dress or skirt (knee length or longer), or slacks and professional shirt. Men and women should wear socks or stockings at all times. No open-toed shoes or sleeveless shirts are allowed during the
performance of patient care. With the exception of the surgical suite, tennis shoes are not allowed.
Hospital Rules & Regulations
Each hospital/health care system has individual rules and regulations. Medical students must familiarize themselves with and adhere to these protocols during training.
At no time should a medical student alter, remove or otherwise tamper with medical records. Specific rules and regulations with respect to student entries in medical records must be clarified during orientation or on the first day of the clinical experience.
Students must respect and follow all policies regarding the use of hospital facilities, housing, and equipment. All hospital equipment including library materials, pagers, and keys must be returned before leaving a clinical experience. Students are financially responsible for any damage to or loss of hospital property. As a result, it is strongly recommended that students obtain and retain a receipt as proof that property was returned and/or damage was not incurred.
Special Accommodations
Students needing special accommodations need to ensure that BOTH the clinical training site AND KCUMB are aware of the need for the accommodation. To allow KCUMB and the clinical training site ample time to make accommodations, it is recommended that the student make contact as soon as possible.
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The work and call schedule during clinical experiences is at the discretion of the core site hospital, service and/or preceptor. Students generally follow the same schedule as their preceptor, however, if the preceptor is on vacation, or scheduled away from the office/hospital, additional arrangements must be made for completion of the clinical experience. If this occurs, contact your KCUMB Student Administrator immediately. Additional call time may be required on evenings, weekends or holidays. Students should clarify work and call schedules during orientation. Work/call scheduling imposed by KCUMB, the core site hospital, clinical experience service or preceptor must be followed without exception. Federal laws restricting
intern/resident work hours do not apply to medical students.
Medical Ethics
All medical students are expected to conduct themselves in a professional manner
demonstrating an awareness and compliance with the ethical, moral and legal values of the osteopathic medical profession. In observing the principles and practices of medical ethics, students will:
o Place primary concern on the patient’s best interests
o Be available to patients at all reasonable times as expected by the preceptor/core site
o Perform medical activities only within the limitations of a medical student’s capabilities and within the guidelines determined by the site and/or preceptor
o Strictly maintain patient and institutional confidentiality
Physical Examinations
During the third and fourth-year clinical experiences, students are routinely expected to see and examine intimate parts of patient bodies. It is necessary that all intimate examinations of
patients be appropriately structured, supervised, and consented in the interests of all parties, including the patient, student and attending physician.
Students must wear their KCUMB picture identification badge and introduce themselves to patients as a medical student. Patient consents for a student to perform an intimate examination must always be voluntary. Consent for an intimate examination must be either verbal and/or written. Irrespective of the gender of the examining student and the patient being examined, a chaperone, defined as another medical professional, preferably the preceptor is required during all intimate examinations. A chaperone is not an accompanying person i.e. friend or relative of the patient. A chaperone, similarly, is not another medical student. Students are highly
encouraged to record the date, time, and the results of the examination as well as the name of the chaperone in the medical record.
PROCEDURES
Absence from Clerkship Experiences
Any absence must be reported to both the core site and Preceptor and the KCUMB Student Administrator prior to the start of an assigned shift. Failure to report an absence
to the core site or preceptor and the KCUMB Student Administrator will be considered
abandonment of duties and the student will face appropriate disciplinary action. (For additional information see Clinical Clerkship Manual).
7 Faculty Contact Information
John Dougherty, DO jdougherty@kcumb.edu
