PHYSICAL MEDICINE &
REHABILITATION
DEFINITION:The
consultant in Physical Medicine and Rehabilitation (or physiatrist) is a
medical specialist expert in the comprehensive diagnosis, management and
rehabilitation of people of all ages with neuromusculoskeletal disorders
and associated disabilities.
GENERAL
OBJECTIVES:On completion of
the educational program, the graduate physician will be competent to
function as a consultant in Physical Medicine and Rehabilitation.
Residents must demonstrate the knowledge, skills and attitudes relating
to gender, culture and ethnicity pertinent to physical medicine and
rehabilitation. In addition, all residents must demonstrate an ability
to incorporate gender, cultural and ethnic perspectives in research
methodology, data presentation and analysis.
SPECIFIC
OBJECTIVES:At the completion of training, the resident
will have acquired the following competencies and will function
effectively as:
Medical
Expert/Clinical Decision-Maker
General
Requirements
- Demonstrate
diagnostic and therapeutic skills for ethical and effective
patient care.
- Access
and apply relevant information to clinical practice.
- Demonstrate
effective consultation services with respect to patient care,
education and medical-legal opinions.
Specific
Requirements
- Demonstrate
understanding of basic sciences relevant to the specialty
(including anatomy, physiology, pathology, kinesiology and
ergonomics) and the application of basic science principles to
clinical care.
- Demonstrate
knowledge of clinical features, diagnostic criteria, epidemiology,
natural history, pathophysiology, complications and functional
consequences of clinical problems commonly encountered in the
specialty required to diagnose and manage those problems
(including amputations, arthritides, brain injury, cerebrovascular
disease, cerebral palsy and other neurologic disorders of
childhood, complications of immobility, disability due to
cardiorespiratory disease, disability due to cancer, diseases of
nerve and muscle, disorders of the spinal cord, multiple
sclerosis, and musculoskeletal injuries and pain syndromes).
- Describe
the approach to diagnosis of neuromusculoskeletal disorders
commonly encountered in the specialty, the indications for common
diagnostic tests and their interpretation and/or application
including: electromyography, nerve conduction studies, x-rays and
other imaging tests, blood chemistry, lumbar puncture, exercise
stress tests, psychometric testing and urodynamics.
- Describe
the approach to treatment of patients with neuromusculoskeletal
disorders commonly seen in the specialty and select appropriate
therapeutic options.
- Perform
a relevant physical examination with special emphasis on the
assessment of the neuromusculoskeletal system and functional
abilities.
- Perform
diagnostic and therapeutic procedures as required (including
arterial puncture for blood gas analysis, arthrocentesis,
catheterization of the urinary bladder, intra-articular
injections, plaster cast applications, shoulder sling
applications, soft tissue injections, superficial surgical
debridement of wounds and venipuncture).
- Formulate
a comprehensive medical, functional and psychosocial problem list
for a given patient and an appropriate plan for management with
consideration of all factors including gender and culture.
- Select
and prescribe orthoses and prostheses, exercise programs, physical
modalities, rehabilitation therapies and drugs.
- Demonstrate
understanding of the basic principles of Rehabilitation Medicine
including: the concepts of impairment, disability and handicap,
and the role of the interdisciplinary team.
Communicator
General
Requirements
- Establish
therapeutic relationships with patients/families.
- Obtain
and synthesize relevant history from
patients/families/communities.
- Listen
effectively.
- Discuss
appropriate information with patients/families and the health care
team.
Specific
Requirements
- Gather
the data necessary for diagnosis and treatment of a particular
patient through history taking, interviews with family members and
review of relevant documentation.
- Communicate
clearly, concisely and effectively to patients, families, allied
health professionals and other physicians.
- Prepare
complete and informative consultation reports and medicolegal
reports.
- Demonstrate
a patient centred, compassionate and empathetic approach to
patients and their families that includes concern for the
psychosocial, cultural and economic implications of a patient's
unique situation and disability.
Collaborator
General
Requirements
- Consult
effectively with other physicians and health care professionals.
- Contribute
effectively to other interdisciplinary team activities.
Specific
Requirements
- Discuss
the principles of interdisciplinary team functioning, the special
training and unique abilities of its members (such as
physiatrists, family physicians, physiotherapists, occupational
therapists, nurses, speech and language pathologists,
psychologists, social workers, orthotists and prosthetists) and
the special relationship of the patient and family to the team.
- Assume
a leadership role on the interdisciplinary rehabilitation team and
effectively lead team and family conferences.
- Demonstrate
the desire to promote autonomy and the involvement of patients and
their families in decision making when dealing with disability.
- Demonstrate
understanding and respect for the role of other members of the
interdisciplinary team and a willingness to deal with differences
of opinion in a professional and sensitive manner.
Manager
General
Requirements
- Utilize
personal resources effectively to balance professional and
non-professional activities.
- Allocate
finite health care resources wisely.
- Work
effectively and efficiently in a health care organization.
- Utilize
information technology to optimize patient care, life-long
learning and other activities.
Specific
Requirements
- Prepare
and maintain complete and informative clinical records.
- Show
understanding of basic principles of management and administration
of hospitals, clinical programs, academic institutions and
licensing bodies.
- Perform
managerial and administrative functions in an efficient and
organized fashion and incorporate principles of quality management
into everyday situations.
- Acknowledge
the increased strains of health care economics on patients and
their families, residents, medical staff and allied health
professionals.
Health Advocate
General
Requirements
- Identify
the important determinants of health affecting patients.
- Contribute
effectively to improved health of patients and communities.
- Recognize
and respond to those issues where advocacy is appropriate.
Specific
Requirements
- Demonstrate
sensitivity to special issues of gender, culture and social bias
in dealing with patients, families and persons with disabilities.
- Discuss
the role of national organizations in shaping public policy on
care for persons with disabilities, and the prevention of
disability.
- Assist
patients and families in accessing health and social resources in
the community, including patient support groups.
- Promote
a heightened awareness of the challenges and abilities of persons
with disabilities.
Scholar
General
Requirements
- Develop,
implement and monitor a personal continuing education strategy.
- Critically
appraise sources of medical information.
- Facilitate
learning of patients, housestaff/students and other health
professionals.
- Contribute
to development of new knowledge.
Specific
Requirements
- Demonstrate
understanding of critical appraisal as applied to review of the
rehabilitation literature and basic research methodology.
- Demonstrate
basic research skills necessary to develop and evaluate research
proposals and complete a research project.
- Demonstrate
an ability to incorporate gender, cultural and ethnic perspectives
in research methodology, data presentation and analysis.
- Teach
effectively in a variety of settings and to diverse groups of
learners such as students, residents, physicians, allied health
professionals, patients, families and the lay public.
- Accurately
assess professional and personal strengths and weaknesses and make
changes in behaviour where necessary.
- Demonstrate
a commitment to life-long self-directed learning and the
application of new information to clinical practice using the
principles of evidence based medicine.
Professional
General
Requirements
- Deliver
highest quality care with integrity, honesty and compassion.
- Exhibit
appropriate personal and interpersonal professional behaviours.
- Practise
medicine ethically consistent with obligations of a physician.
Specific
Requirements
- Demonstrate
a commitment to the application of exemplary bioethical standards
to clinical practice and research in such areas as truth-telling,
consent, advanced directives, confidentiality, end-of-life issues,
conflict of interest, resource allocation, and research ethics.
- Display
attitudes commonly accepted as essential to professionalism.
- Continually
evaluate one's abilities, knowledge and skills, and know the
limitations of professional competence.
- Recognize
the principles and effects of a balanced lifestyle on one's
practice and ability to provide optimal care for patients.
- Know
and understand the professional, legal and ethical codes to which
physicians are bound.
- Analyse
and know how to deal with unprofessional behaviours in clinical
practice, taking into account local and provincial regulations.
CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM:
There
must be an organized program of rotations and other educational
experiences, both mandatory and elective, designed to provide each
resident with the opportunity to fulfill the educational requirements
and achieve competence in the specialty.
The content and
organization of each accredited program in Physical Medicine and
Rehabilitation must be consistent with the specialty training
requirements.
The program must be
organized such that residents are given individual professional
responsibility, under appropriate supervision, according to their level
of training, ability, and experience.
In addition to
offering the components noted in the specialty training requirements all
accredited programs in physical medicine and rehabilitation should offer
community-based learning experiences.
RESOURCES:There
must be sufficient resources including teaching faculty, the number and
variety of patients, physical and technical resources, as well as the
supporting facilities and services necessary to provide the opportunity
for all residents in the program to achieve the educational objectives
and receive full training as defined by the specialty training
requirements in physical medicine and rehabilitation.
In those cases
where a university has sufficient resources to provide most of the
training in Physical Medicine and Rehabilitation but lacks one or more
essential elements, the program may still be accredited provided that
formal arrangements have been made to send residents to another
accredited residency program for periods of appropriate prescribed
training.
Learning
environments must include experiences that facilitate the acquisition of
knowledge, skills, and attitudes relating to aspects of age, gender,
culture, and ethnicity appropriate to Physical Medicine and
Rehabilitation.
- Teaching
Faculty
The
faculty must include sufficient numbers of physiatrists and other
qualified physicians with an interest in postgraduate clinical training
to appropriately supervise residents on all clinical rotations,
including all ambulatory care experiences.
- Number
and Variety of Patients
There
must be a sufficient number and variety of patients available to allow
residents to gain experience in the broad spectrum of clinical practice
in the specialty.
- Clinical
Services Specific to Physical Medicine and Rehabilitation
The program must
include experience in the following areas of the specialty:
- rehabilitation
of patients with acquired brain injury (including traumatic brain
injury and stroke)
- diagnosis,
management and rehabilitation of patients with peripheral nerve
disorders and muscle diseases
- rehabilitation
of patients with common and complex musculoskeletal disorders
including polytrauma and burns, rheumatic disorders and
inflammatory joint disease
- rehabilitation
of patients with spinal cord disorders (including spinal cord
injury)
- rehabilitation
of amputees and the principles of prosthetic and orthotic
management
- rehabilitation
of the disabled child and adolescent
- diagnosis
and comprehensive management of musculoskeletal disorders and pain
syndromes
- rehabilitation
of patients with cardiopulmonary disorders
i.
Ambulatory
The
program must provide ambulatory care experiences including appropriate
clinical space and support resources. Such services may be in a
traditional hospital outpatient clinic area, or in other settings
including a private office. Supervision by an appropriate clinical
preceptor must be readily available to the resident for consultation at
all times, consistent with the resident's level of training. Timely
review of all consultations with the preceptor must occur.
j.
Consultation
Resident
responsibilities must include consultations to services of all related
medical and surgical disciplines (e.g. internal medicine, neurology,
neurosurgery, orthopedic surgery, plastic surgery, and rheumatology), in
sufficient numbers to allow exposure to and experience in physiatric
consultation practice.
k.
Community Learning Experiences
All
programs should facilitate elective community based rotations. These
rotations/experiences may contain any mix of inpatient, ambulatory care
and consultation responsibilities occurring outside a tertiary
rehabilitation centre or unit.
- Supporting
Services Specific to Physical Medicine and Rehabilitation —
Clinical, Diagnostic, Technical
.
Institutions participating in the program must have access to
supporting facilities including diagnostic and consulting services
(pathology; radiology, especially musculoskeletal and neuroradiology;
nuclear medicine; ultrasonography; and electrodiagnosis).
a.
Adequate and prompt access to emergency support services must be
available to all facilities in which training occurs. This must be
sufficient to ensure quality of care and prevent inappropriate
assumption of acute or intensive care roles on the part of residents and
rehabilitation staff while on rehabilitation services.
b.
The participating teaching services must have adequate facilities
and rehabilitation professional and support staff, appropriate for the
size of that institution and its Physical Medicine and Rehabilitation
service. There should be good liaison between the Physical Medicine and
Rehabilitation services and community providers such as home care,
geriatric or long term care programs and support groups for the
disabled.
ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM:
The academic and
scholarly aspects of the program must be commensurate with the concept
of a university postgraduate education. The quality of scholarship in
the program will, in part, be demonstrated by a spirit of enquiry during
clinical discussions, rounds, and conferences. Scholarship implies an
in-depth understanding of basic mechanisms of normal and abnormal states
and the application of current knowledge to practice.
Specific additional
requirements are listed below.
Organized
Scholarly Activities
Clear scheduling of
all academic/learning opportunities must exist so that there is
protected time from clinical duties for core educational sessions. This
may be provided by an academic half-day or may be distributed throughout
the week.
There must be a
planned, coordinated program that includes the following activities:
- structured
clinical and basic science educational sessions relevant to physical
medicine and rehabilitation
- critical
appraisal of the literature and principles of evidence based
medicine (e.g. journal clubs or other academic activities such as
courses in biostatistics and critical appraisal of data)
- knowledge
of administrative and organizational structures of hospitals, and
regional, provincial and national organizations.
Biomedical
Ethics
Programs must
ensure that residents receive a formal understanding of ethical issues
related to clinical practice, research and particularly to people with
disabilities. Teaching may occur in formal seminars, courses or
workshops and as part of the clinical training in rehabilitation.
Communication
Skills
Programs must
ensure that residents acquire the requisite skills to communicate
effectively with patients, families, other physicians, allied health and
rehabilitation professionals and community groups in settings that
include team and family meetings.
Faculty Research
A satisfactory
level of research and scholarly activity must be maintained among the
faculty identified with the program. It is desirable that the department
or division have clinician-researchers with the time and aptitude to act
as mentors for residents in their research. Programs must ensure that,
where there are no opportunities within the department, that researchers
in related fields have been identified to act as collaborative research
mentors.
PROGRAMS
(WITH TRAINING REQUIREMENTS):
Diplomas(Dip):
Six
months of approved residency training.
Doctor
of Medicine(M.D):
Eighteen
months of approved residency training.
Doctor
of Philosophy(Ph.D):
Forty
eight months(four years)of approved residency training.
|