Faculty Bibliography

Objective: To understand if simplifying access to information can help streamline knowledge attainment and understanding of the great breadth of services and research ongoing in the field of rehabilitation medicine. Design: A podcast was created featuring leaders in the field to discuss key topics relating to value, outcomes, innovation, challenges, and opportunities, as well as to delve into specific specialty-related matters in short 15-minute segments, enhancing access to critical information through short-form burst content in a channel undergoing a resurgence in popularity. Setting: Large academic medical center. Participants: Over 70 leaders over 8 months have provided insights through this channel, including live streams from the AAPM&R conference. Interventions: Not applicable. Main Outcome Measures: Downloads, reviews, participation. Results: The podcast has generated over 14,000 downloads from 12 different countries and all 50 states plus 80 reviews on iTunes, and has featured past executive members of the AAPM&R as well as leaders in allied health, physicians, and researchers in the field. Medical students, residents, and healthcare providers report great satisfaction with the experience in learning about the field and the specific elements within it and a long list of guests is pending. Offshoots of the program are in the process of being finalized including panel discussions, educational modules, and topic-based reviews to further generate interest in and knowledge of scientific advancements in the field of PM&R. Conclusions: It is imperative to share information related to the specialties within rehabilitation medicine as well as on the scientific and research advances that are driving the field. Providing insights from thought leaders throughout the field, coupled with specific examples of application in a medium that permits quick bursts of content has proven successful and sparked greater awareness of and participation in the scientific rudiments of the field

INTRODUCTION: To evaluate patient expectations, concerns, and satisfaction during physical medicine and rehabilitation (PM&R) inpatient hospitalization. Patients were also asked to comment on what resources might benefit them during their stay. DESIGN: More than 150 PM&R patients were asked to fill out a self-administered survey in a cross-sectional design. Patients receiving care under 5 other specialties (general medicine, obstetrics and gynecology, general surgery, orthopedics, and neurology) also were surveyed to determine whether qualitative differences existed between PM&R and other departments. In all, more than 1100 patients were given surveys to complete. Patients rated how concerned they were with more than 20 elements of their hospitalization, ranging from quality of food to pain management. Questions were divided into 2 sections: retrospectively before hospitalization and during current admission. SETTING: This study was completed in a large tertiary care PM&R facility with an adjoining medical center in an urban area. PARTICIPANTS: Patients were given the option to complete this survey in an anonymous fashion during their hospital stay. All those who did so were included in this analysis. Six different specialties were represented in the final tally, but the emphasis was on the PM&R department. MAIN OUTCOME MEASUREMENTS: The survey itself included more than 20 questions regarding the details of patients' hospital stays and how concerned they were with them. These categories included plans after discharge, duration of hospitalization, pain management, follow-up of medical issues, cost, insurance, and familiarity with diagnosis, physician, and medications. Other outcomes included patient input into what interventions they thought would most benefit them as well as a global satisfaction rating. RESULTS: Data analysis was performed with SPSS. Tukey tests provided comparison information across specialties. The response rate within PM&R was 68% (n = 128), whereas for all specialties combined it was 54% (n = 606). Multiple factors were found to be significant when examining expectations versus actual admission concerns. Most prominently within PM&R, patients indicated that they were less concerned during their admission than they thought they would be about potential duration of hospitalization (P < .001), understanding of diagnosis (P < .04), follow-up of medical issues (P < .01), and plan of care (P < .001), among others. However, patient expectations in other areas did not change or were negatively affected, such as help at home (P < .05), plans for discharge (P < .001), family involvement at home (P < .01), and future pain management at home (P < .05). Furthermore, qualitative comparisons among other specialties demonstrated differences in many areas. CONCLUSION: Results support the idea that the multidisciplinary approach inherent in PM&R positively alters many patient expectations related to outcomes. This has direct relevance to patient satisfaction and outcomes and warrants further investigation. The authors offer some potential interventions for future improvement in this area

OBJECTIVE: To examine the effects of implementing a peer review evaluation system on residents' attitudes and perceptions of professionalism, a core competency of the Accreditation Council for Graduate Medical Education (ACGME), in a Physical Medicine and Rehabilitation (PM&R) program. DESIGN: Four classes of residents were divided prospectively into a control and an intervention group. All residents were asked to complete a survey regarding their attitudes and perceptions on both peer review and professionalism. Only 2 of these classes participated in a newly adopted peer review evaluation system, after which time all participants were again asked to fill out the surveys. SETTING: Residents were from a PM&R residency program at an urban tertiary care medical center. PARTICIPANTS: All residents who completed the entire survey preintervention and postintervention were included. METHODS: The intervention was the introduction of peer review into residents' evaluation assessments. All residents filled out a survey with questions relating to peer review and professionalism before and after this intervention. MAIN OUTCOME MEASUREMENTS: Outcomes include understanding how residents perceive various attributes of professionalism, peer review, and the interconnection of the 2. RESULTS: Data analysis using SPSS was performed using survey scores for 46 residents preintrodution and postintroduction of a peer review evaluation system. Analysis revealed that residents who participated in the peer review process were more likely to agree that certain aspects of daily patient care, behaviors, and concepts were components of professionalism. However, they continued to believe that residents are ultimately not responsible for their colleagues' professionalism and that peer review might be harmful to a residency program. CONCLUSION: This study introduces an interesting dichotomy. Peer review clearly influences resident outlook on professionalism and yet there is a high suspicion regarding its implementation. If appropriately implemented, peer review may be a potent method of enhancing the education of this ACGME requirement

OBJECTIVE: This study explores physical medicine and rehabilitation (PM&R) residents' attitudes, knowledge, and perception of health care policy in the context of systems-based practice, one of the Accreditation Council for Graduate Medical Education's core competencies for residency training. DESIGN: A cross-sectional, observational design was used via survey administration. These surveys were categorized into 6 different sections: (1) general health care policy; (2) resident awareness of and involvement in policy matters; (3) specific policy pertaining to physical medicine and rehabilitation; (4) rehabilitation alternatives to acute care; (5) documentation; and (6) educational exposure. Residents filled the survey anonymously, noting only their postgraduate year and program name for identification. SETTING: This study was conducted at 3 large PM&R residency programs in Pennsylvania, New Jersey, and New York. PARTICIPANTS: Residents participating in this study totaled 32 from Program A, 26 from Program B, and 18 from Program C. METHODS: Residents at all 3 programs were asked to complete a 34-question survey. In total, 57 surveys were evaluated. The response rates for completing the entire survey for the 3 programs were 81% (26 of 32), 73% (19 of 26), and 67% (12 of 18). The overall response rate was 75%. Not all residents at each program were given surveys to complete. MAIN OUTCOME MEASURES: This study explored resident's attitudes, knowledge, and perception of healthcare policy. Outcomes included understanding how residents feel about the extent of their general policy education, their awareness of current issues and the organizational entities that shape these policies, and whether they should be exposed to these topics within the setting of their training programs. Responses were measured on a 1 (strongly disagree) to 9 (strongly agree) scale. Specific paired t-tests were performed on select questions to further validate the responses. RESULTS: Residents uniformly agree that healthcare policy is an important aspect of medical education and should be taught within their residency programs but do not feel that they currently play an active role in affecting change (8.1 +/- 0.8 vs. 3.4 +/- 1.6, P < .001). They admit to not being aware of how to get involved but would like to delve more into these issues (3.9 +/- 1.5 vs. 7.1 +/- 1.5, P = .01). Pertaining to PM&R-specific policy, residents believe that functional ability trumps diagnosis as the most important determinant for admission to an acute inpatient facility (7.5 +/- 1.2 vs. 5.9 +/- 1.8, P < .001). Although residents see the importance of documentation, they indicate they are not adequately trained in this area (8.2 +/- 0.7 vs. 3.9 +/- 1.1, P = .04). Finally, residents acknowledge they have limited understanding of other rehabilitation delivery options or insurance companies (5.5 +/- 1.2 and 3.5 +/- 1.7). CONCLUSION: Systems-based practice is a core requirement of residency training yet has not been extensively studied. This study suggests that residents find systems-based issues important to their overall education but are not sufficiently or effectively addressed in residency. The healthcare delivery environment including PM&R is rapidly changing. It is imperative that residents are equipped with the knowledge of and ability to adapt to these changes

OBJECTIVE: This study explores the link between neurologic deficit as measured by the National Institutes of Health Stroke Scale (NIHSS), and its relationship to length of stay (LOS) and discharge destination. DESIGN: A retrospective chart review was completed of 54 patients admitted for rehabilitation after experiencing a cerebrovascular accident. SETTING: The study was completed in an acute inpatient rehabilitation stroke unit in a large urban tertiary care medical center. PARTICIPANTS: Patients were included in this analysis if their record contained an NIHSS score on both admission and discharge, if they had neuroimaging documentation of an acute hemorrhagic or ischemic stroke, and if they were not transferred away from the rehabilitation unit during their stay. Of 54 cases reviewed, 47 were ultimately included. MAIN OUTCOME MEASUREMENTS: Independent variables included were NIHSS admission and discharge scores, change in score from admission to discharge, discharge destination, age, gender, type of stroke, and use of tissue plasminogen activator. These were examined against the dependent variable, LOS. RESULTS: Greater admission NIHSS scores predicted longer hospital stays. Mean admission and discharge scores were significantly greater for patients discharged to subacute facilities, and LOS was also longer for these patients compared with those discharged to the community. Surprisingly, age was inversely related to LOS, admission score, and discharge score. CONCLUSION: Stroke remains one of the most common reasons for admission to acute care hospitals. The authors know of no studies that have examined the rehabilitation aspect of care incorporating the NIHSS in this manner. This study draws a connection between neurologic impairment by using the NIHSS and LOS and discharge destination in an acute inpatient rehabilitation stroke unit. In the future, multidisciplinary rehabilitation teams may consider using this measure to predict LOS and disposition at discharge from inpatient rehabilitation