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 Table of Contents  
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 55-57

4.1 The education of the specialist of physical and rehabilitation medicine: Undergraduate education

1 Department of Physical Medicine and Rehabilitation, Texas Medical Center, Baylor College of Medicine; Department of Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, Virginia, USA
2 Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia; Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA

Date of Web Publication11-Jun-2019

Correspondence Address:
Associate Prof Rochelle T Dy
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge St. Houston, Texas, 77030; Department of Physical Medicine and Rehabilitation, Houston, TX
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisprm.jisprm_14_19

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How to cite this article:
Dy RT, Lew HL. 4.1 The education of the specialist of physical and rehabilitation medicine: Undergraduate education. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:55-7

How to cite this URL:
Dy RT, Lew HL. 4.1 The education of the specialist of physical and rehabilitation medicine: Undergraduate education. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:55-7. Available from: http://www.jisprm.org/text.asp?2019/2/2/55/259340

  Introduction Top

The need for the integration of Physical and Rehabilitation Medicine (PRM) in the undergraduate medical curriculum has long been recognized.[1],[2],[3] With the rising prevalence of chronic and disabling conditions, as well as the increasing aging population, is it all the more crucial that the principles of rehabilitation medicine be incorporated as one of the basic foundational concepts every medical student should understand.

Traditional medical curriculum focuses on curative approaches to acute illness and injuries, oftentimes neglecting the rehabilitation care that follows. Subspecialization may have played a part in fragmented care, with little attention to the holistic approach to the impact of illness or injury on the functional recovery. However, it is becoming a realization that patients treated by all specialties have rehabilitative needs.[3] The emergence of managed care model, with the primary care physician as the main health provider, and other changes in governmental policies affecting health-care provision/distribution precludes the need for a more comprehensive training in the care of individuals with impairments and disabilities, or at least have a better knowledge when to refer to a PRM specialist. The U.S. Liaison Committee on Medical Education, the United Kingdom General Medical Council, and the Australian Medical Council all have made recommendations that disability, care of the elderly, and rehabilitation courses ought to be included in the medical education experience.[1],[4],[5]

  Benefits of Physical and Rehabilitation Medicine in Undergraduate Curriculum Top

From a general clinical perspective:

  • Important contribution of PRM to the healthcare of many individuals
  • PRM interdisciplinary approach, team management concepts, and leadership principles bring a unique contribution to medical student training
  • Continuum of care model: Practice of medicine through multiple stages and settings of care[2]
  • From the patient's perspective, every doctor has to be able to identify and respond to at least some basic rehabilitation needs.

From a specialty perspective:

  • Increase information dissemination about our specialty, both to the public and our colleagues, and highlights the value of PRM as a specialty
  • Growth of the specialty – increase awareness of PRM as a potential career option and eventual recruitment of strong and enthusiastic medical students into the field.[2]

Over the last decade, position statements from national and international associations, observational studies, surveys, and recommendations regarding teaching of rehabilitation medicine to medical students have been published. However, despite the recognized need, this remains to be a challenge globally.

  Current State and Challenges in Physical and Rehabilitation Medicine Undergraduate Education Top

Lack of consistent curriculum

This is a worldwide issue. Not all medical schools include PRM in their education syllabus, and if so, there remains a wide variation with regard to content, structure, and emphasis.[1] Program description and curriculum design are highly based on respective institutional mandates or provisions and/or limitations.

Variable resources

Formal teaching or didactic courses dedicated for PRM typically range from 1 to 2 weeks. Availability for exposure to PRM practice is also very variable in clinical rotations and for the most part is only offered as an elective rotation. Even in developed countries where PRM practice is well established, there are some medical schools wherein clinical clerkship PRM rotation is not available. Thus, a student interested in this field may need to seek out rotations outside their designated/affiliated institutions.

Perception of medical students and other medical specialties

Medical students often have marginal knowledge of PRM and only realize its existence as a separate specialty just prior to clerkship. Its decreased popularity may possibly be due to competition from other specialties, emphasis placed mainly on primary care in medical school curricula, fragmented and inconsistent teaching in rehabilitation medicine, and student impression of lack of prestige and academic and research opportunities in PRM.[1]

  Undergraduate Curriculum Top

In the United States, the Association of Academic Physiatrists Undergraduate Education Committee workgroup developed curriculum goals and objectives for medical students depending on the amount of rehabilitation formal teaching and exposure they may receive. A standard curriculum is suggested for a 2-week educational experience, and a minimum curriculum would be adequate for those 1 week or less exposure to PRM.[3] A collaborative effort among European bodies successfully produced the White Book on PRM in Europe, outlining similar general concepts and principles that needed to be covered in undergraduate teaching.[6] The British Society of Rehabilitation Medicine and the Australasian Faculty of Rehabilitation Medicine have also provided a set of more detailed learning objectives for the PRM undergraduate curriculum which is very much in line with the others and applicable worldwide.[4],[7]

Goals for undergraduate teaching program in PRM:[3],[4],[5],[6],[7]

  1. Provide awareness to the medical practitioner regarding the assessment and care of individuals with disabilities that present for evaluation and a framework on where to look to obtain further information
  2. Provide an awareness of the psychosocial and ethical issues faced by the individual with disability or chronic illness (including International Classification of Functioning, Disability and Health as model and classification) and an understanding of the wider impact of long-term conditions on daily living activities
  3. Provide an appreciation of the need for a functional- or outcomes-based approach to the continuum of medical care
  4. Introduce chronic disease concept in human functioning; link to anatomical and physiological changes; and understand need to treat more than the medical problems alone
  5. Directly correlate anatomy and pathology with chronic disease manifestations and understand the principles of managing the disabling effects of long-term conditions
  6. Provide an exposure to the interdisciplinary/multidisciplinary team approach in providing medical care
  7. Provide a fundamental core of knowledge in the physical diagnosis and treatment of disabling diseases and injuries, encountered in the routine practice of medicine
  8. Provide a fundamental core of knowledge to address the prevention of conditions or complications, which lead to impairment, disability, or handicap
  9. Develop mature attitudes and behavior toward people with disability and their families and engender a life-long learning attitude in relation to disabling effects of long-term conditions.

  Curriculum Implementation and Effectiveness Top

The recommendations put forth by various PRM societies worldwide are a reflection of the specialty's unified aim and mission toward standardization of expected knowledge and attitudes of medical graduates regarding the care of individuals with disability and rehabilitation needs. However, the bigger hurdle is the actual implementation of the curriculum in medical school. A lot of topics need to be fitted into a very limited amount of time, with a great likelihood of overlapping topics with other specialties. In some institutions, PRM is taught in conjunction with rheumatology, neurology, orthopedic, and neurosurgery.[1] Thus, it is crucial that close links between the clinicians and academicians be maintained, and careful planning with ongoing review process, to implement the rehabilitation curriculum, and how it fits into the whole medical program is vital to provide an efficient and effective educational experience for the students.[1],[7]

In Germany, the Hannover Medical School adopted a systematic approach model, wherein theoretical and clinical concepts were integrated among specialties and introduced early on, with repetition of subjects as levels advance, setting up a “learning spiral.” This, in addition to the dedicated 2-week standard rehabilitation course of theoretical and hands-on workshop, allowed for better retention of the subject and was noted to be a successful and well-accepted model.[8]

Other suggestions to enhance physical and rehabilitation teaching include:[1],[7]

  1. Early introduction of PRM to undergraduate curriculum
  2. Physical examination workshops and simulated clinical situations over straightforward lectures;[9] field trips to clinics/schools with PRM host, and home visits with patients with disability
  3. Ensure adequate funding of teaching sessions
  4. Keeping didactic teaching and lectures to a minumum while having more hands-on workshop sessions for skill acquisition may be key to better student engagement.[10]
  5. Emphasize functional assessment in teaching
  6. Include student feedback in course development
  7. Involve patients in teaching and even in the course development
  8. Interprofessional education where students from 2 or more professions in health and social care learn together with the object of cultivating collaborative practice for providing client- or patient-centered health care (e.g., medical, orthotics, and prosthetics, physical therapy student seeing an amputee patient)
  9. Transdisciplinary and interyear approach to the inclusion of rehabilitation concepts and aptitudes[11]
  10. The use of new technology and multimedia as methods in medical education, making resources available online, integration across different disciplines, courses, and assessments.

Stretching learning outside of the school setting can also be done through student membership and active involvement in local/national/international PRM societies, having medical student tracks in annual conferences, mentorship program, medical student essay contests, and exchange programs for medical and paramedical rehabilitation professionals.

  Conclusion Top

The lack of consistent curriculum in PRM is a worldwide issue. Understanding that while variations in the medical education systems and resources globally are inevitable, having a unified standard undergraduate core syllabus for rehabilitation medicine is equally important as its implementation. Curriculum designs can be complex and will need ongoing improvement process through a monitored feedback loop. The success of achieving the learning objectives and expected competencies depend greatly on the active engagement of the physiatrist. It is a responsibility that we all share not only for the growth of the field, but more importantly as a service to our patients and the community, beyond cultural, geographic and ethnic barriers.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Gibson J, Lin X, Clarke K, Fish H, Phillips M. Teaching medical students rehabilitation medicine. Disabil Rehabil 2010;32:1948-54.  Back to cited text no. 1
Bloch RM, Blake DJ, Fiedler IG. Integration of physical medicine and rehabilitation into the undergraduate medical curriculum. The undergraduate education committee of the association of academic physiatrists workgroup. Am J Phys Med Rehabil 1996;75:242-3.  Back to cited text no. 2
Tuel SM, Meythaler JM, Penrod LE. Educational goals and objectives in physical medicine and rehabilitation for the medical school graduate. Association of academic physiatrists undergraduate education committee workgroup. Am J Phys Med Rehabil 1996;75:149-51.  Back to cited text no. 3
Medical Deans Australia and New Zealand Inc. Developing a Framework of Competencies for Medical Graduate Outcomes: Final Report. Available from: http://www.medicaldeans.org.au/wp-content/uploads/Competencies-Project-Final-Report.pdf. [Last accessed on 2018 Mar 20].  Back to cited text no. 4
Graham S, Eley D, Cameron I, Thistlethwaite J. Inclusion of rehabilitation medicine concepts in school of medicine resources. Disabil Rehabil 2014;36:1555-61.  Back to cited text no. 5
Grutenbrunner C, Ward A, Chamberlain MA. White book on physical and rehabilitation medicine in Europe. Eura medicophys 2006;42:287-332. J Rehabil Med 2007; Suppl 45:1-48.  Back to cited text no. 6
British Society of Rehabilitation Medicine. Undergraduate Medical Education in Rehabilitation Medicine. London: British Society of Rehabilitation Medicine; 2006.  Back to cited text no. 7
Gutenbrunner C, Schiller J, Schwarze M, Fischer V, Paulmann V, Haller H, et al. Hannover model for the implementation of physical and rehabilitation medicine teaching in undergraduate medical training. J Rehabil Med 2010;42:206-13.  Back to cited text no. 8
Altschuler EL, Cruz E, Salim SZ, Jani JB, Stitik TP, Foye PM, et al. Efficacy of a checklist as part of a physical medicine and rehabilitation clerkship to teach medical students musculoskeletal physical examination skills: A prospective study. Am J Phys Med Rehabil 2014;93:82-9.  Back to cited text no. 9
Laskowski E, Moutvic M, Smith J, Newcomer-Aney K, Showalter, C. Integration of Physical Medicine and Rehabilitation into a Medical School Curriculum. Am J Phys Med Rehabil 2000;79:551-7.  Back to cited text no. 10
Ankam N. Implementation of a Fourth Year Rehabilitation Curriculum for Medical Students. Poster Presentation. Sacramento, CA: Association of Academic Physiatrists Annual Metting; 2016.  Back to cited text no. 11


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