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House Staff Manual Volume 1 MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL MEDSTAR NATIONAL REHABILITATION HOSPITAL Physical Medicine & Rehabilitation Residency Training Program CURRICULUM MANUAL 2 Integrated Competency Based Curriculum 2012-2013 Integrated Competency Based Curriculum Adding Physiatrists who Care© 1 Integrated Competency Based Curriculum 2012-2013 A word from the residency program director On behalf of the faculty, I welcome you to the MedStar National Rehabilitation Hospital and wish you every success. We believe that each house officer contributes directly to the MedStar NRH’s growth and prosperity, and we hope you will take pride in being a member of our team. Postgraduate medical training is the basis for your future practice. It is the foundation on which you will build your approach to patient care. These years will be among your most challenging, rewarding and enjoyable. The Graduate Medical Education Committee, the Residency Training Office, the administration and professional staff are committed to delivering a top-quality educational experience. Input from the house staff is welcomed and solicited on a continuous basis. In 2002 the MedStar National Rehabilitation Hospital’s PM&R program merged with the MedStar Georgetown University Hospital to form the quintessential learning environment to produce our next generation of quality Physiatrist - physicians in the field of Physical Medicine & Rehabilitation. This curriculum has taken many hours of our dedicated faculty’s time to create. I believe this program to be one of the best in the country. It is my honor to serve as a mentor, leader and provider of education to our residents. Sincerely, Curtis L. Whitehair, MD Program Director, MEDSTAR GUH - MEDSTAR NRH PM&R Residency Training Program 2 Integrated Competency Based Curriculum 2012-2013 GUH- NRH PM&R RESIDENCY What you will find in this guide In this manual, you will get information on how our program is structured to deliver a high quality educational experience for the resident physician in our Physical Medicine & Rehabilitation training program. • Domain Structures • Progression of Responsibility • Rotations • Didactic Topics • Assessment Tools • Current Outcomes 3 Integrated Competency Based Curriculum 2012-2013 GUH- NRH PM&R RESIDENCY Table of Contents A word from the residency program director ............................................................................................................... 2 WHAT YOU WILL FIND IN THIS GUIDE ............................................................................................................................... 3 TABLE OF CONTENTS ...............................................................................................................................................................4 INTRODUCTION ....................................................................................................................................................................... 17 Overall Educational Goals of the Program ........................................................................................................... 18 Curriculum Framework ........................................................................................................................................ 18 Progression of Learning and Responsibility .......................................................................................................... 20 PGY 2 Level (Care of Inpatients and Exposure to Ambulatory Care) ........................................................................... 20 PGY 3 Level (Care of Inpatients and Outpatient (Predominant), Pediatric Rehabilitation and Electrodiagnostic Studies) ........................................................................................................................................................................ 20 PGY 4 Level (Consultative Care, Electives/Selectives, Ambulatory Care, Electrodiagnostic Studies and Senior Inpatient Rotation) ...................................................................................................................................................... 21 Criteria Used at All Training Levels to Assess Progression of Learning ........................................................................ 22 DOMAINS ................................................................................................................................................................................... 23 Electrodiagnostic Medicine .................................................................................................................................. 24 Goals & Objectives – Beginners ................................................................................................................................... 24 Patient Care ................................................................................................................................................................. 24 Medical Knowledge ..................................................................................................................................................... 24 ANATOMY & PHYSIOLOGY ..................................................................................................................................... 24 Instrumentation..................................................................................................................................................... 25 Nerve conduction Studies (NCS) ............................................................................................................................ 25 Needle Electromyography (EMG) .......................................................................................................................... 26 Practice-Based Learning and Improvement ................................................................................................................ 26 Interpersonal and Communication Skills ..................................................................................................................... 27 Professionalism ............................................................................................................................................................ 27 System-Based Practice ................................................................................................................................................. 27 Goals & Objectives – Advanced ................................................................................................................................... 27 Patient Care ................................................................................................................................................................. 27 Medical Knowledge ..................................................................................................................................................... 28 ANATOMY & PHYSIOLOGY ..................................................................................................................................... 28 Nerve Conduction studies (NCS) ............................................................................................................................ 29 Electromyography(EMG) ....................................................................................................................................... 29 Practice-Based Learning and Improvement ................................................................................................................ 29 Interpersonal and Communication Skills ..................................................................................................................... 30 Professionalism ............................................................................................................................................................ 30 System-Based Practice ................................................................................................................................................. 30 Didactics Lectures ........................................................................................................................................................ 30 4 Integrated Competency Based Curriculum 2012-2013 GUH- NRH PM&R RESIDENCY See Didactics – Chapter 4 ............................................................................................................................................ 30 SCI Rehabilitation ................................................................................................................................................ 31 Goals & Objectives ....................................................................................................................................................... 31 Patient Care ................................................................................................................................................................. 31 Medical Knowledge ..................................................................................................................................................... 32 Practice-Based Learning and Improvement ................................................................................................................ 33 Interpersonal and Communication Skills ..................................................................................................................... 34 Professionalism ...........................................................................................................................................................
Recommended publications
  • Diagnoses to Include in the Problem List Whenever Applicable
    Diagnoses to include in the problem list whenever applicable Tips: 1. Always say acute or open when applicable 2. Always relate to the original trauma 3. Always include acid-base abnormalities, AKI due to ATN, sodium/osmolality abnormalities 4. Address in the plan of your note 5. Do NOT say possible, potential, likely… Coders can only use a real diagnosis. Make a real diagnosis. Neurological/Psych: Head: 1. Skull fracture of vault – open vs closed 2. Basilar skull fracture 3. Facial fractures 4. Nerve injury____________ 5. LOC – include duration (max duration needed is >24 hrs) and whether they returned to neurological baseline 6. Concussion with or without return to baseline consciousness 7. DAI/severe concussion with or without return to baseline consciousness 8. Type of traumatic brain injury (hemorrhages and contusions) – include size a. Tiny = <0.6 cm b. Small/moderate = 0.6-1 cm c. Large/extensive = >1 cm 9. Cerebral contusion/hemorrhage 10. Cerebral edema 11. Brainstem compression 12. Anoxic brain injury 13. Seizures 14. Brain death Spine: 1. Cervical spine fracture with (complete or incomplete) or without cord injury 2. Thoracic spine fracture with (complete or incomplete) or without cord injury 3. Lumbar spine fracture with (complete or incomplete) or without cord injury 4. Cord syndromes: central, anterior, or Brown-Sequard 5. Paraplegia or quadriplegia (any deficit in the upper extremity is consistent with quadriplegia) Cardiovascular: 1. Acute systolic heart failure 40 2. Acute diastolic heart failure 3. Chronic systolic heart failure 4. Chronic diastolic heart failure 5. Combined heart failure 6. Cardiac injury or vascular injuries 7.
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  • Schwann Cell Supplementation in Neurosurgical Procedures After Neurotrauma Santiago R
    ll Scienc Ce e f & o T l h a e Unda, J Cell Sci Ther 2018, 9:2 n r a r a p p u u DOI: 10.4172/2157-7013.1000281 y y o o J J Journal of Cell Science & Therapy ISSN: 2157-7013 Review Open Access Schwann Cell Supplementation in Neurosurgical Procedures after Neurotrauma Santiago R. Unda* Instituto de Biotecnología, Centro de Investigación e Innovación Tecnológica, Universidad Nacional de La Rioja, Argentina *Corresponding author: Santiago R. Unda, Instituto de Biotecnología, Centro de Investigación e Innovación Tecnológica, Universidad Nacional de La Rioja, Argentina, Tel: 3804277348; E-mail: [email protected] Rec Date: January 12, 2018, Acc Date: March 13, 2018, Pub Date: March 16, 2018 Copyright: © 2018 Santiago R. Unda. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Nerve trauma is a common cause of quality of life decline, especially in young people. Causing a high impact in personal, psychological and economic issues. The Peripheral Nerve Injury (PNI) with a several grade of axonotmesis and neurotmesis represents a real challenge for neurosurgeons. However, the basic science has greatly contribute to axonal degeneration and regeneration knowledge, making possible to implement in new protocols with molecular and cellular techniques for improve nerve re-growth and to restore motor and sensitive function. The Schwann cell transplantation from different stem cells origins is one of the potential tools for new therapies. In this briefly review is included the recent results of animal and human neurosurgery protocols of Schwann cells transplantation for nerve recovery after a PNI.
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  • Two Types of Delayed Post-Traumatic Intracerebral Hematoma
    Two Types of Delayed Post-Traumatic Intracerebral Hematoma Takashi TSUBOKAWA Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173 Summary The findings of repeated CT scans, clinicalcourses and pathologicalstudies in 28 cases of delayed post-traumatic intracerebral hematoma were studied retrospectivelyto elucidate the mechanism of bleeding and to establish adequate treatment. Based on the results obtained, it became clear that there are two types of delayed hematoma. In 10 of the 28 cases, initial CT findings within 6 hours after head injury revealed cerebral contusion or hemorrhagic contusion, and spots of high density scattered in the low density zone gradually became confluent to form an irregularly shaped hematoma according to follow-up CT findings. This was termed "hematoma within a contusional area." In 15 of the 28 cases, initial CT findings within 6 hours after head injury revealed no abnormal density within the brain and the hematoma appeared suddenly 3 6 days after the injury. In eight of the 15 cases, emergency surgery was performed for the removal of epidural or subdural hematoma. This type of hematoma is termed "contusional hem atoma" and constitutes the second group. In three of the 28 cases, both types of hematoma were observed. Based on histological findings for the two types of delayed hematoma. The first group may be induced by an anoxic vasodilation mechanism (Evans et al.9)), while the second group may be derived from a different mechanism related to ishemic changes and the free radical reaction caused by the reflow phenomenon (Tsubokawa et al.14-16)1 It is important to establish correct diagnoses 1for delayed hematomas based on differences between follow-up findings of repeated CT and an initial CT performed within 6 hours after head injury since the operative indications and operative results for the two groups are different as indicated by our 28 cases.
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  • Management of the Head Injury Patient
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  • Types and Classification of Nerve Injury: a Review
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  • Sports-Related Concussions: Diagnosis, Complications, and Current Management Strategies
    NEUROSURGICAL FOCUS Neurosurg Focus 40 (4):E5, 2016 Sports-related concussions: diagnosis, complications, and current management strategies Jonathan G. Hobbs, MD,1 Jacob S. Young, BS,1 and Julian E. Bailes, MD2 1Department of Surgery, Section of Neurosurgery, The University of Chicago Pritzker School of Medicine, Chicago; and 2Department of Neurosurgery, NorthShore University HealthSystem, The University of Chicago Pritzker School of Medicine, Evanston, Illinois Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diag- nosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7–10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.
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  • Enhanced Repair Effect of Toll-Like Receptor 4 Activation on Neurotmesis: Assessment Using MR Neurography
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  • Perioperative Upper Extremity Peripheral Nerve Injury and Patient Positioning: What Anesthesiologists Need to Know
    Anaesthesia & Critical Care Medicine Journal ISSN: 2577-4301 Perioperative Upper Extremity Peripheral Nerve Injury and Patient Positioning: What Anesthesiologists Need to Know Kamel I* and Huck E Review Article Lewis Katz School of Medicine at Temple University, USA Volume 4 Issue 3 Received Date: June 20, 2019 *Corresponding author: Ihab Kamel, Lewis Katz School of Medicine at Temple Published Date: August 01, 2019 University, MEHP 3401 N. Broad street, 3rd floor outpatient building ( Zone-B), DOI: 10.23880/accmj-16000155 Philadelphia, United States, Tel: 2158066599; Email: [email protected] Abstract Peripheral nerve injury is a rare but significant perioperative complication. Despite a variety of investigations that include observational, experimental, human cadaveric and animal studies, we have an incomplete understanding of the etiology of PPNI and the means to prevent it. In this article we reviewed current knowledge pertinent to perioperative upper extremity peripheral nerve injury and optimal intraoperative patient positioning. Keywords: Nerve Fibers; Proprioception; Perineurium; Epineurium; Endoneurium; Neurapraxia; Ulnar Neuropathy Abbreviations: PPNI: Perioperative Peripheral Nerve 2018.The most common perioperative peripheral nerve Injury; MAP: Mean Arterial Pressure; ASA CCP: American injuries involve the upper extremity with ulnar Society of Anesthesiology Closed Claims Project; SSEP: neuropathy and brachial plexus injury being the most Somato Sensory Evoked Potentials frequent [3,4]. In this article we review upper extremity PPNI with regards to anatomy and physiology, Introduction mechanisms of injury, risk factors, and prevention of upper extremity PPNI. Perioperative peripheral nerve injury (PPNI) is a rare complication with a reported incidence of 0.03-0.1% [1,2]. Anatomy and Physiology of Peripheral PPNI is a significant source of patient disability and is the Nerves second most common cause of anesthesia malpractice claims [3,4].
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  • En 13-Correlation Between.P65
    Morgado FL et al. CorrelaçãoARTIGO entre ORIGINAL a ECG e •achados ORIGINAL de imagem ARTICLE de TC no TCE Correlação entre a escala de coma de Glasgow e os achados de imagem de tomografia computadorizada em pacientes vítimas de traumatismo cranioencefálico* Correlation between the Glasgow Coma Scale and computed tomography imaging findings in patients with traumatic brain injury Fabiana Lenharo Morgado1, Luiz Antônio Rossi2 Resumo Objetivo: Determinar a correlação da escala de coma de Glasgow, fatores causais e de risco, idade, sexo e intubação orotraqueal com os achados tomográficos em pacientes com traumatismo cranioencefálico. Materiais e Métodos: Foi realizado estudo transversal prospectivo de 102 pacientes, atendidos nas primeiras 12 horas, os quais receberam pontuação segundo a escala de coma de Glasgow e foram submetidos a exame tomográfico. Resultados: A idade média dos pacientes foi de 37,77 ± 18,69 anos, com predomínio do sexo masculino (80,4%). As causas foram: acidente automobilístico (52,9%), queda de outro nível (20,6%), atropelamento (10,8%), queda ao solo ou do mesmo nível (7,8%) e agressão (6,9%). No presente estudo, 82,4% dos pacientes apresentaram traumatismo cranioencefálico de classificação leve, 2,0% moderado e 15,6% grave. Foram observadas alterações tomográficas (hematoma subgaleal, fraturas ósseas da calota craniana, hemorragia subaracnoidea, contusão cerebral, coleção sanguínea extra-axial, edema cerebral difuso) em 79,42% dos pacientes. Os achados tomográficos de trauma craniano grave ocorreram em maior número em pacientes acima de 50 anos (93,7%), e neste grupo todos necessitaram de intubação orotraqueal. Con- clusão: Houve significância estatística entre a escala de coma de Glasgow, idade acima de 50 anos (p < 0,0001), necessidade de intubação orotraqueal (p < 0,0001) e os achados tomográficos.
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  • Development of a Z-Stack Projection Imaging Protocol for a Nerve Allograft
    DEVELOPMENT OF A Z-STACK PROJECTION IMAGING PROTOCOL FOR A NERVE ALLOGRAFT by SELVAANISH SELVAM Submitted in partial fulfillment of the requirements for the degree of Master of Science Dissertation Advisor: Dr. George F. Muschler Department of Biomedical Engineering CASE WESTERN RESERVE UNIVERSITY August 2018 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis of Selvaanish Selvam candidate for the degree of (Master of Science) *. Committee Chair Dr. George F. Muschler Committee Member Dr. Eben Alsberg Committee Member Dr. Robert Kirsch Committee Member Cynthia Boehm Date of Defense May 4th 2018 *we also certify that written approval has been obtained For any proprietary material contained therein 2 Table of Contents List of Tables……………………………………………………………………..4 Figures List……………………………………………………………………….5 Acknowledgments………………………………………………………………..6 List of Abbreviations………………………………………………………….....7 Abstract…………………………………………………………………………...8 Introduction……………………………………………………………………..10 Methods………………………………………………………………………….21 Data and Analysis………………………………………………………………31 Conclusions and Future Directions……………………………………………51 References……………………………………………………………………….53 3 List of Tables Table 1: Overall summary of ratios and retention rates……………………..31 Table 2: Selection Ratio for grafts (3X – 10-minute rinse) ………………….35 Table 3: Selection Ratio for grafts (15-minute soak) ………………………...35 4 List of Figures: Figure 1: 2D 10X DAPI stained image using current techniques…….……….9 Figure 2: Peripheral Nerve Anatomy………………………………………….10
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  • Restoration of Neurological Function Following Peripheral Nerve Trauma
    International Journal of Molecular Sciences Review Restoration of Neurological Function Following Peripheral Nerve Trauma Damien P. Kuffler 1,* and Christian Foy 2 1 Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, 201 Blvd. del Valle, San Juan, PR 00901, USA 2 Section of Orthopedic Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00901, USA; [email protected] * Correspondence: dkuffl[email protected] Received: 12 January 2020; Accepted: 3 March 2020; Published: 6 March 2020 Abstract: Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery.
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  • Traumatic Brain Injury(Tbi)
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