Mentorship in physical medicine and rehabilitation residencies.

Mentorship is considered by many authorities as being possibly the most important developmental tool for the progression of a professional in training. In recent years, progressively increasing support of mentoring programs has been documented, especially in business, academia, and overall career development. Despite its recognized importance, there is a paucity of literature examining the needs of physicians in residency training programs in regard to mentorship. A 21-item questionnaire was sent to all physical medicine and rehabilitation (PM&R) residents in training in United States residency programs in May of 1993. The objectives of this survey were 3-fold: to assess interest in mentorship among PM&R residents, to determine the effect of preresidency mentorship on candidates choosing PM&R as a specialty, and to identify the factors that establish a successful mentorship in PM&R residency. A response rate of 36.2% (406/1123) was obtained. Analysis of the results indicated that 97.3% (390/401) of the respondents were interested in mentorship programs during PM&R residency; however, only 28.1% (114/406) had a mentor at the time of the survey. Before residency, 35.4% (143/404) of the respondents had a mentor, and of those, 75.9% (107/141) indicated that mentorship had a positive effect on their decision to choose PM&R as a specialty. Regarding the current mentorship, respondents benefited the most in the categories of increased knowledge of PM&R, 72.8% (83/114), and improved clinical skills, 65.8% (75/114). The least satisfaction was with the mentor's assistance with a research project, 46% (52/113), and with the effect of mentorship on the resident's visibility and reputation, 38.6% (44/114). Overall resident satisfaction with mentorship was significantly higher (P < 0.0001) in mentorships formed by free choice compared with those that were formally assigned by the residency program. Success of mentorship significantly correlated (P < 0.0001) with frequency of communication between mentor and protégé, while gender and ethnicity had no effect.

Rehabilitation of eosinophilic fasciitis. A case report.

Eosinophilic fasciitis (EF), first described in 1974, is characterized by the sudden onset of painful swelling with induration of the soft tissues and peripheral eosinophilia, often after an episode of intense physical exertion. It rapidly progresses to joint contractures because of inflammation and fibrosis of the fascia. Of the 200 cases reported in the medical literature, most have responded positively to a prolonged course of oral prednisone. Although complete recovery is possible, more frequently signs and symptoms of EF persist. There were no detailed descriptions found in the literature of any rehabilitative interventions in this disease. This case study describes the methods used in a successful, comprehensive rehabilitation treatment of a 21-yr-old man admitted to the Palo Alto VA Medical Center rehabilitation program 8 mo after the onset of symptoms. Previous medication therapy included prednisone and methotrexate. The patient underwent 2 mo of inpatient rehabilitation, which consisted of upper and lower extremity nerve blocks, serial splinting, application of physical modalities, massage, stretching and strengthening exercises and interdisciplinary pain management. Significant improvement was made in the range of motion in all extremities, strength, hand function, level of pain, gait and endurance. Aggressive therapy did not increase eosinophilia. In fact the eosinophil count returned to normal by the time of discharge. A detailed review of the patient's rehabilitation program is presented.

Nerve conduction studies and vibration perception thresholds in diabetic and uremic neuropathy.

Two parameters of nerve conduction studies (nerve conduction velocities and amplitudes of the evoked sensory and motor responses) were compared with quantitative vibration perception thresholds (VPT) in patients with peripheral neuropathy (diabetes mellitus and/or end-stage renal disease). VPT measurements were made using a "two-alternative, forced-choice" method in which the patient is required to identify which of the two rods is vibrating at progressively decreasing vibration intensities. VPTs correlated significantly with nerve conduction velocities in all upper and lower extremity sensory and motor nerves tested, and with the amplitudes of the evoked motor responses in three motor nerves: median and ulnar (motor components) and tibial. For the median and ulnar nerves (motor components) the amplitudes of the evoked motor responses were more sensitive than nerve conduction velocities in correlation with VPTs. Comparison of VPT values, based upon whether or not evoked sensory and motor responses were obtained, indicated that mean VPTs were consistently higher among subjects in whom these evoked responses were not elicited. VPT measurements is thus shown to be a valid and valuable method for evaluation of severity in peripheral neuropathy. It has the advantages of being simple, quick and painless. Patient cooperation and compliance with this form of testing are excellent.