Association of Academic Physiatrists Residency and Fellowship Program Directors' Resident Recruitment Subcouncil Position Paper on Residency Recruitment.

ABSTRACT: Residency recruitment practices have undergone significant changes in the last several years. Interviews are now conducted fully virtually leading to both positive and negative downstream effects, including decreased cost to applicants and programs, decreased time away from clinical activities, flexibility in scheduling, and increased applications for applicants and program directors. In response to these changes, the Association of Academic Physiatrists Residency and Fellowship Program Directors Council convened a workgroup consisting of program directors, program coordinators, residents, and medical students who reviewed the available literature to provide an evidence-based set of best practices for program leaders and applicants. Available data from the Association of American Medical Colleges and its relevance to future recruitment cycles are also discussed.

Use of supported standing in males with Duchenne muscular dystrophy: Individual and family perspectives.

PURPOSE: This study aimed to explore stander use in individuals with Duchenne Muscular Dystrophy (DMD). METHODS: This mixed method research study employed a survey with categorical and open-ended questions related to stander use. Categorical responses were analyzed quantitatively. Qualitative analysis of open-ended responses was linked to the International Classification of Function. Qualitative and quantitative results were merged to derive meta-inferences. RESULTS: Of 147 respondents, 28.6% (n = 42) reported stander use. Equipment used included sit-to-stand stander (n = 27), power standing feature in a wheelchair (n = 13), and unspecified equipment (n = 2). Economic services were the most common barrier to stander obtainment. Age of loss of ambulation (LOA) and age of start of stander use were positively correlated (r = 0.61, p < 0.0001, n = 36), with 59.5% initiating stander use after LOA. Twenty-nine respondents reported standing less than the recommended dose of 60-90 minutes at least five days a week, with frequency directionally less than five days per week (p = 0.06) and time significantly less than 60-90 minutes (p = 0.002). Respondents' total dose was significantly lower than the recommended 300 minutes (p = 0.02). Lack of time and presence of contractures contributed to decreased duration of use. CONCLUSION: This study provides a greater understanding of stander use among individuals with DMD and can assist with decision making about stander use prior to complications of disease progression to promote optimal health despite reported barriers.

Normal childhood development curriculum in a pediatric rehabilitation training program: An interactive, novel approach.

PURPOSE: Though knowledge of normal childhood developmental milestones, essential for physician subspecialists, begins in medical school, it continues in pediatric subspecialty residency and fellowship training. Despite widespread education in developmental milestones, published curricula related to this content area are lacking. This pilot curriculum was developed to address the lack of published developmental curricula. METHODS: Participants included pediatric rehabilitation trainees who completed 8-12 sessions per year of a novel, adult-learner centered child development curriculum, for two consecutive years. Outcome measures included a novel survey, knowledge based test, verbal feedback sessions, and the end of the year program evaluation committee meeting. RESULTS: Trainees were successfully able to attend curricula sessions within their typical fellowship and residency responsibilities. Pediatric rehabilitation medicine fellows reported improved competence in normal growth and development. Pediatric rehabilitation residents rated the curriculum as a high value to their education (3.5 ± 0.58 on a 1-4 point scale). While not statistically significant, ratings of perceived knowledge of developmental milestones, structured educational sessions attended related to development, and overall interest in the topic increased from pre-curriculum to post-curriculum. CONCLUSION: This study introduces a novel approach to developmental milestones education that is tailored to the adult learner and pediatric rehabilitation trainees.

Characteristics and Outcomes of Children With Conversion Disorder Admitted to a Single Inpatient Rehabilitation Unit, A Retrospective Study.

BACKGROUND: Conversion disorder (CD) can lead to impaired functioning. Few studies present demographic and outcome data for pediatric patients. Many have had success with rehabilitation; however, further details are not known. OBJECTIVE: To identify characteristics and outcomes of children admitted to a pediatric inpatient rehabilitation program with CD symptoms. DESIGN: Retrospective study. SETTING: Inpatient rehabilitation unit within a large children's hospital. PATIENTS: All patients with diagnosis of CD or functional gait disorder (FGD) during designated time period. METHODS: Data were obtained from chart review and United Data Systems for Medical Rehabilitation. Descriptive statistics and Wilcoxon signed rank tests were used to analyze data. A P value of <.05 was statistically significant. OUTCOME MEASURES: Average length of stay, Functional Independence Measure for Children (WeeFIM) scores, WeeFIM change, WeeFIM efficiency, recommended therapies, number of repeat admissions to the same hospital for conversion disorder symptoms in the 12 months following discharge, and school reentry characteristics. RESULTS: Thirty admissions were identified that met criteria. Before diagnosis, duration of symptoms was 58 ± 145 days, physician visits averaged 1.9 ± 2.1, hospital admissions to the same hospital averaged 0.7 ± 0.9, and absence from school was 6 ± 12 weeks. Overall, 83% exhibited mixed symptoms. Length of inpatient rehabilitation stay was 8.4 ± 4.2 days with WeeFIM score change of 30 ± 11.9 (P <.001). WeeFIM efficiency was 4.8 ± 4.1 points/d. For patients with documented WeeFIM scores at 3 months, all were improved or maintained. More than three-fourths (80%) had no documented readmission to the same hospital for CD symptoms for 1 year after discharge from inpatient rehabilitation. Close to half (47%) returned to school within 1 week of discharge from inpatient rehabilitation (when school was in session). CONCLUSIONS: This study suggests that a multidisciplinary inpatient rehabilitation approach is a potentially effective and efficient treatment for children and adolescents with conversion disorder and leads to sustained functional improvement and return to school after discharge. LEVEL OF EVIDENCE: III.

Transition of Care in Adolescents With Cerebral Palsy: A Survey of Current Practices.

BACKGROUND: Transition of care from pediatric to adult health care providers for youth with special needs (including cerebral palsy [CP]) is of current interest because these individuals are now living well into adulthood. Studies have attempted to identify barriers to transition, ideal timing for transition of care, and key elements for successful transition programs. These studies often encompass a wide range of diagnoses, and results cannot be fully applied to those with CP. OBJECTIVE: To identify and describe current transition-of-care (TOC) practices and beliefs among physician providers of adolescents with CP in multidisciplinary CP clinics. DESIGN: Descriptive survey. SETTING: Multidisciplinary CP clinics in the United States. PARTICIPANTS: Physician leaders in the aforementioned CP clinics. METHODS: Respondents completed an electronic survey. Responses were deidentified and reported in aggregate by the use of descriptive statistics. MAIN OUTCOME MEASURE: Electronic survey addressing 3 domains: demographics of clinics, current opinions/practices related to TOC processes, and perceived barriers to successful TOC. RESULTS: Fifteen surveys were sent with 11 returned (response rate = 73%). TOC practices varied among clinics surveyed. Fifty-five percent of clinics had a structured transition program, but only one transitioned 100% of their patients to adult providers by 22 years of age. Only one clinic had an absolute upper age limit for seeing patients, and 36% of clinics accepted new patients older than 21 years. No respondent was "completely satisfied" with their transition process, and only one respondent was "moderately satisfied." The majority of respondents felt the ideal care setting for adults with CP was a comprehensive, multidisciplinary adult-focused clinic in an adult hospital/clinic with primarily adult providers. They noted the top 3 perceived barriers to successful TOC were limited adult providers willing to accept CP patients, concern about the level of care in the adult health care system, and lack of financial resources. CONCLUSION: Current TOC practices vary considerably among multidisciplinary pediatric CP clinics and are not satisfactory to individual physician providers within these clinics. Respondents desired a multidisciplinary clinic in an adult care setting with adult providers; however, the top 3 perceived barriers involved the adult health care system, making it difficult for pediatric providers to develop effective TOC programs. LEVEL OF EVIDENCE: Not applicable.