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Educational Objectives
Magee Spinal Cord Injury Rotation

Medical Knowledge

1. Describe neuroanatomy of the spinal cord structure/system.
2. Describe vascular anatomy of the spinal cord structure/system.
3. Summarize the pathologic consequences of traumatic spinal cord injury.
4. Describe the physiology of autonomic dysfunction in SCI patients including orthostatic hypotension, autonomic dysreflexia and thermoregulation.
5. Summarize the pathologic consequences of myelopathy due to cancer:
   1. Primary
   2. Metastatic
6. Describe congenital disorders of the spinal cord:
   1. Spina bifida
   2. Myelodysplasia
7. Describe rehabilitation issues unique to the pediatric SCI patient.
8. Define the various levels of SCI using standardized criteria (e.g., ASIA).
9. Describe the concepts of neural recovery and the key prognostic factors for functional outcome in SCI.
10. Summarize bowel and bladder evaluative strategies for SCI patients.
11. Describe evaluation of skin problems in the SCI population.
12. Summarize the evaluation of deep venous thrombosis and pulmonary embolus in the SCI population.
13. Summarize the assessment of sexual function in SCI patient populations.
14. Recognize the functional impact of normal changes associated with aging when superimposed on a SCI disability.
15. Summarize the unique psychosocial needs of individuals with SCI.
16. Recognize pharmacologic alterations associated with spinal cord injury, including changes in pharmacokinetics, pharmacodynamics, drug interactions, over-medication, and compliance.
17. Identify the indications for and the use of clinical neurophysiologic testing to assess the extent of neuropraxia, denervation, reinnervation, phrenic nerve function, and spinal cord function.
18. Discuss the epidemiology of SCI including basic demographic data, etiology, life expectancy, causes of death, and costs of care.
19. Summarize the organization and interdisciplinary practices of the Emergency Medical Services system relating to the pre-hospital and initial Emergency Department care of spinal cord injured patients as well as their concomitant and associated injuries.
20. Summarize the ethical and legal issues pertinent to spinal cord injury including diminished competence and the right to refuse treatment.

Patient Care

1. Summarize evaluation & treatment strategies for common medical and surgical complications of SCI (early and late):
   1. GI complications
   2. Cardiac issues
   3. Fever
   4. Metabolic changes
   5. Bladder dysfunction
   6. Fractures
   7. Pain syndromes
   8. Upper extremity overuse injury
   9. Tendon transfers
   10. Syringomyelia
   11. Osteoporosis/heterotopic ossification
   12. Hypercalcemia/anemia
2. Summarize procedures used for spinal stabilization, including spinal orthotics.
3. Summarize comprehensive management of spasticity for patients with SCI.
4. Summarize the role of therapeutic modalities (e.g., range of motion, biofeedback, electrical stimulation, adaptive equipment) in treating associated conditions of SCI.
5. Summarize bowel & bladder management strategies in SCI.
6. Summarize prevention & management of skin problems in the SCI population.
7. Summarize prevention & management strategies in patients with deep venous thrombosis and pulmonary embolus in the SCI population.
8. Advise patients & families concerning options, treatment & education regarding sexual function in the SCI population.
9. Advise patients & families concerning functional outcome and prognostication.
10. Perform a functional assessment based on neurological, musculoskeletal and cardiopulmonary examinations and psychosocial and prevocational evaluations.
11. Determine functional goals for self-care, mobility, vocational and avocational activities based on the level and completeness of the lesion.
12. If appropriate, prescribe motor retraining and conditioning activities, orthoses, and the adaptive equipment needed to meet the rehabilitation goals.
13. Prescribe appropriate motor vehicle modifications to promote independence in mobility and transportation.
14. Summarize vocational rehabilitation options for SCI patients, with particular reference to local agencies designed to assist in this process.
15. Summarize community reintegration options for SCI patients, with particular reference to local agencies designed to assist in this process.
16. Anticipate the approximate length of stay, cost of hospitalization, & equipment needs with the involvement of the patient, the patient's support persons and appropriate agencies.
17. Summarize the needs for personal care attendants, architectural modifications, and community follow-up care.

Interpersonal and Communication Skills

1. Present information to patients & other care team members in an effective manner.
2. Establish trust and maintain positive rapport with patients, caregivers & family members.
3. Demonstrate effective listening skills.
4. Promote teamwork in the clinical setting.
5. Complete dictations and chart notes in a legible & timely manner.

Professionalism

1. Demonstrate sensitivity and responsiveness to age, culture, disability and gender of patients and colleagues.
2. Consider effects of personal, social and cultural factors in the disease process and patient management.
3. Demonstrate reliability, punctuality, integrity and honesty in all interactions with patients and colleagues.
4. Accept personal responsibility for own actions & decisions.
5. Apply sound ethical principles in practice (e.g., informed consent, confidentiality, veracity, provision or withholding of care).

Practice-Based Learning and Improvement

1. Demonstrate skill in supervising junior residents and medical students in information gathering, decision-making, and patient management.
2. Evaluate and/or modify own practice based on feedback from others.
3. Use information technology to appraise & assimilate evidence from scientific studies to enhance patient care outcomes.

Systems-Based Practice

1. Summarize the physicians role in advocating for care needs
2. Summarize the physicians role in disease management across various levels of the health care system in a cost effective manner
3. Demonstrate how to access various community resources on behalf of the patient
4. Demonstrate integrity and responsibility in interactions with insurance and/or disability-oriented agencies.