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Educational Objectives
Musculoskeletal Outpatient Rotation

Medical Knowledge

1. Summarize appropriate use of radiographic imaging studies (e.g., X-ray, MRI, CT and bone scans) of the spine and extremities
2. Summarize interpretation of radiographic imaging studies, including normal anatomy and pathology.
3. Describe the advantages, disadvantages and prescription of the following components:
   1. Carbon Copy II, Multi-Access Foot, SACH, Seattle, Flex
   2. Endoskeletal vs. Exoskeletal Systems
   3. PTB socket, Supra-condylar socket, Supracondylar-suprapatellar socket
   4. Different suspension systems; i.e., neoprene sleeve, cuff strap, thigh corset, Iceross
   5. Knee joints, i.e., manual locked knee, weight-activated knee, polycentric knee, hydraulic and pneumatic knee
4. List the common issues pertaining to wearing a prosthesis:
   1. Pre- and post-prosthetic management
   2. Joint alignment
   3. Phantom pain
   4. Breakdown
5. List the available upper extremity prostheses.
6. Describe the clinical presentation and pathophysiology for the following conditions:
   1. Acute strain/sprain of the cervical, thoracic and/or lumbar spine
   2. Arachnoiditis
   3. Brachial plexopathy
   4. Coccygodynia
   5. Compression fracture
   6. Deconditioning
   7. Discogenic disease
   8. Facet joint syndrome
   9. Failed back surgery syndrome
   10. Metastatic disease
   11. Pathological fracture
   12. Peripheral nerve entrapment
   13. Radiculopathy
   14. Sacroiliac joint syndrome
   15. Spinal stenosis
   16. Spondyloarthropathy
   17. Spondylolisthesis
   18. Spondylolysis
   19. Sacral fracture
   20. Knee/hip osteoarthritis
7. Describe relationship between the anatomy and biomechanics unique to the function of the shoulder girdle and upper extremity.
8. Summarize the pathophysiology of metabolic bone diseases including osteoporosis, osteomalacia, and Pagets disease.
9. Identify the basic elements of an occupational medicine program.
10. Summarize the concepts of work conditioning and work hardening.
11. Summarize the concepts of disability vs. impairment.
12. Identify non-musculoskeletal barriers (e.g., psychosocial) to returning to work.
13. Summarize physiatric interventions needed to support patients with disabilities who are employed or seeking employment.

Physiatric Interventional Spine Care - Medical Knowledge

1. Summarize the anatomy and pathology of the cervical, thoracic and lumbar spine.
2. Summarize the indications for performing epidural space steroid and zygoapophoseal joint injections.
3. Recognize the appearance of traumatic lesions on plain radiographs with an emphasis on findings of spinal instability.
4. Discuss current evidence relating to changes in intervertebral discs and the role of mechanical and biological factors in diagnoses.
5. Describe the presentation and elucidation of the diagnosis of radiculopathy and the indications for electrodiagnostic testing.
6. Identify and differentiate biomechanical medical disorders that involve the spine.

Patient Care

1. Describe the approach to evaluation of injured workers, their common injuries and treatments, and their prognosis for return to work.
2. Accurately prescribe upper and lower extremity orthotics and summarize the principles of bracing, as well as the advantages and disadvantages of various components.
3. Describe the differential diagnosis, diagnostic testing, and available non- operative treatment plans (including pharmacotherapy, therapeutic injections, surgical consultation, & modalities) for the following conditions:
   1. Acute strain/sprain of the cervical, thoracic and/or lumbar spine
   2. Arachnoiditis
   3. Brachial plexopathy
   4. Coccygodynia
   5. Compression fracture
   6. Deconditioning
   7. Discogenic disease
   8. Facet joint syndrome
   9. Failed back surgery syndrome
   10. Metastatic disease
   11. Pathological fracture
   12. Peripheral nerve entrapment
   13. Radiculopathy
   14. Sacroiliac joint syndrome
   15. Spinal stenosis
   16. Spondyloarthropathy
   17. Spondylolisthesis
   18. Spondylolysis
   19. Sacral fracture
   20. Knee/hip osteoarthritis
4. Summarize post-operative management and precautions (hip, knee, shoulder, elbow) of joint arthroplasties and their alternatives.
5. Perform the clinical examination of the upper extremity.
6. Perform the clinical examination of the lower extremity.
7. Perform the clinical examination of the spine.
8. Prescribe and justify a referral form a functional capacity evaluation.
9. Justify the need for restrictions and therapeutic interventions in the injured worker.
10. Design a work station modification plan for a patient with upper limb dysesthesias, back pain and neck pain.
11. Summarize issues that necessitate referral of an injured worker to other medical specialties.
12. Describe appropriate body mechanics and their application to patients and their work activities (e.g., lifting, pulling, pushing).

Physiatric Interventional Spine Care - Patient Care

1. Describe when, why, and how medications are used in treating painful spinal disorders.
2. Recognize the indications for imaging and select the appropriate tests and views for the desired information.
3. Develop expertise in interpreting plain radiographs. Acquire advanced skills in interpreting spinal MRI's and CT scans.
4. Understand the medical logic underpinning the performance of discography, radio frequency denervation, vertebroplasty, and kyphoplasty.
5. Set goals for physical therapy treatment and how to measure its success.
   
6. Describe the various percutaneous disc decompression procedures; indicate where they fit in a therapeutic algorithm.
7. Describe the indications and outcomes for spinal decompressive procedures.

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 and timely manner.

Professionalism

1. Demonstrate sensitivity and responsiveness to age, culture, disability and gender of patients & colleagues.
2. Consider effects of personal, social and cultural factors in the disease process & 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 patient 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.