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Educational Objectives
Musculoskeletal Inpatient Rotation

Medical Knowledge

1. Demonstrate knowledge of musculoskeletal and peripheral neuromuscular anatomy including surface anatomy and function.
2. Understand indications for joint arthroplasties and their alternatives (hip, knee, shoulder, elbow).
3. Describe the 3 major types of joints and the forces acting on joints.
4. Summarize the clinical features and pathophysiology of:
   1. rheumatoid arthritis
   2. spondyloarthropathies
   3. systemic lupus erythematosis
   4. polymyositis/dermatomyositis
   5. systemic vasculidities
   6. crystal induced arthropathies
   7. scleroderma
   8. septic arthritis
5. Summarize the basic concepts of a rehabilitation program in acute versus chronic arthritides.
6. Describe the uses and contraindications of superficial heat and cold, ultrasound, iontophoresis, and phonopheresis.
7. Summarize and be able to formulate impairment, disability and handicap as it pertains to a particular patient.
8. Summarize the principles of bracing for both upper and lower extremities.
9. Describe the advantages, disadvantages and complications of various assistive devices as well as the energy cost of ambulation with them.
10. Describe a normal gait pattern, timing of muscle activation during different phases of gait, and location of center of gravity.
11. Discuss the anatomy & physiology of the normal heart and its response to various types of exercise re: oxygen consumption, cardiac output, heart rate, blood pressure, stroke volume, & myocardial oxygen consumption.
12. Recognize the clinical manifestations of coronary artery disease, heart failure, hypertension, valvular disease, & cardiomyopathy; define risk factors for each.
13. Discuss the goals of a cardiac rehabilitation program re: risk factor modification & exercise training.
14. Discuss the anatomy & physiology of the normal lungs and how chronic pulmonary diseases impact normal functioning.
15. Recognize the clinical manifestations of COPD (e.g., emphysema, asthma, cystic fibrosis, chronic bronchitis).
16. Discuss pre- and post-operative procedures for lung volume reduction and lung transplant surgery.
17. Assess the role of various social support systems in the rehabilitation management of the older adult.
18. Describe surgical techniques that are important for residual limb healing and prosthetic fit in amputation patients.
19. Discuss the epidemiology of limb amputation, including incidence, etiology & cost.
20. Discuss the indications, advantages, disadvantages and functional implications for common levels of amputation.
21. Discuss prosthetic alignment and correction for various gait abnormalities.
22. Discuss the component options for various prosthetic limbs, their advantages and disadvantages.

Patient Care

1. Perform a thorough examination of soft tissues, all joints, peripheral neurologic examination, and identify bony landmarks.
2. Formulate differential diagnosis of neuromuscular and musculoskeletal disorders from history and physical.\
3. Summarize post-operative management of joint arthroplasties, including precautions (hip, knee, shoulder, elbow).
4. Summarize the diagnosis and treatment of:
   1. rheumatoid arthritis
   2. spondyloarthropathies
   3. systemic lupus erythematosis
   4. polymyositis/dermatomyositis
   5. systemic vasculidities
   6. crystal induced arthropathies
   7. scleroderma
   8. septic arthritis
5. Grade and prescribe treatment for decubitus ulcers
6. Summarize the treatment of metabolic bone diseases including osteoporosis, osteomalacia, and Pagets disease.
7. Assess and manage the effects of the patients premorbid personality and social milieu.
8. Formulate the individual program plan with the patient and interdisciplinary team and manage the patients program.
9. Demonstrate the ability to manage acute & chronic medical conditions, comorbidities & complications commonly seen in the cardiac patient
10. Formulate a cardiac rehabilitation program for various types of cardiac disease, including:
    1. Myocardial infarction
    2. Angina pectoris
    3. Post-CABG
    4. Post-cardiac transplant
    5. Valvular heart disease
    6. Cardiomyopathy
    7. Cardiac disease co-existing with disability
11. Discuss the long-term medical, psychological, financial & social implications of cardiac disease.
12. Formulate an appropriate rehabilitation plan for pulmonary disease patients including:
    1. Nutrition
    2. Breathing retraining
    3. Pharmacological management
    4. Stress & anxiety management
    5. Exercise therapy/prescription
    6. Use of oxygen & respiratory equipment
    7. Energy conservation/work simplification
13. Formulate an appropriate management plan for post-surgical pulmonary patients (e.g. transplant, lung volume reduction).
14. Discuss the indications and contra-indications for a patient who requires mechanical ventilation.
15. Formulate a rehabilitation management strategy for the disabled older adult to address the normal physiologic changes associated with aging of the major organ systems.
16. Formulate a comprehensive rehabilitation prescription addressing common functional limitations for older adults with:
    1. coronary heart disease
    2. peripheral vascular disease
    3. chronic obstructive pulmonary disease
17. Develop management strategies in the rehabilitation and community settings for the older adult with cognitive impairments or mental illness.
18. Formulate a post-operative management plan including residual limb prosthetic preparation and therapeutic exercise.
19. Formulate a treatment plan for common amputee problems, e.g., phantom limb pain/sensation, residual limb pain, skin breakdown.
20. Discuss key elements in taking a history related to pre-prosthetic evaluation.
21. Perform a prosthetic fit evaluation.
22. Perform gait analysis and identify abnormalities and the specific mal-alignments that may be causing them.

Interpersonal and Communication Skills

1. Serve as leader of the rehabilitation team on rounds and during interdisciplinary team conferences.
2. Present information to patients, family members, caregivers & other health care providers in an effective manner.
3. Establish trust and maintain positive rapport with patients.
4. Demonstrate effective listening skills.
5. Promote teamwork in the clinical setting.
6. 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.
4. Identify appropriate assessment & measurement tools to evaluate functional status or outcomes of interventions.

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.