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Educational Objectives
PVAMC Outpatient Rotation

Medical Knowledge

1. Describe fracture from x-ray study including open/closed, displacement, angulation, common names. Describe complications from common fractures:
   1. midshaft humerus -radial nerve
   2. distal humerus - ulnar tardy palsy
   3. colles- carpal tunnel syndrome
   4. prox fibula - peroneal nerve
   5. ankle - tarsal tunnel
   6. RSD
   7. pelvic L-S plexus 2 retroperitoneal hematoma/sciatic nerve
   8. hip-sciatic nerve.
2. Read bone X-rays and CTs and explain their indications.
3. Explain the indications for electrodiagnostic evaluation.
4. Discuss pathophysiology and etiology of restrictive and obstructive lung diseases.
5. Summarize the types of motor disorders seen in patients with a variety of neuromuscular problems including spasticity, rigidity, paresis, paralysis, myoclonus, ataxia, dysmetria, apraxia, and movement disorders.
6. Summarize the mechanisms accounting for late neurological and functional recovery after brain injury (cerebral plasticity).
7. Summarize the various outcome measurement instruments employed in stroke rehabilitation.
8. Interpret basic findings on computerized tomography scans and magnetic resonance imaging scans such as contusions, intracerebral hemorrhages, infarctions, encephalomalacia, hygromas, hydrocephalus, and atrophy.
9. Explain the unique components of amputee rehabilitation:
   1. Perform a detailed functional history and examination.
   2. Demonstrate knowledge of musculoskeletal and peripheral neuromuscular anatomy including surface anatomy and function.
   3. Explain the advantages, disadvantages and complications of various assistive devices as well as the energy cost of ambulation with them.
   4. Describe a normal gait pattern, timing of muscle activation during different phases of gait, and location of center of gravity.
   5. Describe various amputations, their limitations, advantages and energy of ambulation and walking speeds.
   6. Describe the phantom limb pain, and residual limb pain, and appropriate treatment programs.
   7. Describe the sequelae of peripheral vascular disease, including clinical syndrome, diagnostic tools, and anatomy.
   8. Describe the advantages and disadvantages in the use of the following prosthetic 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
   9. List the common complications of wearing a prosthesis.
   10. List the available upper extremity prosthesis.
   11. Describe the relationship between the anatomy and the biomechanics unique to the function of the shoulder girdle and upper extremity.
   12. Discuss the relationship between the anatomy and biomechanics unique to the function of the lower extremity.
   13. Summarize the roles of the Amputee Clinic treatment team - physician, prosthetist and therapist

Patient Care

1. Discuss the treatment of osteoarthritis.
2. Demonstrate the ability to write physiatric prescriptions, equipment needs including wheelchairs and other mobility devices, ADL equipment and prosthetic and orthotic devices.
3. Discuss the advantages and disadvantages of the different types of wheelchairs and mobility devices.
4. Demonstrate the ability to prescribe and fit the patient with an appropriate mobility device.
5. Summarize the management of motor disorders seen in patients with a variety of neuromuscular problems including spasticity, rigidity, paresis, paralysis, myoclonus, ataxia, dysmetria, apraxia, and movement disorders.
6. Evaluate sensory dysfunction and prescribe a treatment program for a patient with:
   1. thalamic pain and other central pain syndromes
   2. hyperesthesia
   3. hemianesthesia
7. Take a substance abuse history and suggest treatment strategies for a patient who has such a history.
8. Accurately perform gait analysis on appropriate patients.
9. Perform a clinical examination of the shoulder and upper extremity.
10. Perform a clinical examination of the lower extremity.
11. Demonstrate the skills required to provide physiatric management of patients with chronic complex medical and rehabilitation needs.
12. Recommend a treatment plan that includes appropriate interventions, goals and disposition.

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 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.