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Chronic Care Clerkship - Conjoint 690

Introduction to Rehabilitation Clinical Focus

EXPECTATIONS:

The overall expectation for the Rehab Medicine Focus of the Chronic Care Clerkship is that you will acquire the knowledge and skills necessary to understand the assessment and competent management of people with chronic diseases, impairments, disabilities, and handicaps. We expect that you will recognize the impact that these disorders have on the individual and society, and that the goal of intervention is to optimize the function and quality of life for each individual.

The goals and objectives for the overall clerkship apply to the Rehab Medicine Focus. There are several additional goals and objectives specific to the focus, listed below.

Goal 1: Functional Assessment:

  • The student will recognize that quality of life is defined by the patient and may not correlate with the severity of the pathophysiology, impairment, functional limitations, disability, or expectations of society.
  • Develop skills in the clinical assessment of function including mobility, activities of daily living, bowel, bladder, and sexual function.
  • Recognize how physical, psychosocial, and environmental factors influence vocational and avocational function.
  • Understand the clinical value of functional assessments that assist in management of disabilities.

Goal 2: Assessment and Diagnostic Methods:

  • The student will demonstrate competency in the neurologic, musculoskeletal, and functional examinations.
  • Understand how physical derangements contribute to impairments and functional limitations.
  • Successfully complete a comprehensive history, physical examination, and functional assessment on the individual with disabilities.
  • Form a clinical assessment and indicate the need for additional pertinent diagnostic tests.

Goal 3: Medical Management:

  • The student will Understand the principles of management of commonly occurring acute illnesses in the patient with pre-existing chronic disease.
  • Develop strategies to reduce the risk of secondary complications for the disabled individual (e.g. contracture, D.V.T., skin breakdown).
  • Develop a working knowledge of the management and treatment of common chronic illnesses and disabling conditions.

Goal 4: Disability and Society:

  • The student will Understand that the physician-patient relationship during acute rehabilitation incorporates an educational model rather than the traditional contractual model.
  • Appreciate the process of adaptation to disability and reintegration of the disabled patient into the family, community, and workplace.
  • Understand that handicaps are a result of the interaction between the individual and the environment rather than the individual and his/her disease. Societal efforts can create and remove handicaps.
  • Appreciate the values that our society places on ambulation, communication, continence, and physical appearance and that impairments in these areas have profound psychosocial impacts on the patient, family, and the work/school environment.
  • Understand the potential differences between the patients' and the health care providers' perceptions of adjustment to chronic disease, disability, and handicap.
  • Gain familiarity with caregiver responsibilities.
  • Appreciate the family adjustment that is required for successful reintegration of the disabled patient back into the family and community.

STUDENT REQUIREMENTS FOR THE REHAB MEDICINE FOCUS:

Rehab Manual - 18.2MB Word | 1.5MB PDF*

The core material for this clerkship is contained in the selected web-based syllabus. This series of current articles have been chosen to communicate a minimal knowledge base and the background information essential for skill development.

We suggest you read the articles as outlined below. This scheme will introduce you to the basics for more immediate application.

Chapter Title Reading Schedule
Chapters 1-3 Intro to PM&R, the concepts of functional disability, and the nuances of patient encounters in PM&R 1st and 2nd evening
Chapter 4 Electrodiagnostics Before spending time in the EMG lab/clinic
Chapters 5-9 Rehabilitation of Neurologic and Neuromuscular Disorders Should be read as the time you see patients with these problems, and certainly by the end of the 3rd week of the clerkship.
Chapters 10-13 Rehabilitation of Musculoskeletal Disorders ****
Chapters 14-15 Rehabilitation of Special Populations ****

Inpatient and Outpatient Work for Skill Development - Each student is assigned to one of the following sites in the Seattle area: Harborview Medical Center, University of Washington Medical Center, Seattle Veterans Administration Medical Center, Children's Hospital and Medical Center, Overlake Medical Center, Northwest Hospital, Virginia Mason Medical Center, or Providence Hospital. The patients you see will be inpatients and/or outpatients and/or consultation patients of the rehabilitation medicine service at the assigned institution.

The clinical material will vary depending on the site. For example, students at Harborview will be exposed to the disability associated with trauma, students at Children's will concentrate on the chronic diseases and disabilities unique to young people. Students at Providence, Virginia Mason, Overlake and Northwest Hospital will see a wide variety of common disabling conditions. Students at the VAMC will have the opportunity to concentrate on spinal cord injury and amputation rehabilitation. All sites will have a variety of clinical material that will support the goals and objectives.

Students must come prepared on the first day of the clinical clerkship to see patients and should appear with their examination equipment, namely stethoscope and percussion hammer.

Unless otherwise arranged, attendance is expected from 8:00 a.m. until the work is completed. The clinical clerk's workday will parallel the schedule of the rehabilitation medicine housestaff. There is no night or weekend call. In addition to the daily patient work, your preceptor will try to arrange, when possible, the following for you:

  • At least one complete new patient admission per week
  • Discharge and post-discharge patient encounter(s) on one patient
  • The home visit or "atypical outpatient experience" with a patient recently discharged from the rehabilitation unit.
  • Weekly multidisciplinary panels (chart rounds) or case conference interactions.
  • Sessions with the clinical psychologist seeing your patients.
  • Sessions with the speech and language pathologist seeing your patients.
  • Sessions with the social service worker seeing your patients.
  • Sessions with the vocational/education contact seeing your patients.
  • Physical therapy information, demonstration session.
  • Occupational therapy information, demonstration session.
  • Other sessions, if warranted by the patients assigned.

*Adobe Acrobat Reader is required for viewing or printing PDFs. Acrobat Reader is available free of charge from the Adobe Web site at http://www.adobe.com/prodindex/acrobat/readstep.html

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