Download Goals and Objectives - Stony Brook University School of Medicine

Subspecialty Rotation: Physical Medicine & Rehabilitation
(PMR)
**All Goals and Objectives for this rotation are identical across all PL years**
Primary Goals for this Rotation
Competency
5.86 GOAL: Prevention, Counseling and Screening (PM&R).
Understand the role of the pediatrician in preventing conditions
affecting muscular/neurological functions in children, and in counseling
and screening individuals at risk for these disorders.
5.86.1 : Provide routine counseling to all parents and patients
about:
1. Prevention of brain and spinal cord injuries through the
appropriate use of car restraint systems and protective
sports equipment
2. Recognition of activities associated with neurologic injuries,
including water sports and trampoline play, and strategies
to reduce risk
3. Genetic and familial basis for certain disabling conditions
4. The influence of alcohol on fetal development and its
contribution to developmental and behavioral problems
5. Federal and state programs available to provide
individualized and appropriate educational services to
children of all abilities, in the least restrictive environment
IC, PC, K
5.86.2 : Provide counseling to parents and patients with specific
conditions about:
1. The rights of the child and family when physical or
developmental disabilities are present, including Family
Medical Leave Act (FMLA), Individuals with Disabilities
Education Act (IDEA), and the Americans with Disabilities
Act (ADA)
2. The natural history of cerebral palsy, from infancy to early
adulthood, including the impact of illness on the individual,
family and community
3. The role of folic acid in preventing neural tube defects and
the importance of adequate intake prior to conception in all
sexually active females of childbearing age
4. The role of early intervention in conditions affecting
muscular/neurological function
IC, PC, K
5.87 GOAL: Normal Vs. Abnormal (PM&R). Distinguish normal from
pathological conditions affecting muscular/neurological functions in
children.
5.87.1 : Differentiate the child with idiopathic toe walking from the
child with mild spastic diplegic cerebral palsy through the
recognition of obligate vs. nonobligate gait patterns and the signs
and symptoms of upper motor neuron disease.
PC, K
5.87.2 : Explain the time course for the acquisition and loss of
primitive reflexes and the implications of persistence.
K
5.87.3 : Identify the spectrum of normal muscle tone and discuss
the clinical significance of hypertonicity and hypotonicity.
PC, K
5.87.4 : Recognize developmental variations in growing preterm
infants and distinguish normal variations from early signs of
cerebral palsy.
K, PC
5.87.5 : Assess motor strength in children of all ages and
distinguish those children with normal strength from those with
proximal, distal and global weakness.
PC
5.87.6 : Recall the clinical uses and side effects of commonly used
medications to improve muscular/neurological function in children
within disabling conditions (e.g., baclofen, intrathecal baclofen,
botox, etc.).
K, PC
5.88 GOAL: Undifferentiated Signs and Symptoms (PM&R). Evaluate,
treat and/or refer children with presenting signs and symptoms that may
indicate conditions affecting muscular/neurological functions.
5.88.1 : Create a strategy to determine which of the following signs
and symptoms would be improved through PM&R interventions and
refer these children.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Abnormality of tone
Alterations in strength
Asymmetrical use of extremities
Loss of range of motion
Failure to thrive
Dysphagia and feeding difficulties
Recurrent respiratory illnesses
Hip asymmetry
Recurrent urinary tract infections
Developmental delays
PC, K
5.89 GOAL: Common Conditions Not Referred (PM&R). Diagnose and
manage patients with conditions affecting muscular/neurological
function that generally do not require referral.
5.89.1 : Diagnose, explain and manage the following PM&R
conditions:
1.
2.
3.
4.
5.
Chronic constipation
Post-traumatic epilepsy
Gastroesophageal reflux
Autonomic dysreflexia following spinal cord injuries
Impulsivity and attention deficits following traumatic brain
injuries
6. Gastrostomy tube related issues (dislodgement,
granulomas, leakage, local infections, participation in
PC, K
activities)
7. Decubitus ulcers, grades 1 and 2
8. Bladder colonization vs. infection in children with
neurogenic bladder dysfunction
9. School failures in children with chronic or disabling
conditions
5.90 GOAL: Conditions Generally Referred (PM&R). Recognize and
initiate management of children with conditions affecting
muscular/neurological function that generally require referral.
5.90.1 : Identify, explain, initially manage and refer the following
conditions affecting muscular/neurological function:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Cerebral palsy
Spina bifida
Brachial plexopathies
Spinal cord injuries
Strokes
Congenital syndromes affecting development and function
Post-traumatic brain syndrome
Neuromuscular disorders
Limb deficiencies
Post-acute burn rehabilitation
5.90.2 : Identify the role and general scope of practice of PM&R;
recognize situations where children benefit from the skills of
specialists trained in caring for children; and work effectively with
these professionals to care for children with neuromuscular
disorders.
PC, K
SBP
5.91 GOAL: Case Management (PM&R). Understand the general
pediatrician's role in providing case management and coordination of
services for children with common chronic conditions.
5.91.1 : Develop and implement a case management plan for the
following chronic conditions with functional limitations:
1.
2.
3.
4.
Cerebral palsy
Spina bifida
Limb deficiencies
Post-traumatic brain syndrome
5.91.2 : Provide counseling and support to the family of a child with
physical limitations who needs additional care coordination and
access to community resources.
6.95 GOAL: Pediatric Competencies in Brief (Subspecialty Rotation).
Demonstrate high standards of professional competence while working
with patients under the care of a subspecialist. [For details see Pediatric
Competencies.]
SBP, PC, K
IC, PC, SBP
6.95.1 : Competency 1: Patient Care. Provide family-centered
patient care that is development- and age-appropriate,
compassionate, and effective for the treatment of health problems
and the promotion of health.
PC
6.95.1.1 :Use a logical and appropriate clinical approach to the care
of patients presenting for specialty care, applying principles of
evidence-based decision-making and problem-solving.
PC
6.95.1.2 :Describe general indications for subspecialty procedures
and interpret results for families.
PC, K
6.95.2 : Competency 2: Medical Knowledge. Understand the scope
of established and evolving biomedical, clinical, epidemiological and
social-behavioral knowledge needed by a pediatrician; demonstrate
the ability to acquire, critically interpret and apply this knowledge in
patient care.
K
6.95.2.1 :Acquire, interpret and apply the knowledge appropriate
for the generalist regarding the core content of this subspecialty
area.
K
6.95.2.2 :Critically evaluate current medical information and
scientific evidence related to this subspecialty area and modify your
knowledge base accordingly.
K, PBLI
6.95.3 : Competency 3: Interpersonal Skills and
Communication. Demonstrate interpersonal and communication
skills that result in information exchange and partnering with
patients, their families and professional associates.
IC
6.95.3.1 :Provide effective patient education, including reassurance,
for a condition(s) common to this subspecialty area.
IC, PC
6.95.3.2 :Communicate effectively with primary care and other
physicians, other health professionals, and health-related agencies
to create and sustain information exchange and teamwork for
patient care.
IC, SBP
6.95.3.3 :Maintain accurate, legible, timely and legally appropriate
medical records, including referral forms and letters, for
subspecialty patients in the outpatient and inpatient setting.
PC, SBP
6.95.4 : Competency 4: Practice-based Learning and
Improvement. Demonstrate knowledge, skills and attitudes needed
for continuous self-assessment, using scientific methods and
evidence to investigate, evaluate, and improve one's patient care
practice.
SBP, K, PC
6.95.4.1 :Identify standardized guidelines for diagnosis and
treatment of conditions common to this subspecialty area and adapt
them to the individual needs of specific patients.
K, PC
6.95.4.2 :Identify personal learning needs related to this
subspecialty; systematically organize relevant information resources
for future reference; and plan for continuing acquisition of
knowledge and skills.
K, PBLI
6.95.5 : Competency 5: Professionalism. Demonstrate a
commitment to carrying out professional responsibilities, adherence
to ethical principles, and sensitivity to diversity.
P
6.95.5.1 :Demonstrate personal accountability to the well-being of
patients (e.g., following up on lab results, writing comprehensive
notes, and seeking answers to patient care questions).
P
6.95.5.2 :Demonstrate a commitment to carrying out professional
responsibilities.
P
6.95.5.3 :Adhere to ethical and legal principles, and be sensitive to
diversity.
P
6.95.6 : Competency 6: Systems-based Practice. Understand how
to practice high-quality health care and advocate for patients within
the context of the health care system.
SBP
6.95.6.1 :Identify key aspects of health care systems as they apply
to specialty care, including the referral process, and differentiate
between consultation and referral.
SBP
6.95.6.2 :Demonstrate sensitivity to the costs of clinical care in this
subspecialty setting, and take steps to minimize costs without
compromising quality
SBP
6.95.6.3 :Recognize and advocate for families who need assistance
to deal with systems complexities, such as the referral process, lack
of insurance, multiple medication refills, multiple appointments with
long transport times, or inconvenient hours of service.
SBP, IC
6.95.6.4 :Recognize one's limits and those of the system; take steps
to avoid medical errors.
SBP, P, PBLI
Procedures
7.1.GOAL: Technical and therapeutic procedures. Describe the following
procedures, including how they work and when they should be used;
K, PC
competently perform those commonly used by the pediatrician in practice.
Gastrostomy tube replacement
Tracheostomy tube: replacement
7.2. GOAL: Diagnostic and screening procedures. Describe the following
tests or procedures, including how they work and when they should be used; K, PC
competently perform those commonly used by the pediatrician in practice.
Developmental screening test
Hearing screening
Vision screening
Source
Kittredge, D., Baldwin, C. D., Bar-on, M. E., Beach, P. S., Trimm, R. F.
(Eds.). (2004). APA Educational Guidelines for Pediatric Residency.
Ambulatory Pediatric Association Website. Available online:
www.ambpeds.org/egweb. [Accessed 03/24/2011]. Project to develop this
website was funded by the Josiah Macy, Jr. Foundation 2002-2005.
Core Competencies: K Medical Knowledge
PC - Patient Care
IPC - Interpersonal and Communication Skills
PProfessionalism
PBLI - Practice-Based Learning and Improvement
SBP - Systems-Based Practice
Performance Expectations by Level of Training
Beginning
Developing
Accomplished
Competent
Description of
identifiable
performance
characteristics
reflecting a
beginning level of
performance.
Description of identifiable
performance
characteristics reflecting
development and
movement toward
mastery of performance.
Description of
identifiable
performance
characteristics
reflecting near
mastery of
performance.
Description of identifiable
performance
characteristics reflecting
the highest level of
performance.
Medical
Knowledge
Patient Care
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL1, PL2
PL2, PL3
PL3
Interpersonal and
Communication
Skills
Professionalism
Practice-Based
Learning and
Improvement
Systems-Based
Practice
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL1
PL1, PL2
PL2, PL3
PL2, PL3
PL3
PL3
PL1
PL1, PL2
PL2, PL3
PL3