Medical Student Exposure to PM&R

I consider myself lucky to have stumbled upon the field of PM&R…but one shouldn’t have to rely on luck. Have you ever heard a physician ask what a physiatrist does? Have you met a resident or medical student who said, “If only I had heard of PM&R sooner, I would have wanted to do my residency in that area”? I believe medical student exposure to PM&R is inadequate, and I am confident that the solution to this problem lies in the residents’ hands.

Lack of exposure

Multiple studies have examined medical student exposure to and knowledge of PM&R. In one study, following a weeklong mandatory course in rehabilitation, 103 fourth-year medical students were surveyed. Of those surveyed, 73% believed they achieved a better understanding of physical disability after taking the course, 31% reported an improved perception of the field of rehabilitation medicine, and 81% found the course relevant to their chosen specialty. Interestingly, 96% of those students had already chosen their specialty, and 10% said they would have considered a residency in PM&R if they had been exposed to it earlier (Sorell et al., 1981). In another study, following a two-week mandatory clerkship in PM&R, fourth-year medical students were surveyed. Of those surveyed, 59% believed more emphasis should be placed on PM&R during medical school (Kirshblum et al., 1998). These results suggest that the desire for exposure to our field is present, and it seems that we are not meeting the demand.

Lack of knowledge

From a business perspective, we should be concerned that future physicians are lacking knowledge of PM&R. In the study following a two-week clerkship (mentioned previously), medical students reported increased awareness that physiatrists can perform EMG/NCS, nerve blocks, and SCI patient ventilation management. They also expressed increased understanding that physiatrists commonly treat patients with low back pain, multiple sclerosis, muscular dystrophy, pain, and traumatic brain injury (Kirschblum et al, 1998). Medical students were given clinical vignettes and were asked to hypothetically refer these patients to one of eight specialists as if they were their primary care physicians. In three of five cases, the frequency of physiatry referrals correlated with the level of student’s self-rated knowledge of PM&R. Of note, students at medical schools with a mandatory PM&R rotation had higher self-rated knowledge (Abramson et al, 1998). In order to increase our referral base, we must educate medical students on our professional responsibilities and opportunities in the field.

Lack of programs

I recently surveyed PM&R clerkship directors (whose medical schools are affiliated with a PM&R residency) about medical student exposure to the field. Only 12% of their affiliated medical schools had a required rotation in PM&R, and 32% had a “selective” rotation. Also, 32% of rehabilitation hospitals and 24% of PM&R outpatient clinics were not located on the main medical school campus. More than half of respondents replied that their medical school does not have a PM&R club or interest group. This shows how many medical students could complete four years of school with minimal knowledge of the field.

Solutions

The RPC Board has begun to address this issue by working on the Medical Student Symposium to be held at the AAPM&R 2008 Annual Assembly. We have provided input on lecture format, guest speakers, and event promotion. I believe this will encourage more medical student participation at the assembly, a small piece of the puzzle. The larger issue of early exposure to PM&R can, in my opinion, only be rectified with a grassroots effort by residents. Talk with your program director about starting a PM&R interest group or ask how you can help with an existing group. Organize a talk or panel discussion, or simply send out an e-mail to medical students offering to answer their questions about the field. The onus is on us to take action and increase understanding of PM&R among our future peers.

Carley Kreps, MD
PGY2 – The University of Virginia Health System
RPC Liaison to AAPM&R Medical Education Committee
 

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