Promoting PM&R Awareness to Medical Students

By: Russell C. DeMicco, DO

As residents, we cross paths with medical students often. What follows is a set of guidelines of basic goals that we should help medical students attain when rotating on a PM&R service, all in the hopes of promoting our specialty, and of course, educating medical students.

Promoting PM&R Awareness to Medical Students

Promoting awareness of our specialty is very important in this new competitive market of healthcare. This needs to be accomplished on all different levels. Informing the public (i.e., patient base) of what we do as physiatrists is one level. Another is to insurance companies, for which we need to demonstrate our cost-effectiveness in treating certain conditions. Yet another is to other physicians, who we rely on for referrals. And finally, to medical students because they will soon be our referral source, but also in hopes of promoting interest in our field for students to consider physiatry as a career choice.

As residents, we primarily cross paths with medical students in teaching/supervisory roles when students take their 1-2 week rotation, mandatory at some medical schools, on a PM&R service. This is obviously a very short time that needs to be utilized appropriately, so students can, at least, "get a feel" for our specialty. I hope to present a template here for how we, as supervisors of medical students, can do our own part in promoting awareness of the field of PM&R. What follows is a set of guidelines of basic goals that we should help medical students attain when rotating on a PM&R service, all in the hopes of promoting our specialty, and of course, educating medical students.

First, all medical students, especially those working with disabled patients, should be made aware of the differences between disease, impairment, disability, and handicap. Knowing this is the first step to understanding what physiatrists do and how we approach patient care. Since the way we approach patient care is typically very different than how other medical and surgical specialties do, we need to highlight this to medical students as well. Specifically, that we typically, do not follow an organ-system approach but rather work with patients on a more global basis in order to focus on general patient well being. This leads to the way I like to explain to medical students what physiatrists do. I use an analogy like this: as cardiologists are "heart doctors" and orthopaedists are "bone doctors," physiatrists are "function doctors." This may be rather simplistic, but it at least tries to explain a term (physiatrists) that they likely have never heard before by correlating it with obviously better known fields.

Even more practical, is teaching medical students physical examination skills, such as a complete neurological and musculoskeletal exam. The former is an exam that many students have difficulty with, especially if there isn't a required neurology rotation at their school, because it can encompass so much. The latter is fairly neglected in medical education in general and thus is also important to teach, and usually very appreciated by medical students.

Staying on a practical level - it is important that medical students learn about ancillary services when rotating on a PM&R service. PT and OT are obviously major aspects of PM&R and thus, on such a rotation, students can learn a bit about what these disciplines do, which will help them to utilize their services more appropriately during their residencies and beyond. A good way to do this is to allow students to spend a morning or afternoon each with an individual therapist. This leads to stressing the importance of a team-based approach to patient care, which is another unique aspect of this field that can best be emphasized to students on a short rotation by attending a team conference. This way the students can at least get a view of how physiatrists interact with the other rehab disciplines and the importance, as well as fun, of a cohesive team approach to patient care.

Lastly, to help students empathize with a large portion of our patient population, have one of the days of the rotation be "Wheelchair Day." This would be a full day that the student spends in a wheelchair - rounding, attending conferences, and even going out to lunch (in the community would be preferred). If you weren't as lucky as I was in having a fellow medical school classmate in a wheelchair, then I think spending at least a full day in a wheelchair will give you somewhat of an appreciation of what a wheelchair user's everyday life is like, which is an experience that can go a lot farther than just reading about it or observing it peripherally.

Of course, not all students will be receptive to this; but many will, especially if you define the goals of a short PM&R rotation at the onset. The primary objectives are to gain an understanding of this broad field, what physiatrists do, and an overall better understanding of disability. The hope of these objectives is to supplement students general medical education, as well as to promote our specialty as a career choice and demonstrate how and why to utilize our services for the benefit of patients in the future.

Quick Reference Chart of Topics and Goals to Accomplish on a Medical Student PM&R Rotation

1. Disease, impairment, disability, and handicap

2. Physiatrists as "function doctors"

3. Neurological exam

4. Musculoskeletal exam

5. Global approach to patient care

6. Team-based approach to patient care

7. Spend a half day with PT and OT

8. Wheelchair day