Review Committee for Physical Medicine and Rehabilitation

New Application: Spinal Cord Injury

Review Committee for Physical Medicine and Rehabilitation

ACGME

Institutions

Sponsoring Institution

1.Is the sponsoring institution a care center for persons with spinal cord dysfunction? [PR I.A.1.]
...... ☐YES ☐NO

If “NO,” name the care center for spinal cord dysfunction with which the program is affiliated.
[PR I.A.1.]

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2.Describethefinancialresources,includingsalaries,fringebenefits,andopportunitiesforfellows’continuingmedicaleducation,providedbythesponsoringinstitution.[PRI.A.3.]

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Participating Sites

If fellows will be assigned to rotations requiring daily attendance at a participating site requiring more than one hour of travel time, are they provided with overnight accommodations? [PR I.B.3.]
...... ☐YES ☐NO

If“NO,”explain.

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ProgramPersonnelandResources

ProgramDirector

1.Isthereawrittensupervisionpolicy,developedandimplementedbythe spinal cord injury medicine fellowshipprogramdirectorincooperationwiththecore physical medicine and rehabilitation residency programdirector,whichspecifiesthelinesofresponsibilityforfaculty members andfellows,aswellasresidentsinthecoreprogram? [PR II.A.3.e)] ☐YES ☐NO

2.Brieflydescribehowtheprogramdirector will ensureclosecooperationbetweenthecoreresidencyprogramandthe fellowship program. [PR II.A.3.f)]

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3.Whatmechanismsdoestheprogramdirectorhaveinplaceformonitoringfellowstress,includingmentaloremotionalconditionsinhibitingperformanceorlearning,anddrug-oralcohol-relateddysfunction?[PRII.A.3.g)]

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Faculty

Indicate with a check mark the personnel who will interact regularly with fellows at each participating site and provide instruction on the areas of their practices relevant to spinal cord dysfunction. (PR II.B.6.)

Team Members / Site #1 / Site #2 / Site #3 / Site #4
Anesthesiology / ☐ / ☐ / ☐ / ☐ /
Emergency medicine / ☐ / ☐ / ☐ / ☐ /
Internal medicine / ☐ / ☐ / ☐ / ☐ /
Neurology / ☐ / ☐ / ☐ / ☐ /
Neurological surgery / ☐ / ☐ / ☐ / ☐ /
Orthopaedic surgery / ☐ / ☐ / ☐ / ☐ /
Pediatrics / ☐ / ☐ / ☐ / ☐ /
Physical medicine and rehabilitation / ☐ / ☐ / ☐ / ☐ /
Plastic surgery / ☐ / ☐ / ☐ / ☐ /
Psychiatry / ☐ / ☐ / ☐ / ☐ /
Diagnostic radiology / ☐ / ☐ / ☐ / ☐ /
General/trauma surgery / ☐ / ☐ / ☐ / ☐ /
Urology / ☐ / ☐ / ☐ / ☐ /

For categories of personnel that are unavailable, describe how that function will be addressed in the program.

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Other Program Personnel

Indicate whether staff members in the following disciplines will be available to the program. [PR II.C.1.]

Staff / Site #1 / Site #2 / Site #3
Occupational therapy / Choose an item. / Choose an item. / Choose an item. /
Orthotics and prosthetics / Choose an item. / Choose an item. / Choose an item. /
Physicaltherapy / Choose an item. / Choose an item. / Choose an item. /
Psychology / Choose an item. / Choose an item. / Choose an item. /
Rehabilitationnursing / Choose an item. / Choose an item. / Choose an item. /
Respiratorytherapy / Choose an item. / Choose an item. / Choose an item. /
Socialservice / Choose an item. / Choose an item. / Choose an item. /
Speech-languagepathology / Choose an item. / Choose an item. / Choose an item. /
Therapeuticrecreation / Choose an item. / Choose an item. / Choose an item. /
Vocationalcounseling / Choose an item. / Choose an item. / Choose an item. /

Resources

1.Does the program have access to a service delivery system dedicated to the care of persons with spinal cord dysfunction? [PR II.D.1.] ☐YES ☐NO

2.Indicate whether the following resources are available to the program. [PR II.D.2.]

Resource / Site #1 / Site #2 / Site #3
Emergency department that treats patients with spinal cord injury [PR II.D.2.a)] / Choose an item. / Choose an item. / Choose an item. /
Acute care hospital [PR II.D.2.b)] / Choose an item. / Choose an item. / Choose an item. /
Inpatient rehabilitation unit [PR II.D.2.c)] / Choose an item. / Choose an item. / Choose an item. /
Designated outpatient clinic for persons with spinal cord dysfunction [PR II.D.2.d)] / Choose an item. / Choose an item. / Choose an item. /
Home care and other community reintegration resources [PR II.D.2.e)] / Choose an item. / Choose an item. / Choose an item. /

3.Brieflydescribetheequipment,diagnosticimagingdevices,electrodiagnosticdevices,laboratoryservices,urodynamiclaboratory,andclinicalfacilitiesavailabletotheprogram.[PRII.D.2.f)]

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4.Indicatewhetherconsultingservicesinthefollowingspecialtiesandsubspecialtiesareavailabletotheprogram.[PRII.D.2.g)]

Consulting Services / Site #1 / Site #2 / Site #3
Anesthesiology / Choose an item. / Choose an item. / Choose an item. /
Emergency medicine / Choose an item. / Choose an item. / Choose an item. /
Internal medicine / Choose an item. / Choose an item. / Choose an item. /
Neurological surgery / Choose an item. / Choose an item. / Choose an item. /
Neurology / Choose an item. / Choose an item. / Choose an item. /
Orthopaedic surgery / Choose an item. / Choose an item. / Choose an item. /
Pathology / Choose an item. / Choose an item. / Choose an item. /
Pediatrics / Choose an item. / Choose an item. / Choose an item. /
Physical medicine and rehabilitation / Choose an item. / Choose an item. / Choose an item. /
Plastic surgery / Choose an item. / Choose an item. / Choose an item. /
Psychiatry / Choose an item. / Choose an item. / Choose an item. /
Diagnostic radiology / Choose an item. / Choose an item. / Choose an item. /
General/trauma surgery / Choose an item. / Choose an item. / Choose an item. /
Urology / Choose an item. / Choose an item. / Choose an item. /

5.PatientPopulation[PRII.D.3.]

Datashouldbespecifictobedsdedicatedtospinal cord injury medicine (SCIM),census,admissions,etc.Iftypesofbedsand/orcarearenotspecificallyidentifiable,explain.

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Site#1 / Site#2 / Site#3 / Site34
Adults / Children / Adults / Children / Adults / Children / Adults / Children
Averagedailycensus/inpatientSCIM / # / # / # / # / # / # / # / # /
Acute care / # / # / # / # / # / # / # / # /
Inpatientrehabilitation / # / # / # / # / # / # / # / # /
Numberofnewadmissionsperyear/SCIM / # / # / # / # / # / # / # / # /
Acute care / # / # / # / # / # / # / # / # /
Inpatientrehabilitation / # / # / # / # / # / # / # / # /
Numberofadmissionsforcontinuingcareperyear/SCIM / # / # / # / # / # / # / # / # /
Acute care / # / # / # / # / # / # / # / # /
Inpatientrehabilitation / # / # / # / # / # / # / # / # /
Numberofoutpatientvisitsperyear/SCIM / # / # / # / # / # / # / # / # /
FTECorePhysical Medicine and RehabilitationResidentsAssignedforDirectPatientManagementtoBedServiceatAnyOneTime
Acute care / # / # / # / # / # / # / # / # /
Initial and ongoing medical rehabilitation / # / # / # / # / # / # / # / # /
Continuing care / # / # / # / # / # / # / # / # /
Planned FTECoreSCIMFellowsAssignedforDirectPatientManagementtoBedServiceatAnyOneTime
Acute care / # / # / # / # / # / # / # / # /
Initial and ongoing medical rehabilitation / # / # / # / # / # / # / # / # /
Continuing care / # / # / # / # / # / # / # / # /

6.Brieflydescribethesystemsprovidedtofellowsforcommunicationandinteractionwithsupervisingfaculty members.[PRII.D.4.]

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FellowAppointments

Will theprogramnotifyeachfellowinwritingoftherequiredlengthofappointmentpriortoappointmentintheprogram? [PR III.A.3.] ☐YES ☐NO

EducationalProgram

PatientCare

Indicatethesettingsandactivitiesinwhichfellowswill developproficiencyineachofthefollowingareasofpatientcare.Alsoindicatethemethod(s)usedtoevaluateproficiencyineacharea.

ProficiencyArea / Settings/Activities / Assessment Method(s)
Performingacomprehensiveneurologicassessmentanddeterminingtheinjurylevelofthepatient
[PRIV.A.2.a).(1).(a).(i)] / Click here to enter text. / Click here to enter text. /
Performingafunctionalassessmentbasedonneurological,musculoskeletalandcardiopulmonaryexaminationsandpsychosocialandprevocationalevaluations
[PRIV.A.2.a).(1).(a).(ii)] / Click here to enter text. / Click here to enter text. /
Evaluatingthestabilityofthespine
[PRIV.A.2.a).(1).(a).(iii)] / Click here to enter text. / Click here to enter text. /
Coordinatingandmanagingthetransitionfrom acute caretorehabilitation
[PRIV.A.2.a).(1).(a).(iv)] / Click here to enter text. / Click here to enter text. /
Referring and collaborating with programs of vocational rehabilitation in order to determine thefunctionalgoalsforself-care,mobility,vocationalandavocationalactivitiesbasedonthelevelandcompletenessofthelesion
[PRIV.A.2.a).(1).(a).(v)] / Click here to enter text. / Click here to enter text. /
Establishingshort-andlong-termrehabilitationgoalsandcoordinatingtheimplementationoftherehabilitationprogramtomeetsuchgoals
[PRIV.A.2.a).(1).(a).(vi)] / Click here to enter text. / Click here to enter text. /
Prescribingappropriate vehicle modifications and motorretrainingandconditioningactivities in order to promote independence in mobility and transportation,orthoses,andtheadaptiveequipmentneededtomeettherehabilitationgoals
[PRIV.A.2.a).(1).(a).(vii)] / Click here to enter text. / Click here to enter text. /
Evaluating and managing assistive equipment, including motorized wheelchairs, environmental control systems, and home modifications
[PR IV.A.2.a.(1).(a).(viii)] / Click here to enter text. / Click here to enter text. /
Determiningwhentherehabilitationgoalshavebeenachieved,finalizingthedischargeplan,andarrangingfortheappropriatelevelofcaretomatchthepatient'sneeds
[PRIV.A.2.a).(1).(a).(ix)] / Click here to enter text. / Click here to enter text. /
With appropriate consultation:
Coordinatingtreatmentandinfectioncontrol,includingthejudicioususeofantimicrobials
[PRIV.A.2.a).(1).(b).(i)] / Click here to enter text. / Click here to enter text. /
Evaluatingandmanagingcomplications, includingdeepveinthrombosis,pulmonaryembolus,autonomichyperreflexia,substanceabuse,pain,spasticity,depression,andthesequelaeofassociatedillnessesandpre-existingdiseases
[PRIV.A.2.a).(1).(b).(ii)] / Click here to enter text. / Click here to enter text. /
Evaluatingandmanagingintercurrentdisease,withspecialemphasisonthepreventionandmanagementofthesediseasesinpatientsatvariouslevelsofspinalcordinjury
[PRIV.A.2.a).(1).(b).(iii)] / Click here to enter text. / Click here to enter text. /
Evaluatingandmanagingtheuseofappropriatesurgicalproceduresforskinproblems,includingresectionofbone,thedevelopmentofflapsforsofttissuecoverage,andthepre-andpost-operativemanagementofthesepatients
[PRIV.A.2.a).(1).(b).(iv)] / Click here to enter text. / Click here to enter text. /
Evaluating and managing:
Orthostatichypotensionandothercardiovascularabnormalitiesduringinitialmobilizationofthepatient
[PRIV.A.2.a).(1).(c).(i)] / Click here to enter text. / Click here to enter text. /
Abnormalitiesandcomplicationsinotherbodysystemsresultingfromspinalcordinjury,includingpulmonary,genitourinary,endocrine,metabolic,vascular,cardiac,gastrointestinal,andintegumentary
[PRIV.A.2.a).(1).(c).(ii)] / Click here to enter text. / Click here to enter text. /
Respiratorycomplicationsincluding:airwayobstruction,atelectasis,pneumonia,andtrachealstenosis,andcomplicationsassociatedwith ventilator-dependentpatientswithspinalcordinjury,includinginvasive(i.e.,tracheostomy)andnon-invasive(i.e.,oral/nasalinterfaces)approaches,andphrenicnervepacing
[PRIV.A.2.a).(1).(c).(iii)] / Click here to enter text. / Click here to enter text. /
Thecareofpatientswithneurogenicbowelandbladderdisfunction
[PRIV.A.2.a).(1).(c).(iv)] / Click here to enter text. / Click here to enter text. /
Paindisordersassociatedwithspinalcorddisease/injury
[PR IV.A.2.a).(1).(c).(v)] / Click here to enter text. / Click here to enter text. /
Musculoskeletaldisordersassociatedwithspinalcorddisease/dysfunction,includingshoulderpain,overusesyndromes,neckpain,shouldersubluxation,andheterotopicossification
[PR IV.A.2.a).(1).(c).(vi)] / Click here to enter text. / Click here to enter text. /
Skinproblemsutilizingspecializedbeds,cushions,wheelchairs,andpressuremapping
[PRIV.A.2.a).(1).(c).(vii)] / Click here to enter text. / Click here to enter text. /
Thetreatmentofthecomplicationsassociatedwithchronicspinalcordinjury,includingpressuresores,spasticity,pain,urinarycalculi,urinarytractinfection,fractures,post-traumaticsyringomyelia,andprogressiverespiratorydecline
[PR IV.A.2.a).(1).(c).(viii)] / Click here to enter text. / Click here to enter text. /
Post-acutemedicalcareofpatientswithmedicalspinalcorddisease/dysfunction,includingmultiplesclerosis,motorneurondisease,transversemyelitis,anddisordersaffectingthespinalcord,includinginfectiousdisorders,neoplasticdisease,vasculardisorders,toxic/metabolicdisordersandcongenital/developmentaldisorders
[PRIV.A.2.a).(1).(c).(ix)] / Click here to enter text. / Click here to enter text. /
Thespecialneedsandproblemsofchildrenandadolescentswithspinalcordinjury,includingbehavior,bladder,bowel,andskincare,growthanddevelopment,immunizations,mobility,nutrition,pediatrics,self-care,recreationandschooling
[PRIV.A.2.a).(1).(c).(x)] / Click here to enter text. / Click here to enter text. /
Themedicationsofpatientswithspinalcordinjury,includingchangesinpharmacokinetics,pharmacodynamics,druginteractions,over-medication,andcompliance
[PRIV.A.2.a).(1).(c).(xi)] / Click here to enter text. / Click here to enter text. /
Providingregularfollow-up,evaluationandpreventivehealthcaretokeepthepatientathis/hermaximumhealthandrehabilitationstatus,andcoordinatingthiscarewiththepatient’spersonalcommunityphysician
[PRIV.A.2.a).(1).(d)] / Click here to enter text. / Click here to enter text. /
Implementing,overthecourseoftheindividualpatient'slifetime,ahealthmaintenanceanddiseasepreventionprogramwithearlyrecognitionandeffectivetreatmentofcomplicationsrelatedtospinalcorddysfunction
[PRIV.A.2.a).(1).(e)] / Click here to enter text. / Click here to enter text. /
Monitoringtheevolutionofneuraldysfunctioninordertorecognizeconditionsthatmayrequireadditionalevaluation,consultation,ormodificationortreatment
[PRIV.A.2.a.(1).(f)] / Click here to enter text. / Click here to enter text. /
Useofclinicalneurophysiologictestingtoassesstheextentofneurapraxia,denervation,reinnervation,phrenicnervefunction,andspinalcordfunction
[PR IV.A.2.a).(2).(a)] / Click here to enter text. / Click here to enter text. /

MedicalKnowledge

Indicatethesettingsandactivities(lectures,conferences,journalclubs,clinicalteachingrounds,etc)inwhichfellowswill developproficiencyintheirknowledgeineachofthefollowingareas.Alsoindicatethemethod(s)usedtoevaluatefellowproficiencyineacharea.

CompetencyArea / Settings/Activities / Assessment Method(s)
TheorganizationandinterdisciplinarypracticesoftheEmergencyMedicalServicessystemrelatingtothepre-hospitalandinitialEmergencyDepartmentcareof persons with spinal cord injury,aswellasconcomitantandassociatedinjuries
[PRIV.A.2.b).(1)] / Click here to enter text. / Click here to enter text. /
Thesupportiveroleofspinalcordinjurymedicinetoneurologicalsurgery,orthopaedicsurgery,emergencymedicine,andotherappropriatephysiciansininitialacutecaresites,includingintensiveandcriticalcareunits
[PR IV.A.2.b).(2)] / Click here to enter text. / Click here to enter text. /
Therelationshipbetweentheextentandlevelofspinalcordinjuryontheultimateresidualfunctionalcapacity
[PRIV.A.2.b).(3)] / Click here to enter text. / Click here to enter text. /
Themanagementoftheneurogenicbladderandsexualdysfunctionandtheroleoftheurologistinassistingwiththediagnosisandmanagementofbladderdysfunction,urinarytractinfection,urinarycalculi,sexualdysfunction,obstructiveuropathywithorwithoutstones,infertilityandproblemsofejaculation
[PR IV.A.2.b).(4)] / Click here to enter text. / Click here to enter text. /
Thekinesiologyofupperextremityfunctionandtheuseofmusclesubstitutionpatternsinretraining
[PR IV.A.2.b).(5)] / Click here to enter text. / Click here to enter text. /
Thevalue,indicationsandcontraindicationsoftendonandmuscletransfersandotheroperativeproceduresthatwouldenhancefunction
[PR IV.A.2.b).(6)] / Click here to enter text. / Click here to enter text. /
Indicationsandcontraindicationsofphrenicnervepacing, as well as invasive (i.e. tracheostomy) and non-invasive (i.e., oral/nasal interfaces) ventilator approaches)
[PR IV.A.2.b).(7)] / Click here to enter text. / Click here to enter text. /
Indicationsforpersonalcareattendants,typesofarchitecturalmodificationstoaccommodatepatientneeds,andcommunityresourcesforfollow-upcare
[PR IV.A.2.b).(8)] / Click here to enter text. / Click here to enter text. /
Preventionandmanagementofcomplicationsassociatedwithlongstandingdisability,theeffectsofagingwithadisabilityandtheprovisionoflong-termfollow-upservices
[PR IV.A.2.b).(9)] / Click here to enter text. / Click here to enter text. /
Techniquesofappropriatespinalimmobilizationrequiredtoprotectpatientsfromadditionalneurologicaldamage
[PR IV.A.2.b).(10)] / Click here to enter text. / Click here to enter text. /
The variousoptionsfortreatmentoffractures/dislocationsatallvertebrallevels
[PR IV.A.2.b).(11)] / Click here to enter text. / Click here to enter text. /
Indicationsforanduseofclinicalneurophysiologictestingtoassesstheextentofneurapraxia,denervation,reinnervation,phrenicnervefunction,andspinalcordfunction
[PR IV.A.2.b).(1).(l)] / Click here to enter text. / Click here to enter text. /
Indicationsanduseoffunctionalelectricalstimulation(FES)asappliedtothemanagementofspinalcordimpairment
[PR IV.A.2.b).(12)] / Click here to enter text. / Click here to enter text. /
Theprofessionalroleandcontributionsofthevariousalliedhealthprofessionsindividuallyandcollectively
[PR IV.A.2.b).(13)] / Click here to enter text. / Click here to enter text. /
Working with interdisciplinary and interspecialty teams in the management of pre- and post-operative care of patients undergoing operative procedures that enhance extremity function, including muscle and tendon transfers
[PR IV.A.2.b.(14)] / Click here to enter text. / Click here to enter text. /

Practice-based Learning and Improvement

Indicate the settings and activities in which residents will develop the skills and habits to meet the following goals. Also indicate the method(s) that will be used to evaluate competency. [PR IV.A.2.c)]

Competency Area / Settings/Activities / Method(s) Used to Evaluate FellowCompetency
Informing and counseling patients, their families, and other health specialists on a timely basis about the impact of a patient’s disability
[PR IV.A.2.c).(3)] / Click here to enter text. / Click here to enter text. /
Participation in patient education about all aspects of spinal cord dysfunction in order to promote patient independence and patient recognition of illness
[PR IV.A.2.c).(4)] / Click here to enter text. / Click here to enter text. /
Teaching hospital personnel, including medical students, residents, and fellows, as well as other health care providers, patients, local medical communities, and the general public, about relevant topics in spinal cord injury medicine. Including: assessing learning needs; developing objectives and curriculum plans; effectively using audiovisual and other teaching materials; and, evaluating teaching outcomes [PR IV.A.2.c).(5)-PR IV.A.2.c).(5).(d)] / Click here to enter text. / Click here to enter text. /

Interpersonal and Communication Skills

List the settings/activities in which fellows develop competency in the areas listed below. Also specify the method(s) used by the program to evaluate fellow competency in each area.[PR IV.A.2.d)]

Competency Area / Settings/Activities / Method(s) Used to Evaluate FellowCompetency
Counseling patients and families in family meetings/discharge planning conferences, with a focus on community integration and adjustment to disability
[PR IV.A.2.d).(1)] / Click here to enter text. / Click here to enter text. /

Professionalism

Competency Area / Settings/Activities / Method(s) Used to Evaluate FellowCompetency
Develop and maintain a professional relationship with primary care physicians, and assist with or provide primary care for needed follow-up examination and complex issues of spinal cord injury care
[PR IV.A.2.e).(1)] / Click here to enter text. / Click here to enter text. /
Apply legal principles especially pertinent to spinal cord injury, including diminished competence and the right to refuse treatment
[PR IV.A.2.e).(2)] / Click here to enter text. / Click here to enter text. /

Systems-based Practice

List the settings and activities in which fellows develop competence in the areas listed below. Also specify the method(s) used to evaluate fellow competence in this area.[PR IV.A.2.f)]

Competency Area / Settings/Activities / Method(s) Used to Evaluate Fellow Competency
Demonstratea management style compatible with interdisciplinary team process
[PR IV.A.2.f).(1)] / Click here to enter text. / Click here to enter text. /

CurriculumOrganizationandFellowExperiences

1.Will eachfellowprovidecare, directly or in a direct supervisory role, foraminimumofeighthospitalizedpatientswhenonaninpatientrotation? [PR IV.A.3.a).(3)] ☐YES ☐NO

If“NO,”explain.

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2.Brieflydescribefellowexperiencemanaging,inconcertwithappropriatedisciplinesandotherteammembers,thepsychologicaleffectsoftheimpairmentinordertopreventtheirinterferencewiththereintegrationandre-entryintothecommunity.[PRIV.A.3.a).(4)]

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3.Brieflydescribefellowparticipationinprescribingahomecareplanfortheirspinalcordinjurypatients,asappropriate.[PRIV.A.3.b)]

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4.Brieflydescribefellowexperiencecoordinatingtheparticipationoccupationaltherapists,orthotists,physicaltherapists,prosthetists,psychologists,recreationalandvocationalcounselors,rehabilitationnurses,socialworkers,speech/languagepathologists,andin-patientcaremanagementinpatientcaremanagement.[PRIV.A.3.c)]

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5.Brieflydescribefellows’opportunitiestomeetandshareexperienceswithresidentsinthecoreprogramandinotherspecialtiesandsubspecialties.[PRIV.A.3.d)]

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6.Doprogramconferencesincludethefollowing:[PRIV.A.3.e)]

a)Case-orientedmultidisciplinaryconferences...... ☐YES ☐NO

b)Journalclub...... ☐YES ☐NO

c)Qualityimprovementseminars...... ☐YES ☐NO

7.Will eachfellowhavedocumentedattendanceatconferencesthatprovidein-depthcoverageofthemajortopicsinspinalcordinjurymedicineoverthedurationofthe12-monthprogram? [PR IV.A.3.e).(1)] ☐YES ☐NO

8.Will qualityimprovementseminarsincludediscussionofinitial,discharge,andfollow-updatathathavebeenanalyzedregardingthefunctionaloutcomesofpersonsserved, as well as other practice improvement activities that will help engage fellows in maintenance of certification?
[PR IV.A.3.e).(2)]...... ☐YES ☐NO

Faculty Evaluation

Will fellowsprovideconfidentialevaluationofthe members of the facultyatleastsemi-annually?
[PR V.B.3.]...... ☐YES ☐NO

Spinal Cord Injury MedicineUpdated 2/2015