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Editorial

The COVID-19 Pandemic Is an Accelerator of the Evolution of Physiatry

Francisco, Gerard E. MD

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American Journal of Physical Medicine & Rehabilitation: February 2021 - Volume 100 - Issue 2S - p S1-S2
doi: 10.1097/PHM.0000000000001640
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The disruption of medical and graduate medical education in physiatry brought about by the COVID-19 pandemic has forced rapid changes in the delivery of information and platform for training and skills acquisition. This unprecedented event in our history has become the Rubicon in how physicians will be trained, assessed, and certified in years to come.

During the pandemic, we realized that structured physical medicine and rehabilitation (PM&R) educational curriculum—including its content, delivery, and validation—needs to be not only flexible but also easily modifiable in real time to more effectively respond to unexpected and urgent situational demands. However, strict and thoughtful oversight of curriculum implementation needs to be enforced to yield desirable outcomes, in this case, producing competent physiatrists, and ensure compliance with regulatory and accreditation requirements.

The de rigueur physical distancing during the pandemic forced in-person learning experiences to switch to virtual formats and, often, with limited physical patient contact, and incorporate unconventional, informal teaching methods.1 The process of competency assessment, required to demonstrate a trainee’s progress along the educational trajectory and, eventually, licensure and certification, had to be revised in keeping with COVID-19 precautions. In support of PM&R trainees and diplomates, accrediting and certifying bodies have modified processes and requirements to allow focus on patient care and a learning environment that was transformed overnight.2,3 To facilitate faster dissemination of information regarding changes in policies and procedures in response to the pandemic, educational institutions and organizations had to strengthen their communication systems by adopting a multimodal model, concurrently using traditional means, e-mail, website postings, and social media.

Recognizing that these adaptations may become the so-called new normal, educators had to ramp up their creativity and resourcefulness to meet the challenges of training and certification under conditions that deviate from well-established formats. The physical medicine and rehabilitation educators are already modifying curricula and schedules to compensate for missed learning experiences when hospital and clinic operations ceased or were significantly reduced or when trainees in PM&R were redeployed to acute units to help care for patients with COVID. Program directors are recreating their residency selection processes now that interviews will most likely be held virtually. This year many applicants would most likely not have completed visiting rotations because of quarantine and travel restrictions. The latter brings to light the potential inequity in residency selection because programs consider visiting rotations a valuable deciding factor when preparing the residency match rank order list.4

In addition, PM&R educators are now realizing that the current physiatric competencies need to be reassessed to determine how to incorporate “expanded competencies,” such as leading and working within interprofessional team structures, measuring and improving population health outcomes, using technology to optimize work flow and measure performance, leading change management, and optimizing public and global health,5 in the current curriculum.

Even before the COVID-19 pandemic, physiatric educators have already been striving for innovations in training, evaluating, and certifying physiatrists. Many of these proposed or implemented developments and important contemporary issues in PM&R education and certification are discussed by contributors in this issue. Bosques et al.6 and Curtis et al.7 present initiatives to widen the physiatric footprint in medical school curricula. McIntyre et al.8 discuss the implementation of a leadership curriculum in a PM&R residency program, and Yeh et al.9 describe a novel evaluation of competency in neurologic assessment. Taylor and the PM&R Milestones 2.0 team10 present enhancements to the Accreditation Council of Graduate Medical Education milestones to further strengthen its framework as an assessment of competency-based developmental outcomes. Lastly, Sanchez et al.11 and Kinney et al.12 tackle hot topics, such as racial diversity and the interplay between sex, age, and continuing certification by the American Board of Physical Medicine and Rehabilitation.

Although some see the COVID-19 pandemic as a disruption, others see it as an accelerator of the exciting transformation of physiatric training, competency evaluation, and certification, which has been evolving for many years now. The many uncertainties of these times and the post-COVID era provoke anxiety, but we can also harness it to refocus, rethink, and recreate the future of physiatry.

REFERENCES

1. Redinger JW, Cornia PB, Albert TJ: Teaching during a pandemic. J Grad Med Educ 2020;12:403–5
2. From the review committee for physical medicine and rehabilitation. ACGME. Available at: https://acgme.org/Portals/0/Documents/COVID-19/PMRCOVID19LTC.pdf. Accessed November 2, 2020
3. ABPMR COVID-19 updates. American Board of Physical Medicine and Rehabilitation. Available at: https://www.abpmr.org/NewsCenter/Detail/covid-19-updates. Accessed November 2, 2020
4. Lucey CR, Johnston SC: The transformational effects of COVID-19 on medical education. JAMA 2020;324:1033–4
5. Lucey CR: Medical education: part of the problem and part of the solution. JAMA Intern Med 2013;173:1639–43
6. Bosques G, Philip K, Francisco GE: Integration of chronic disability management in a medical student curriculum. Am J Phys Med Rehabil 2021;100(Suppl 2):S30–3
7. Curtis CM, Eubanks JE, Charles SC, et al.: A required, combined neurology-physical medicine and rehabilitation clerkship addresses clinical and health systems knowledge gaps for fourth-year medical students. Am J Phys Med Rehabil 2021;100(Suppl 2):S17–22
8. McIntyre M, Alavinia SM, Matlow A: Implementation of a pilot leadership curriculum for physical medicine and rehabilitation residents. Am J Phys Med Rehabil 2021;100(Suppl 2):S7–11
9. Yeh PC, Gilbert-Baffoe E, Michael A, et al.: Assessing physical medicine and rehabilitation residency education using the neurological assessment competency evaluation system. Am J Phys Med Rehabil 2021;100(Suppl 2):S40–4
10. Taylor CM II, Baer H, Edgar L, et al.: Improving the assessment of resident competency: physical medicine and rehabilitation milestones 2.0. Am J Phys Med Rehabil 2021;100(Suppl 2):S45–50
11. Sanchez AN, Martinez CI, Stampas A, et al.: Ethnic and racial diversity in academic physical medicine and rehabilitation compared with all other medical specialties. Am J Phys Med Rehabil 2021;100(Suppl 2):S12–6
12. Kinney CL, Raddatz MM, Robinson LR: Influence of sex and age on ratings of confidence and relevance in continuing certification longitudinal assessment: a pilot study. Am J Phys Med Rehabil 2021;100(Suppl 2):S3–6
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