A Conversation Between Past and Present Chairs of the American Board of Physical Medicine and Rehabilitation: Four Decades of History and the Future of Board Certification.

On the 75th anniversary of the founding of the American Board of Physical Medicine and Rehabilitation, 11 of the surviving chairs of the board convened virtually to reflect on the past 40 years of major trends for the accrediting body of physiatrists. The field rapidly expanded in the 1980s, driven by changes in the reimbursement environment. This rapid expansion drove an improvement in the caliber of residents choosing the field and in the quality of training programs.

Assessing the Field of Pediatric Rehabilitation Medicine's Interest in Expanding Fellowship Training to Pediatricians.

Background: Training opportunities to pursue a career in pediatric rehabilitation medicine (PRM) have evolved over the last 40 years, with the most recent change being the development and accreditation of PRM fellowships and subspecialty certification in PRM. Currently the American Board of Physical Medicine & Rehabilitation (ABPMR) requires all candidates for PRM subspecialty certification to have completed a physical medicine and rehabilitation (PM&R) residency. The small number of certified PRM physicians has prompted debate within the field about permitting pediatricians to enter PRM fellowships without having to complete a PM&R residency.

Kernohan-Woltman Notch Phenomenon in Two Patients with Subdural Hematoma and Ipsilateral Hemiparesis.

CASE 1: A 9-yr-old boy presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation and imaging are consistent with Kernohan-Woltman notch phenomenon. CASE 2: A 19-yr-old man presents with right subdural hematoma and ipsilateral hemiparesis.

Quality Improvement Education in Residency Training: A Review.

Hospitals and healthcare institutions have strong external and internal pressures to improve patient safety and healthcare quality. Quality improvement education has been mandated for resident physicians by the Accreditation Council for Graduate Medical Education. This review describes didactic and experiential curricula for residents in quality improvement interventions as well as factors that create challenges to implementing such a curriculum and those that foster it.

A Novel Protocol for Contact Isolation for Multidrug-Resistant Organisms in Children on Inpatient Rehabilitation and Effects on Functional Outcomes: A Noninferiority Study.

Background: The incidence of contact isolation for multidrug-resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.

Objective: To determine whether the use of a modified contact isolation protocol (MCI) resulted in noninferior functional outcomes compared with children without contact isolation (NCI) on inpatient rehabilitation.

Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003 to 2015.

Background: Pediatric rehabilitation medicine (PRM) physicians enter the field via several pathways. It is unknown whether different training pathways impact performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of Certification (MOC) Examination.

Objectives: To describe the examination performance of candidates on the ABPMR PRM Examination according to their type of training (physiatrists with a clinical PRM focus, accredited or unaccredited fellowship training, separate pediatric and physical medicine and rehabilitation residencies, or combined pediatrics/physical medicine and rehabilitation residencies) and to compare candidates' performance on the PRM Examination with their initial ABPMR certification and MOC Examinations.

Subacute Progressive Myelopathy: Transverse Myelitis or Subacute Combined Degeneration? A Case Report.

Unlabelled: Evolving subacute myelopathies have many possible etiologies. This is a report of a patient who presented with progressive paresthesias, proprioceptive loss, and gait disturbance with acute myelitis seen on magnetic resonance imaging initially concerning for transverse myelitis. However, she also had vitamin B12 deficiency, and her clinical course ultimately suggested a diagnosis more compatible with subacute combined degeneration.

Does the Physical Medicine and Rehabilitation Self-Assessment Examination for Residents Predict the Chances of Passing the Part 1 Board Certification Examination?

Background: Each year, residents in accredited United States Physical Medicine and Rehabilitation (PMR) residency programs can take the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Self-Assessment Examination for Residents (SAE-R). This 150-question, multiple-choice examination is intended for self-assessment of physiatric knowledge, but its predictive value for performance on the part 1 American Board of Physical Medicine and Rehabilitation Certification Examination (ABPMR-CE) is unknown.

Objective: To investigate the predictive value of the SAE-R in relation to the part 1 ABPMR-CE.

Role of dorsal rhizotomy in spinal cord injury-induced spasticity.

Selective dorsal rhizotomy may have a role in the management of spinal cord injury (SCI)-induced spasticity. Spasticity and spasms are common sequelae of SCI in children. Depending on the clinical scenario, treatments may include physical and occupational therapy, oral medications, chemodenervation, and neurosurgical interventions.

New challenges for the graduate medical educator: implementing the milestones.

Physical medicine and rehabilitation residency programs will face new challenges as they implement the Milestones and establish a Clinical Competency Committee, new requirements in the Accreditation Council of Graduate Medical Education's Next Accreditation System. The milestones require programs to measure the capabilities of individual residents, and programs will be expected to show how residents progress to successively higher levels of behavior during the course of the residency. Program directors will be assisted by a committee of faculty whose role is to assess each individual resident's attainment of milestones and assist in the early identification of residents not making the expected progress.

Reliability of the physical medicine and rehabilitation resident observation and competency assessment tool: a multi-institution study.

Objectives: To assess the psychometric qualities of a method of resident physician evaluation by faculty.

Design: Multicenter study by seven Physical Medicine and Rehabilitation training programs. Faculty physicians observed residents in brief patient encounters or teaching sessions, rated specific competencies, and provided residents with immediate feedback.

Reliability of a 360-degree evaluation to assess resident competence.

Objective: To determine the feasibility and psychometric qualities of a 360-degree evaluation of physical medicine and rehabilitation (PM&R) residents' competence.

Design: Nurses, allied health staff, and medical students completed a 12-item questionnaire after each PM&R resident rotation from January 2002 to December 2004. The items were derived from five of the six competencies defined by the Accreditation Council for Graduate Medical Education (ACGME).

Anterior spinal artery syndrome in two children with genetic thrombotic disorders.

Background: Spinal cord infarction is a well-described, but rare, etiology of myelopathy, especially in children. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, thoracolumbar surgery, sepsis, hypotension, and thromboembolic disorders.

Psychiatric illness after mild traumatic brain injury in children.

Objective: To determine the incidence of psychiatric illness 3 years after mild traumatic brain injury (TBI) in children.

Design: Prospective cohort study with 3-year follow-up.

Setting: Emergency department, hospital, and outpatient clinics in a large health maintenance organization.

Fibrocartilaginous embolism--an uncommon cause of spinal cord infarction: a case report and review of the literature.

Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It is postulated that an acute vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by a retrograde embolization to the central artery. An increased intradiskal pressure resulting from axial loading of the vertebral column with a concomitant Valsalva maneuver is thought to be the initiating event for the embolus.