PM

UAMS DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION RESIDENCY PROGRAM MANUAL KEVIN M. MEANS, M.D., RESIDENCY PROGRAM DIRECTOR JENNIFER C. CROW, RESIDENCY PROGRAM COORDINATOR LAST REVIEWED/REVISED JULY 2009

TABLE OF CONTENTS FOREWARD.............................................................................................................................................4 Our History............................................................................................................................................4 The History of Physiatry An Overview.........................................................................................................................................5 Physical Medicine and Rehabilitation Description of Program.............................................................................................................................7 Overall Goals and Objectives for Residency Training..............................................................................9 Educational Goals - PGY-1 Resident..................................................................................................11 Educational Goals - PGY-2 Resident..................................................................................................11 Educational Goals - PGY-3 Resident..................................................................................................12 Educational Goals - PGY-4 Resident..................................................................................................13 UAMS Department of Physical Medicine and Rehabilitation Faculty Roster..........................................................................................................................................15 Department Chairman/Residency Program Director - Kevin M. Means, M.D.............................................................................................................................18 UAMS Department of Physical Medicine and Rehabilitation Resident Roster........................................................................................................................................30 Introduction for Educational Program.....................................................................................................31 PGY-1 Rotation Introduction..................................................................................................................32 Physical Medicine and Rehabilitation Fundamental Clinical Skills Rotation.....................................34 Emergency Medicine...........................................................................................................................36 Medicine Wards-VAH.........................................................................................................................38 Medicine-Ambulatory Care.................................................................................................................40 Radiology............................................................................................................................................42 Neurology............................................................................................................................................45 Pediatric Wards ACH..........................................................................................................................54 Geriatric Wards...................................................................................................................................56 Rheumatology, BMC or VA................................................................................................................58 Sample Residency Rotation Schedules...................................................................................................60 UAMS PM&R Resident Rotation Schedule 2009/2010.........................................................................61 Introduction for Rotation Objectives.......................................................................................................62 Resident Signs of Fatigue....................................................................................................................63 Inpatient Goals & Objectives .............................................................................................................65 Outpatient Goals & Objectives............................................................................................................72 EMG Goals & Objectives....................................................................................................................80 Scheduled Educational Activities for PM&R Residents 2009-2010................................................................................................................................................83 Master Schedule 2009-2010................................................................................................................................................84 Grand Rounds .........................................................................................................................................85 Resident Seminars...................................................................................................................................86 Seminar Evaluation.................................................................................................................................88 Journal Club.............................................................................................................................................89 Suggested Guideline for Review of a Research Article..........................................................................91 PM&R Resident Self-Assessment Examination.................................................................................................................92 PM&R Resident Scholarly Activity Program.........................................................................................93 2

Resident Mid-Rotation Evaluation by Faculty .......................................................................................95 Objective Structured Clinical Examination (OSCE)...............................................................................96 Residency Program Policy - Resident Selection Criteria and Recruitment Process...........................98 Residency Program Policy - Resident Evaluations...........................................................................101 Residency Program Policy - Faculty Evaluations by Residents........................................................102 Residency Program Policy - Resident Leave....................................................................................103 Residency Program Policy - Educational & Administrative Leave..................................................107 Residency Program Policy - Procedure for Leave Request...............................................................109 Residency Program Policy – Moonlighting......................................................................................110 Residency Program Policy - Duty Hours and Work Environment....................................................111 Residency Program Policy - Night Call............................................................................................113 BHRI PHYSICIAN HOUSESTAFF POLICY.................................................................................114 BHRI Patient Care Policy/Procedure #D-1.......................................................................................116 Residency Program Policy - Meals for BHRI On-Call Residents.....................................................117 Residency Program Policy - CAVH AM/PM Call Coverage...........................................................118 Residency Program Policy - Resident Beepers.................................................................................119 Residency Program Policy - Photocopying for Residents and Medical Students.............................120 Residency Program Policy - Book Funding......................................................................................121 Residency Program Policy - Regarding Travel.................................................................................122 Residency Program Policy - Chief Residents....................................................................................123 Residency Program Policy - Guidelines for Resident to Resident Supervision in PM&R...............125 Residency Program Policy - Criteria and Processes for Academic Actions of Reappointment, Evaluation, Promotion, and Other Disciplinary Actions...................................................................126 Residency Program Policy - UAMS/PM&R Library Rules..............................................................129 Residency Program Policy - PM&R Housestaff-Fringe Benefits.....................................................130 Residency Program Policy - Self-Assessment Examination (SAE)..................................................134 Residency Program Policy - Addressing Resident Concerns............................................................135 Residency Program Policy – Supervision.........................................................................................137 American Board of Physical Medicine & Rehabilitation – Registration of New Residents.................138 APPENDIX...........................................................................................................................................139 Semi-Annual Resident Evaluation of Faculty...................................................................................140 PM&R RESIDENT CHECKOUT FORM........................................................................................141 Request to Participate in Moonlighting Activities............................................................................142 Sample Letter for Resident Elective Rotation...................................................................................143 Resident Counseling Form................................................................................................................146 3

FOREWARD Our History We are a young specialty in an organized sense. Under the leadership of Dr. Frank Krusen, we were recognized as the “American Board of Physical Medicine” in 1947 by the Accreditation Council on Graduate Medical Education (ACGME). Two years later, the word “Rehabilitation” was added at the urging of Dr. Howard Rusk. However, using physical agents, i.e., exercise and heat, may have been the earliest method of medical rehabilitation by our physician forebears. Many American physicians and philanthropists contributed to the development of the specialty “Physical Medicine and Rehabilitation.” An account of the maturation of our specialty reflects somewhat the biases of the persons assembling the history, but clearly this narrative presents an objective view of our beginnings and subsequent growth during the past 75 years. Others may add to or subtract from the story, but this will serve as the consensus for our own album. Much appreciation to Bradley R. Johns for his thorough investigation and presentation. Ernest W. Johnson, MD Professor of PM&R The Ohio State University September 14, 1994 4

The History of Physiatry An Overview Physical means of healing have been practiced since prehistoric times, but Physiatry did not become recognized as a separate medical specialty until 1947. Most widely known as the field of Physical Medicine and Rehabilitation, the medical specialty of modern-day Physiatry comprises the related disciplines of Physical Medicine, Rehabilitation Medicine and Electromyography. The term Physiatry derives from the Greek word physikos (physical) and iatreia (art of healing). A Physiatrist is a physician who creatively employs physical agents as well as other medical therapeutics to help in the healing and rehabilitation of a patient. Treatment involves the whole person and addresses the physical, emotional and social needs that must be satisfied to successfully restore the patient’s quality of life to its maximum potential. Since the beginning of time, people have used physical means for treatment of illness and injury. Such physical agents for healing have included water, heat, cold, massage, light, exercise and electricity. Throughout history, water has functioned as a primary means of physical healing. Written accounts of physical techniques for healing can be traced as far back as the writing of Hippocrates in 400 B.C. Rehabilitation involves the restoration of a diseased or disabled person to optimal physical, psychological and social functioning. 5

The History of Physiatry Presented by the Association of Academic Physiatrists Historical Committee Link to http://www.physiatry.org/field/history.html 6

Physical Medicine and Rehabilitation Description of Program Physical Medicine and Rehabilitation (PM&R) program encourages residents to become competent Physiatrists by having experience in clinical, didactics, and by participating in research curriculum. This program has qualified faculty to implement the program and residents are expected to fulfill the components of this program. The University of Arkansas for Medical Sciences (UAMS) is the sponsoring institution and several sites participate in this program. The PM&R program is a multi-clinical site utilizing Arkansas Children’s Hospital (ACH), Baptist Health Rehabilitation Institute (BHRI), Central Arkansas Veterans Hospitals in Little Rock (CAVH-LR) and North Little Rock (CAVH-NLR), and the University of Arkansas for Medical Sciences (UAMS). These facilities allow students to have the opportunity to work in a rehab facility and private practice. Arkansas Children’s Hospital (ACH) is the seventh largest pediatric hospital in the country, and the only pediatric medical center in the state. ACH has a strong pediatric rehab program with a large number of patients and a 20-bed inpatient rehabilitation pediatric unit. In addition to inpatient care, there are regular clinics for myelomingocele, muscular dystrophy, and cerebral palsy. Burn and hemophilia clinics are optional. BHRI is a free standing institute that allows residents to obtain good clinical training in PM&R. In addition to inpatient care, there are extensive on-site outpatient facilities, as well as multiple satellite therapy centers. UAMS is an acute care teaching hospital. PM&R residents interact with medical students of different specialties, residents, and faculty from other services such as Neurosurgery, Neurology, Trauma Surgery, Medicine, Geriatrics, Oncology, Rheumatology, Family Practice, and Orthopedics. CAVH-LR is an acute care hospital with a spacious section devoted to Rehabilitation Medicine Services. It is a tertiary facility that admits complex medical problems from the surrounding district plus the usual mix of patients from the local metropolitan area. The hospital is adjacent to and closely affiliated with University Hospital and the faculty of most services have joint appointments in the hospitals. There is a PM&R consultation service at this hospital. CAVH-NLR is a long-term hospital for patients with psychiatric and chronic medical problems. A 20-bed rehabilitation unit and a 38-bed geriatric unit provide a solid environment for learning and training. There is an extensive consultation service, including diagnostic EMG’s and numerous outpatient clinics (i.e., brace, seating, spinal cord, general rehabilitation, back, amputee clinics, and falls clinics.) PM&R is a four-year graduate medical education program that requires four years of graduate medical education to complete training for a physician seeking specialization in this field, three years of which must be physical medicine and rehabilitation training. Of these three years, no more than six months can be elective. Three years are spent in the Department of Physical Medicine and Rehabilitation with three month rotations, which provide a wide variety of clinical experience in both neuromuscular and musculoskeletal diagnosis. This includes comprehensive rehabilitation of severe physical disabilities such as spinal cord injury, head injury, stroke, amputation, electrodiagnosis, management of acute and chronic musculoskeletal problems, and management of chronic pain syndromes. No more than one month of this elective time may be taken in a non-ACGME – accredited program, unless prior approval is given by the Residency Review Committee (RRC). 7

The remaining months of this year may include any combination of accredited specialties or subspecialties. Most or best areas excelled in: Spinal Cord, Geriatrics, and VA (Spinal Cord expanded with VA). Students are going to get a variety of experiences in patient populations at VA-Geriatrics, BHRI-Private Rehab, UAMS and ACH-Pediatrics, which will give students diversity. One year of the four years of training is to develop fundamental clinical skills. This year of training in fundamental clinical skills must consist of an accredited transitional year or include six months or more responsibility in accredited training with inpatient responsibility in family practice, internal medicine, obstetrics-gynecology, pediatrics, or surgery, or any combination of these patient care experiences. Accredited training in any of these specialties or subspecialties selected must be for a period of at least four weeks. PGY-1 would do six months of inpatient ward medicine at the VA and six months of the following specialty areas: Neurology, Emergency Medicine, Ambulatory Medicine (VA), Radiology/Rheumatology and PM&R. No more than eight weeks may be in non-direct patient care experiences. Training in fundamental clinical skills must be completed within the first two years of the four-year training program. This training program may choose either to provide three years of physical medicine and rehabilitation training and appoint residents at the PGY-2 level contingent on satisfactory completion of first year’s accredited training in fundamental clinical skills or to provide four years of training to include twelve months of these fundamental clinical skills in areas other than physical medicine and rehabilitation. It is the responsibility of this program for the quality of the integrated educational experience for the entire training program, including twelve months of training in fundamental clinical skills in areas other than physical medicine and rehabilitation. 8

Overall Goals and Objectives for Residency Training It is the intent of the Physical Medicine and Rehabilitation (PM&R) program to develop physicians well trained and able to practice in a competent and independent manner as Physiatrists. This training will be achieved through a) supervised clinical work with increasing responsibility for outpatients and inpatients and b) a foundation of organized instruction in the basic neurosciences. Physicians completing the program will be eligible for certification by the American Board of Physical Medicine and Rehabilitation with an ultimate goal of an eventual 100% pass rate on both the oral and written examinations. This program has training level specific educational goals that must be met to ensure residents are aware of the level of education in this program. They are: Mastery Level: Competent in all essential knowledge areas; technically proficient in skill areas; minimal input by attending faculty required for subtle or fine points only; capable of unsupervised independent PM&R practice. Advanced Level: Competent in most essential knowledge areas; basic knowledge areas have been mastered, but some advanced areas may need further improvement; technically proficient in many, but not all skills areas; requires some supervisory input by attending faculty, but less than basic level resident. Basic Level: Familiar with basic PM&R knowledge areas; competence still improving; familiar with some PM&R technical skills; requires moderate supervisory input by attending faculty, especially for advanced areas. Residents are also required to develop competencies in the six areas below to the level expected of a new practitioner. Toward this end, the resident is provided through the training program with the appropriate experience to develop and demonstrate the following specific knowledge, skills, and attitudes: a. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. b. Medical Knowledge about established and evolving biomedical, clinical and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. c. Practice-based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvement in patient care. d. Interpersonal and Communication Skills that result in effective information exchange and learning with patients, their families, and other health professionals. e. Professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. f. Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. Physical Medicine and Rehabilitation residency program must document that it provides an educational experience of such quality and excellence as to offer its graduates the opportunity for attainment of those competencies necessary for entry level independent practice of this specialty. This 9

must include knowledge about the diagnosis, pathogenesis, treatment, prevention and rehabilitation of those neuromusculoskeletal, neurobehavioral, cardiovascular, pulmonary, and other system disorders common to this specialty in patients of both sexes and all ages. This program will provide the opportunity for the graduate to develop the attitudes and psychomotor skills required to: a. modify history-taking technique to include data critical to the recognition of functional abilities and physical and psychosocial impairments that may cause functional disabilities; b. perform the general and specific physiatric examinations, including electromyography, nerve conduction studies, and other procedures common to the practice of physical medicine and rehabilitation; c. make sound clinical judgments; and d. design and monitor rehabilitation treatment programs to minimize and prevent impairment and maximize functional abilities. In addition, this program must provide the opportunity for the graduate to be able to coordinate effectively and efficiently an interdisciplinary team of allied rehabilitation professionals for the maximum benefit of the patient by: a. an understanding of each allied health professional’s role, b. the ability to write adequately detailed prescriptions based on functional goals for physiatric management, and c. the development of management and leadership skills. Additionally, this training program will stress the importance of self-evaluation, continuing medical education and continued professional development after graduation. The training program must provide the opportunity for the resident to develop the necessary written and verbal communication skills essential to the efficient practice of physiatry. The organization and philosophy of the residency program must provide the opportunity for development of the clinical competence of the resident. The curiosity and creativity of all residents must be stimulated and must be involved in the critical appraisal of current literature. All provisions of the Institutional Requirements must also be met for accreditation. Clinical competence requires: a. A solid fund of basic and clinical knowledge, b. The ability to perform an adequate history and physical exam, c. The ability to order and interpret appropriate diagnostic tests, d. Adequate technical skills to carry out selected diagnostic procedures, e. Clinical judgment to critically apply the above data to individual patients, f. Attitudes conducive to the practice of Physiatry, including appropriate interpersonal interactions with patients, professional colleagues, supervisory faculty, and all paramedical personnel, g. Personal integrity, h. Regular, timely attendance at departmental and divisional educational activities, i. Timely dictations and signature of inpatient discharge summaries and outpatient notes, as well as completion of appropriate letters or phone calls to referring physicians, j. Recognition of personal limits. Controversial issues require direct and immediate participation of the responsible attending, 10

k. Ongoing dedication to critical evaluation of one’s own skills and knowledge and to continuing education through literature review, communication with colleagues, and attendance at society meetings and other educational forums, and l. Interaction with other facets of the health care delivery system at large in a comprehensive yet cost-effective manner. Within the PM&R program, there are educational goals for specific PGY level residents. These goals ensure residents have mastered skills at a certain level before progressing to a higher level. The educational goals for PGY 1-4 are as follows: Educational Goals - PGY-1 Resident Upon completion of the first postgraduate year, a PM&R resident should: 1. Recognize typical clinical problems among patients with physical medicine and rehabilitation problems in various clinical settings and their management. (Patient Care, Systems-Based Practice, Medical Knowledge) 2. Discuss the management of typical clinical problems among patients with physical medicine and rehabilitation problems in various clinical settings. (Systems-Based Practice, Medical Knowledge, Practice-Based Learning) 3. Demonstrate proper history and examination techniques. (Patient Care, Communication, Professionalism) 4. Identify various diseases and conditions that are amenable to rehabilitation efforts. (Medical Knowledge) 5. Describe allied health professionals involved in the rehabilitation team. (Systems-Based Practice, Practice Based Learning) Educational Goals - PGY-2 Resident Upon completion of the second postgraduate year, a PM&R resident should: 1. Demonstrate proficiency in physiatric assessment, diagnosis and prescription for functional impairments, arising from acute and chronic neurological, musculoskeletal, cardiovascular and pulmonary conditions. (Patient Care, Medical Knowledge) 2. Perform basic physiatric interventional procedures like trigger point and intra-articular injections, nerve and phenol blocks, botox injections and diagnostic examination, including nerve conduction and electromyographic studies. (Patient Care, Medical Knowledge) 3. Develop leadership skills to promote the team approach and responsible utilization of consulting services to maximize rehabilitation outcomes. (Systems-Based Practice, Interpersonal and Communication Skills, Professionalism) 4. Demonstrate a basic level competence in performing the comprehensive and physiatric physical examination and in the analysis of data from pertinent diagnostic tests to achieve the appropriate diagnosis. (Patient Care, Medical Knowledge) 5. Demonstrate a basic ability to formulate, implement and monitor appropriate PM&R treatment plans to archive maximum physical, psychological, social, vocational, avocational and educational outcomes for 11

patients in the acute hospital setting, the acute rehabilitation unit or hospital, the sub-acute or long-term care environment and the outpatient setting. (Patient Care, Medical Knowledge) 6. Demonstrate a basic understanding of the roles of interdisciplinary rehabilitation team members and a basic ability to lead and coordinate their efforts. (Patient Care, Medical Knowledge, Systems-Based Practice) 7. Demonstrate basic communication skills in communicating with patients, families, medical staff, team members, and other personnel. (Communication) 8. Demonstrate a basic level of competency relative to decision-making in the physical medicine and rehabilitation management of adults and children with most of the following conditions: traumatic brain injury, stroke, spinal cord injury, amputations, hereditary, developmental and acquired neuromuscular and musculoskeletal conditions, acute and chronic pain syndromes, cardiovascular and pulmonary disorders, soft-tissue disorders including burns and ulcers. (Patient Care, Medical Knowledge) 9. Demonstrate basic familiarity with journals that constitute the medical literature relevant to PM&R and in the basic components of research papers. (Practice Based Learning) 10. Demonstrate basic familiarity with common cost containment issues in physical medicine and rehabilitation practice, (Systems-Based Practice) Educational Goals - PGY-3 Resident Upon completion of the third postgraduate year, a PM&R resident should: 1. Demonstrate an advanced level competence in performing the comprehensive and physiatric physical examination and in the analysis of data from pertinent diagnostic tests to achieve an appropriate diagnosis. (Patient Care, Medical Knowledge) 2. Demonstrate an advanced ability to formulate, implement and monitor appropriate PM&R treatment plans to achieve maximum physical, psychological, social, vocational, avocational, and educational outcomes for patients in the acute hospital setting, the acute rehabilitation unit or hospital, the sub-acute or long term care environment and the outpatient setting. (Patient Care, Medical Knowledge, Systems-Based Practice, Communication) 3. Demonstrate advanced ability to lead and coordinate the efforts of an interdisciplinary rehabilitation team. (Systems-Based Practice, Professionalism, Communication) 4. Demonstrate advanced communication skills to be an effective communicator with patients, families, medical staff, team members, and other personnel. (Interpersonal and Communication Skills) 5. Demonstrate an advanced level of competency relative to decision-making in the physical medicine and rehabilitation management of adults and children with most of the following conditions: traumatic brain injury, stroke, spinal cord injury, amputations, hereditary, developmental and acquired neuromuscular and musculoskeletal conditions, acute and chronic pain syndromes, cardiovascular and pulmonary disorders, soft-tissue disorders including burns and ulcers. (Patient Care, Medical Knowledge) 12

6. Demonstrate advanced technical skill in the performance of common PM&R procedures (and in the prevention and management of associated complications) including: Electrodiagnosis (electromyography and nerve conduction studies), joint and soft tissue injections. (Patient Care, Medical Knowledge) 7. Demonstrate advanced knowledge of the biomedical research process and demonstrate advanced knowledge of the components of research papers and what journals constitute the medical literature relevant to PM&R. (Practice-Based Learning) 8. Take an active role in common cost containment issues in physical medicine and rehabilitation practice when making choices in types of procedures and management. (Systems-Based Practice) Educational Goals - PGY-4 Resident Upon completion of the fourth postgraduate year, a PM&R resident should: 1. Recognize Physical Medicine and Rehabilitation conditions, address the natural history, and anticipate nature of conditions when providing care. (Patient Care, Medical Knowledge) 2. Demonstrate competence in performing comprehensive physical examination and analysis of pertinent data from diagnostic tests to achieve an appropriate diagnosis. (Patient Care, Medical Knowledge) (OSCE) 3. Continue to demonstrate the ability to formulate, implement and monitor appropriate PM&R treatment plans to achieve maximum physical, psychological, social, vocational, avocational and educational outcomes for patients in the acute hospital setting, the acute rehabilitation unit or hospital, the sub-acute or long term care environment and the outpatient setting. (Patient Care, Medical Knowledge) 4. Demonstrate ability to lead and coordinate the efforts of an interdisciplinary rehabilitation team with minimal supervision. (Systems-Based Practice, Communication) 5. Demonstrate excellent communication skills to be an effective communicator with patients, families, medical staff, team members, and other personnel. (Communication) 6. Continue to demonstrate a level of competency to be able to independently make decisions regarding appropriate physical medicine and rehabilitation management of adults and children with all of the following conditions: traumatic brain injury, stroke, spinal cord injury, amputations, hereditary, developmental and acquired neuromuscular and musculoskeletal conditions, acute and chronic pain syndromes, cardiovascular and pulmonary disorders, soft tissue disorders including burns and ulcers. (Patient Care, Medical Knowledge, Systems-Based Practice) 7. Continue to demonstrate technical skill in the performance of common PM&R procedures and in the prevention and management of associated complications including: Electrodiagnosis (electromyography and nerve conduction studies), joint and soft tissue injections. (Patient Care, Medical Knowledge) 8. Completion of research project. (Practice Based Learning) 9. Demonstrate the ability to supervise and guide junior residents in PM&R activities. (Practice Based Learning) 13

UAMS Department of Physical Medicine and Rehabilitation Faculty Roster As of December 22, 2008 http://www.uams.edu/pmr/faculty/ CHAIRMAN Kevin M. Means, M.D. UAMS, Stephens Spine Institute, Suite 709 4301 W. Markham, # 602 Little Rock, AR 72205 501-221-1311 RESIDENCY PROGRAM DIRECTOR Kevin M. Means, M.D. UAMS, Stephens Spine Institute, Suite 709 4301 W. Markham, # 602 Little Rock, AR 72205 501-221-1311 PROFESSORS Kevin M. Means, M.D. UAMS, Stephens Spine Institute, Suite 709 4301 W. Markham, # 602 Little Rock, AR 72205 501-221-1311 Eldon Schulz, M.D. ACH-Pediatric Rehabilitation Finkbeiner Building, # 900 Little Rock, AR 72205 501-364-4374 ASSOCIATE PROFESSORS Pamela Brown, M.D. Thomas Kiser, M.D. UAMS, Stephens Spine Institute, Suite 719 UAMS, Stephens Spine Institute, Suite 721 4301 W. Markham, # 602 4301 W. Markham, #602 Little Rock, AR 72205 Little Rock, AR 72205 501-221-1311 501-221-1311 Richard Gray, M.D. Vikki Stefans, M.D. CAVH-NLR ACH-Pediatric Rehabilitation Rehabilitation Medicine Service 800 Marshall, #512-30 117/NLR Little Rock, AR 72205 North Little Rock, AR 72118 501-364-4374 501-257-2992 Esther Tompkins, D.O. ACH-Pediatric Rehabilitation 800 Marshall, #512-30 Little Rock, AR 72205 501-364-4374 15

ASSISTANT PROFESSORS Kimberly Adametz, M.D. Patrick Kortebein, M.D. UAMS, Stephens Spine Institute, Suite 745 UAMS, Stephens Spine Institute, Suite 745 4301 W. Markham, # 602 4301 W. Markham, # 602 Little Rock, AR 72205 Little Rock, AR 72205 501-221-1311 501-221-1311 David Neale, M.D. Johnny Smelz, M.D. CAVH-NLR CAVH-NLR Rehabilitation Medicine Service Rehabilitation Medicine Service 117/NLR 117/NLR North Little Rock, AR 72118 North Little Rock, AR 72118 501-257-2996 501-257-2996 17

Department Chairman/Residency Program Director - Kevin M. Means, M.D. Kevin M. Means, M.D., is the Residency Program Director, as well as the Department Chairman in the UAMS Department of Physical Medicine and Rehabilitation. He holds the rank of Professor. Dr. Means received his M.D. degree from Howard University School of Medicine in Washington, D.C. He completed a residency in Physical Medicine and Rehabilitation at the Rehabilitation Institute of Chicago, located in Chicago, Illinois. Dr. Means became certified by the American Board of Physical Medicine and Rehabilitation in 1986. After residency, he came to Arkansas as one of six founding faculty members of the newly created UAMS Department of Physical Medicine and Rehabilitation. Dr. Means was instrumental in developing the UAMS PM&R residency program that was started in 1987. Since that time, Dr. Means has been involved in virtually every aspect of the department and residency program at one time or another. He has served as Chief of the PM&R Service at Central Arkansas Veteran’s Healthcare and Medical Director at BHRI. In 1997, Dr. Means became the second Chairman and the third Residency Program Director in the history of the UAMS Department of PM&R. He has served on the department’s Curriculum, Research, and Resident Selection Committees and has chaired or served on every PM&R clinical and administrative committee. Dr. Means founded the PM&R Department’s research program and developed a research experience for the PM&R residents that became mandatory starting in 1997. Clinically, Dr. Means holds PM&R leadership positions on the medical staff and actively practices in three of the four UAMS PM&R affiliated hospitals. His area of clinical expertise is in geriatric rehabilitation. He is nationally and internationally recognized for his work in prevention of falls and rehabilitation of balance disorders. Dr. Means was awarded the PM&R Department’s “Outstanding Clinical Educator” award in 1996 and has received other honors for his work as a researcher, a clinician and an educator. Dr. Means is an active member of several professional organizations and has held several leadership positions within these organizations, including National Chairman of the PM&R Section of the National Medical Association and chairman of several committees and task forces. Dr. Means has authored and edited several publications and he has extensive experience mentoring scholarly projects of residents, students, and professional staff. He is a regular guest examiner for the American Board of Physical Medicine and Rehabilitation.

Faculty Curriculum Vitae (From 2007 PIF prepared April 2007) Name: Kevin M. Means Year of Birth: 1955 Medical School / Degree: Howard University College of Date of Graduation: May 1982 Medicine / M.D. Other School / Degree: Date of Graduation: ABPMR Certification: Yes Date: 1986 Maintenance of Certification if applicable: ( )YES ( )NO Date: (X) N/A Subspecialty certification: ( )YES (X)NO Type: Date: Active State Licensure(s): Arkansas Residency Training Location and Dates: PM&R, Northwestern University/Rehabilitation Institute of Chicago; Chicago, IL, 1982-1985 Fellowship Training – Type, Location and Dates: Current Academic Positions: Professor of PM&R, UAMS College of Medicine; Department Chairman; Residency Program Director Current Hospital Appointments: UAMS Medical Center: Chief of PM&R Service; Member, Hospital Medical Board CAVHS: Staff Physician; Member, Partnership Affiliation Council BHRI: Medical Director, Active Medical Staff; Chair, Rehabilitation Section; Chair, Pharmacy & Therapeutics Committee; Chair, Brain Injury Task Force; Member, Executive Committee; Member, Credentials Committee BMC-Little Rock: Consulting & Admitting Medical Staff BMC-North Little Rock: Consulting Medical Staff Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS PM&R: Chair 1999-present, Interim Chair 1997-1999; Professor 2005-present, Associate Professor 1991-2005, Assistant Professor 1985-1991 Residency Program Director 1997-present Member, UAMS Graduate Medical Education Committee and Internal Review Subcommittee, 1989- present List most recent publications in refereed journals (maximum 10 articles): Means KM, Rodell DE, O'Sullivan P: Effects of a rehabilitation exercise program on balance, mobility and falls among community-dwelling elderly persons. Am J Phys Med Rehabil 2005;84:238-250. Tsai PF, Means KM: Osteoarthritic knee or hip pain: Possible indicators in elderly adults with cognitive impairment. J Gerontol Nurs 31:39-45, 2005. Means KM, O'Sullivan PS, Rodell DE: Psychosocial effects of an exercise program in older persons who fall. J Rehabil Research & Development 2003;40:49-58. Means KM, O'Sullivan PS, Rodell DE: Balance, mobility and falls among community-dwelling African American elderly women. Am J Phys Med Rehabil 2000;79:30-39. Means KM, O'Sullivan PS: Modifying a functional obstacle course to test balance and mobility in the community. J Rehabil Research & Development 2000;37:621-632. Means KM, Rodell DE, O'Sullivan P, Winger RT: Comparison of a functional obstacle course with an index of clinical gait and balance and postural sway. J Gerontol A Biol Sci Med Sci 1998;53A:M331-335. Means KM, Rodell DE, O'Sullivan P: Obstacle course performance and risk of falling in community-dwelling elderly persons. Arch Phys Med Rehabil 1998;79: 1570-1576. Means KM: The obstacle course: A tool for the assessment of balance and mobility in the elderly. J Rehabil Research & Development 33:413-428, 1996. Means KM, Rodell DE, O'Sullivan P, Cranford L: Use of a low to moderate intensity exercise program in the rehabilitation of elderly fallers: a pilot study. Arch Phys Med Rehabil 77:1030-1036, 1996. Means KM, Rodell DE, O'Sullivan P: Use of an obstacle course to assess balance and mobility in the elderly: A validation study. Am J Phys Med Rehabil 75:88-95, 1996.

Activities in national professional organizations: Member, Board of Trustees, Association of Academic Physiatrists Member , 2005-present Member, Advisory Board , Rehabilitation Medicine Scientist Training Program, 2006-present Member Program Planning Subcommittee, American Academy of PM&R, 2003-present Member Nominating Committee, American Academy of PM&R 2006 Manuscript Reviewer, Jrnl. of Rehabil. Research & Development, 1999-present Manuscript Reviewer, American Journal of Phys Med Rehabil, 1999-present Manuscript Reviewer Journal of the National Medical Association, 2003-present Fellow, American Academy of PM&R, and Association of Academic Physiatrists, 1986-present Member, American Geriatrics Society, 1989-present Member, regular presenter, National Medical Association, 1981-present Member, presenter, Gerontological Society of America, 1987-present Other recent publications (chapters, etc., excluding abstracts) – maximum 10: Means KM, Petty M: “Reinvigorating a Residency Program through Team-Based Learning: The Experience of a Physical Medicine and Rehabilitation Program” in Team-Based Learning: A Transformative Use of Small Groups in College Teaching by Larry K. Michaelsen LK, Bauman-Knight A, Fink LD (Eds.) in press. Means KM: “Ultraviolet Light and Laser Therapy” in: Shankar K, Randall K (Eds): Therapeutic Physical Modalities, Hanley & Belfus, 2002 Means KM: (Associate Editor) “Section IV: Specific Concerns,” in Grabois M, Garrison SJ, Hart K, Lehmkuhl D (Eds): Physical Medicine and Rehabilitation: The Complete Approach. Cambridge, MA, Blackwell Science, 2000. Means KM: “Rehabilitation of Contractures” in Grabois M, Garrison SJ, Hart K, Lehmkuhl D (Eds): Physical Medicine and Rehabilitation: The Complete Approach. Cambridge, MA, Blackwell Science, 2000. Means KM: “Anatomy of Aging” in: Shankar K: (Ed): Physical Medicine and Rehabilitation State of the Art Reviews- Physiatric Anatomic Principles, V.10, No. 3, Hanley & Belfus, Oct, 1996. Means KM, Sankey FD: Geriatric Rehabilitation Research: State of the Art and Future Projections in Felsenthal G, Garrison SJ, Steinberg, FU (Eds): Rehabilitation of the Aging and Older Patient. Baltimore, Williams & Wilkins, 1994. Means KM, Gershkoff A, Curry D: Geriatric Rehabilitation: IV. Assessment, preservation, and enhancement of fitness and function. Arch Phys Med Rehabil 74:S-417-S-420, 1993.

Name: Richard P. Gray Year of Birth: 1954 Medical School / Degree: Tufts University School of Medicine / Date of Graduation: 1980 M.D. Other School / Degree: Penn State University / B.S.; University of Date of Graduation: 1975, 1976 Massachusetts / M.S. ABPMR Certification: Yes Date: 1985 Maintenance of Certification if applicable: ( )YES ( )NO Date: (X) N/A Subspecialty certification: ( )YES (X)NO Type: Date: Active State Licensure(s): Arkansas Residency Training Location and Dates: PM&R, University of Minnesota, 1980-1983 Fellowship Training – Type, Location and Dates: Current Academic Positions: UAMS PM&R: Associate Professor Current Hospital Appointments: Central Arkansas Veterans Healthcare System (CAVHS), Chief, Physical Medicine & Rehabilitation Service Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS PM&R: Associate Professor 1991-present, Assistant Professor 1985-1991, Residency Program Director 1991-1997 CAVHS: Resident Clinical Coordinator 1986-1991 Penn State University: Clinical Assistant Professor 1984-1985 List most recent publications in refereed journals (maximum 10 articles): Qureshi A, Gray R, Mauldin D, Fann A: Hypotension in Post-Stroke Patients: Effects on Outcome. Arch Phys Med Rehabil (in press). Karim MR. Fann AV. Gray R. Neale DF. Escarda JD. Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain. Am J Phys Med Rehabil. 2005 May;84(5):376-80. Shell M, VanBiervliet A, Gray R: Integration of Information Technologies into PM&R Residency Program. Arch Phys Med Rehabil, 74 (11), p.1237. 1993. Gray R, Sowell T, Russell S, King-Otto J, Maloney F: Fatigue of Velo-Pharyngeal Closure in Motor Neuron Disease. Arch Phys Med Rehabil, 70:A-77. 1989. Shankar K, Maloney F, Gray R: Peer Review of Electrodiagnostic Test Reports. Arch Phys Med Rehabil, 70:A-78. 1989. Janati A, Gray R, Souheaver G: A mental syndrome associated with colonic carcinoma: Limbic encephalitis? Psychosomatics, 28:48-50. 1987. Activities in national professional organizations: Member, American Academy of PM&R, 1985-2000 Member, American Academy of PM&R Self Assessment Exam Committee, 1986-1991 American Board of PM&R Written Exam Item Writer, 1991-1996 American Board of PM&R Oral Board Examiner, 1991-2000 Teaching Scholar, UAMS, 1996

Other recent publications (chapters, etc., excluding abstracts) – maximum 10: Gray R: “Swallowing” in Handbook of Manual Muscle Testing: Cutter N, Kevorkian G (eds): McGraw Hill, New York. 1997 p.269-285. Gray R, Cranford L: “Quality Management Issues” in Management for Rehabilitation II: Maloney F, Gray R (eds): Hanley and Belfus, Philadelphia, PA. 1995 p.393-400. Stefans V, Gray R, Sowell T: “Pediatric and Adult Swallowing Videofluoroscopy” in Physiatrist Procedures in Clinical Practice: Lennard T (ed): Hanley and Belfus/Mosby, Philadelphia, PA. 1995 p.105-113. Gray R, Brown P, Maloney F: “Vocational Capacity with Neuromuscular Impairment” in Assessing the Vocational Capacity of the Impaired Worker: Scheer S (ed): Aspen Publishing. 1990 in press. Gray R, Stefans V, Sowell T: “Dysphasia in the Geriatric Population” in Rehabilitation and the Aging Population: Maloney F, Means KM (eds): Hanley and Belfus, Philadelphia, PA. 1990 p.105-112.

Name: Thomas S. Kiser Year of Birth: 1959 Medical School / Degree: University of Missouri-Columbia / M.D. Date of Graduation: 1992 Other School / Degree: Tulane University of Public Health and Date of Graduation: 2000 Tropical Medicine / M.P.H. ABPMR Certification: Yes Date: 1997 Maintenance of Certification if applicable: (X)YES ( )NO Date: 2005 ( ) N/A Subspecialty certification: (X)YES ( )NO Type: Spinal Cord Date: 1999 Injury Medicine Active State Licensure(s): Arkansas Residency Training Location and Dates: PM&R, University of Arkansas for Medical Sciences, 1992-1996 Fellowship Training – Type, Location and Dates: Musculoskeletal Fellowship, PM&R, University of Arkansas for Medical Sciences, 1996-1997 Current Academic Positions: UAMS PM&R: Associate Professor, 2004-present, Assistant Professor 1998-2004 Current Hospital Appointments: University Hospital: Active Medical Staff Baptist Health Rehabilitation Institute: Active Medical Staff Baptist Health Medical Center-Little Rock: Consulting Medical Staff Baptist Health Medical Center-North Little Rock: Consulting Medical Staff Select Specialty Hospital-Little Rock: Consulting Medical Staff Semper Care Hospital-Little Rock: Consulting Medical Staff Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS PM&R: Associate Professor 2004-present, Assistant Professor 1998-2004, Instructor 1996-1998, Chief Resident 1995-1996 List most recent publications in refereed journals (maximum 10 articles): Reese NB, Skinner RD, Mitchell D, Yates C, Barnes, Kiser TS, Garcia-Rill E. Restoration of frequency-dependent depression of the H-reflex by passive exercise in spinal rats. Spinal Cord 2006; 44; 28-34. Kiser TS, Reese NB, Maresh T, Hearn S, Yates C, Skinner RD, Pait TG. Garcia-Rill E. Use of a Motorized Bicycle Exercise Trainer to Normalize Frequency-dependent Habituation of the H-reflex in Spinal Cord Injury. J Spinal Cord Med. 2005;28:241-245. MacDiarmid S, Kiser TS, McCluer S. Baldder Management- The Wet Show. In Vanbiervliet A, McClurer S, eds. Take Control: A Multimedia Guide to Spinal Cord Injury. [CD Rom], 1997. Kiser T, Mauldin C, Grant R: Acute Low Back Pain Secondary to Retroperitoneal Hemorrhage in an Elderly Gentleman. Arch Phys Med Rehabil 78:942-5, 1997. Kiser T, Stefans V: Pulmonary Embolism in Rehabilitation Patients: Relation to Time Before Resuming Physical Therapy After Diagnosis of Deep Vein Thrombosis. Arch Phys Med Rehabil 78:942-5, 1997. Vinson DC, Thomas R, Kiser T: Association Between Epidural Analgesia during Labor and Fever. Journal of Family Practice 36 (6), 1993. p.617-622.

Activities in national professional organizations: Member, American Academy of PM&R, 1993-present Member, American Congress of PM&R, 1993-present Member, Association of Academic Physiatrists, 2003-present Member, Arkansas Medical Society, 1993-present Member, Christian Medical and Dental Society, 1993-present Member, American Spinal Injury Association, 1998-present Member International Spinal Cord Society, 1998-present Member, American Paraplegia Society, 1999-present Other recent publications (chapters, etc., excluding abstracts) – maximum 10: Kiser T: “Managing Spasticity” in Paraplegia News, February 1999 53; 2:26-27. Kiser T: “Managing Spasticity” in Total Access, Fall 1999 1; 1:20-22. Kiser T: “Rx for Mercury Rising” in Paraplegia News, May 2001 Vol. 55 No. 5:10-12. Kiser T: “Heterotopic Ossification” in Paraplegia News, September 2002 Vol. 56 No. 9:18. Books: Kiser T: contributed ten cases in Physical Medicine & Rehabilitation Pearls: Lennard TA (ed): Hanley and Belfus, Philadelphia, PA. 2001.

Name: Patrick M. Kortebein Year of Birth: 1962 Medical School / Degree: Washington University / M.D. Date of Graduation: 1992 Other School / Degree: University of California, Los Angeles / Date of Graduation: 1985 B.S. ABPMR Certification: Yes Date: 2002 Maintenance of Certification if applicable: ( )YES ( )NO Date: (X) N/A Subspecialty certification: ( )YES (X)NO Type: Date: Active State Licensure(s): Arkansas, Indiana Residency Training Location and Dates: PM&R, Mayo Clinic, Rochester, MN, July 1998-June 2001 Fellowship Training – Type, Location and Dates: Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, MN, July 1997-June 1998 Current Academic Positions: UAMS PM&R: Assistant Professor Current Hospital Appointments: University Hospital, Baptist Health Rehabilitation Institute, Central Arkansas Veterans Health Administration (CAVHS) Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS PM&R: Assistant Professor, August 2003-present List most recent publications in refereed journals (maximum 10 articles): Kortebein P, Stuart M, Kaufman K, Basford J: Medial Tibial Stress Syndrome. Med Sci Sport Exerc 32 (3), 2000, Suppl: p.27-33. Coker R, Hays N, Williams RH, Brown AD, Freeling SA, Kortebein P, Sullivan D, Starling R, Evans WJ: Exercise-induced changes in insulin action and glycogen metabolism in elderly adults. Med Sci Sport Exerc 38 (3):433-438. March 2006. Przybyla B, Gurley C, Harvey JF, Bearden E, Kortebein P, Evans WJ, Sullivan DH, Peterson CA, Dennis RA: Aging alters macrophage properties in human skeletal muscle both at rest and in response to acute resistance exercise. Exp Gerontol 41(3):320-7. March 2006. Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW: Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther 18(4):411-9. Oct-Dec 2005. Activities in national professional organizations: Research Committee Member, Association of Academic Physiatry Chair, Geriatric SIG (Special Interest Group), American Academy of PM&R Member, American Academy of PM&R Member, Association of Academic Physiatry Member, American College of Sports Medicine Other recent publications (chapters, etc., excluding abstracts) – maximum 10: N/A

Name: David F. Neale Year of Birth: 1948 Medical School / Degree: University of Tennessee / M.D. Date of Graduation: 1978 Other School / Degree: Duke University / B.A. Date of Graduation: 1970 ABPMR Certification: Yes Date: 1990 Maintenance of Certification if applicable: ( )YES ( )NO Date: (X) N/A Subspecialty certification: ( )YES (X)NO Type: Date: Active State Licensure(s): Arkansas Residency Training Location and Dates: PM&R, University of Texas Southwestern, Dallas, TX, 1986-1989 Orthopedic Surgery, University of Texas, San Antonio, TX, 1979-1982 Family Practice, University of Tennessee, Jackson, TN, 1982-1985 Fellowship Training – Type, Location and Dates: Current Academic Positions: UAMS PM&R: Assistant Professor Current Hospital Appointments: J.L. McClellan CAVHS Medical Center: Medical Director, Presentation-Amputation Care and Treatment Program; Staff Physiatrist Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS PM&R: Assistant Professor 1990-present List most recent publications in refereed journals (maximum 10 articles): Karim MR. Fann AV. Gray RP. Neale DF. Escarda JD. Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain. American Journal of Physical Medicine & Rehabilitation. 2005;84:376-80. Activities in national professional organizations: Liaison, Training Program Self-Assessment and Exam of American Association of Electrodiagnostic Medicine, 1992-1994 Other recent publications (chapters, etc., excluding abstracts) – maximum 10: Neale D, Helm P: “Wound Management Procedures for Decubitus and Neuropathic Ulcers” in Physiatrist Procedures in Clinical Practice: Lennard T (ed): Hanley and Belfus/Mosby, Philadelphia, PA. 1995 p.71-83.

Name: Vikki A. Stefans Year of Birth: 1957 Medical School / Degree: Thomas Jefferson Medical College / Date of Graduation: 1979 M.D. Other School / Degree: University of Michigan School of Public Date of Graduation: 1986 Health / MPH ABPMR Certification: Yes Date: 1985 Maintenance of Certification if applicable: ( )YES ( )NO Date: (X) N/A Subspecialty certification: (X)YES ( )NO Type: Pediatrics Date: 1985 Active State Licensure(s): Arkansas Residency Training Location and Dates: PM&R, Rehabilitation Institution of Chicago/Northwestern University Medical Center, 1979-1984; Pediatrics, Columbus Hospital/Northwestern University Medical Center, 1979-1984 Fellowship Training – Type, Location and Dates: Current Academic Positions: UAMS PM&R & Pediatrics: Associate Professor 1993-present Current Hospital Appointments: Arkansas Children’s Hospital: Active Medical Staff UAMS Baptist Medical Center Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS Pediatrics: Associate Professor 1987-present UAMS PM&R: Associate Professor 1993-present University of Michigan: Instructor July 1984-June 1987 Involved in Residency Education since 1984. List most recent publications in refereed journals (maximum 10 articles): Aitken ME, Korehbandi P, Parnell D, Parker JG, Stefans V, Tompkins E, Schulz EG: Experiences from the development of a comprehensive family support program for pediatric trauma and rehabilitation patients. Arch Phys Med Rehabil. 2005 Jan;86(1):175-9. Stefans V: Pediatric Orthotic Management: Children Are Different. O&P World, Vol. 4, No. 2. Spring 2001. Kiser T, Stefans V: Pulmonary embolism in rehabilitation patients: relation to time before return to physical therapy after diagnosis of deep vein thrombosis. Archives of Physical Medicine and Rehabilitation, 78 (9):942-945. September 1997. Warzak WJ, Allan TM, Ford LA, Stefans V. Common obstacles to the daily functioning of pediatric traumatically brain injured patients: perceptions of caregivers and psychologists. Child Health Care. 1995 Spring;24(2):133-41. Warzak W, Engel L, Bischoff L, Stefans V: Developing Anxiety-Reduction Procedures for a Ventilator-Dependent Pediatric Patient. Archives of Physical Medicine and Rehabilitation, 72 (7):503-7. June 1991. Zerelli K, Stefans V, DiPietro M: Protocol for Pediatric Swallowing Videofluoroscopy. American Journal of Occupational Therapy. April 1990. Stefans V: Early Identification and Habilitation Services. Arkansas Medical Journal, Vol. 85, No. 5, 217-220. October 1988. Johnson E, Warzak W, Stefans V: Behavioral Treatment of Hysterical Alexia. Journal of Behavior Therapy and Experimental Psychology, Vol. 18, No. 2. June 1987.

Activities in national professional organizations: Editorial Board for Archives of PM&R, 2001-2005 Associate Editor for American Journal of PM&R, 2005-present Other recent publications (chapters, etc., excluding abstracts) – maximum 10: “Secondary Disabilities in Arkansas with Spina Bifida” presented by Thomas L. Farley, Cheryl L. Vines, Shirley McCluer, Vikki Stefans, Joyce Hunter for the Society for Research into Hydrocephalus and Spina Bifida, Harford, Connecticut, June 22-25, 1994; published in Eur J Pediatr Surg 4, Suppl 1 (1994), p.39-40.

Name: Esther Tompkins Year of Birth: 1955 Date of Graduation: June 10, Medical School / Degree: Ohio University / D.O. 1994 Other School / Degree: Northwestern University / B.S. Physical Date of Graduation: 1980; 1977 Therapy; Greenville College / B.A. Biology ABPMR Certification: Yes Date: May 2000 Maintenance of Certification if applicable: ( )YES ( )NO Date: (X) N/A Subspecialty certification: ( )YES (X)NO Date: Active State Licensure(s): Arkansas, Ohio Residency Training Location and Dates: PM&R and Pediatrics, Medical College of Ohio, Toledo, Ohio, 1995-2000 Fellowship Training – Type, Location and Dates: N/A Current Academic Positions: UAMS PM&R & Pediatrics: Assistant Professor August 2000-present Current Hospital Appointments: Arkansas Children’s Hospital: Active Medical Staff Experience (e.g., teaching, faculty and g.m.e. appointments) and number of years involved in Graduate Medical Education: UAMS Pediatrics: Assistant Professor, August 2000-present UAMS PM&R: Assistant Professor, August 2000-present List most recent publications in refereed journals (maximum 10 articles): Aitken M, Korehbandi P, Parnell D, Parker J, Stefans V, Tompkins E, Schulz E: Experiences from the Development of a Comprehensive Family Support Program for Pediatric Trauma and Rehabilitation Patients. Archives of Physical Medicine and Rehabilitation, Vol. 86. January 2005. Activities in national professional organizations: Arkansas Osteopathic Medical Association Membership Committee, October 2006-present Member, AAPM&R, ACPDM, AOA, AAEM, and CMDS Other recent publications (chapters, etc., excluding abstracts) – maximum 10: N/A

UAMS Department of Physical Medicine and Rehabilitation Resident Roster 2009-2010 http://www.uams.edu/pmr/residents/ UAMS, Stephens Spine Institute, Suite 737 4301 W. Markham, # 602 Little Rock, AR 72205 501-221-1311 Residency Program Coordinator: 501-526-7732 Chief Residents Mark Awoniyi, M.D. (PGY-4) Rani Haley, M.D. (PGY-3) Residents PGY Year (effective 7/1/09) Carlo Adams (PGY-3) Mark Awoniyi, M.D. (PGY-4) Derek Buck, M.D. (PGY-2) Danielle Clayborne, M.D. (PGY-3) Rani Haley, M.D. (PGY-3) Jamie Harrison, M.D. (PGY-2) Laura Hobart, D.O. (PGY-4) Bella Sawkar, M.D. (PGY-3) Jonathan Swenson, M.D. (PGY-2) Reginald Talley, M.D. (PGY-1) Pedro Toweh, M.D. (PGY-3) Jennifer Villacorta, M.D. (PGY-1) Carver Wilkins, M.D. (PGY-1) Brad Wilson, D.O. (PGY-2)

Introduction for Educational Program Points: 1) Curriculum guides educational offerings. 2) Rotations have general objectives that cover general PM&R skills and specific objectives that cover content pertinent to PM&R. 3) Emphasizing general competencies including: interaction with other members of health care teams and working with patient and family to master the system. 4) Relationship between faculty and resident 5) Resident expectations in general – active participation in education, responsible for requirements in syllabus for each rotation and for the general curricular including lectures and journal club. 6) Evaluate faculty 7) Evaluate program 8) Evaluation for competencies 9) Semi-annual meeting with the Residency Program Director Patient Care: Evaluated by faculty at the end of each rotation, oral examination, MiniCEX. Medical Knowledge: Evaluated annually in in-training examination and in the annual PM&R OSCE (Objective Structured Clinical Examination), oral examination. Professionalism: 360 evaluation, faculty end of rotation evaluation. Systems Based Practice: Progress note reports, 360 evaluations, portfolio. Communications and Interpersonal Skills: 360 evaluation, faculty end of rotation evaluation, systems base practice portfolio, communicate with other professionals, communicate with families and caregivers. Practice Based Learning: Journal Club Research Scholarly Activity Conference Presentations Seminars Grand Rounds

PGY-1 Rotation Introduction The first year, the internship, was designed to provide a foundation for subsequent training in Physical Medicine and Rehabilitation. The clinical rotations and didactic curriculum are integrated to prepare resident to competently manage a wide variety of skills that are required by a modern-day physiatrist. Residents in this program will spend one month in Emergency Medicine, four months in Medicine Wards, one month in Medicine Ambulatory Care, one month in Radiology, one month Outpatient Geriatrics, one month in Geriatric Wards, one month in Pediatric Wards, one month in PM&R and one month in Neurology. On the Emergency Medicine rotation, residents will learn this discipline through Baptist Health Medical Center (BMC) where 35,000 Emergency Department patients are treated, which makes this a very active rotation and one that is rich in clinical experience. In addition, there may be an additional rotation of Emergency Medicine held at the Central Arkansas Veterans Hospital. At this facility, residents will learn to approach and treat patients in emergency settings, develop skills in the performance of appropriate diagnostic testing in the emergency department testing, and develop skills in adult and pediatric resuscitation. The Medicine Ward rotation will also be held at the Central Arkansas Veterans Hospital in Little Rock. At this facility, residents are offered a variety of experiences such as learning to analyze patient medical problems through history and physical examination, obtain skills in intervention procedures drawing blood cultures, and analyzing cardiopulmonary resuscitation codes. In addition to the Medicine Ward rotation, residents will also experience Ambulatory Care at the Central Arkansas Veterans Hospital. This will increase awareness of Ambulatory Care through participation in educational programs held at noon each day, determine the appropriate care for patients, and determine treatment for primary care patients who have acute problems. Additionally, residents will also experience Geriatric Wards at the North Little Rock Veterans Hospital. On this rotation residents are offered a variety of learning experiences which include performing history and physical examinations on the geriatric patient. The Radiology rotation will be held at BMC or the University of Arkansas for Medical Sciences (UAMS). Residents will obtain experience in special procedures when cases occur, gain some familiarity with the limitations of common imaging modalities, and observe as many imaging studies as possible during the rotation. The PM&R rotation takes place at BHRI. The purpose of this rotation is to expose the resident to the practice of physical medicine and rehabilitation in various clinical settings including acute care, subacute/recuperative care, acute rehabilitation, and outpatient. The resident will receive instruction and experience in clinical history and examination, identifying and managing clinical problems typical among patients with rehabilitation needs. The resident also will be shown state of the art diagnosis and treatment techniques employed in the diagnosis and management of patients in the outpatient physical medicine and rehabilitation setting. The resident will make daily attending and consultation rounds, will maintain contact (as appropriate) with select patients in physical and occupational therapy, and will see patients in the outpatient setting.

The Geriatric rotation takes place at St. Vincents. The purpose of this rotation is to develop the knowledge, attitudes, and skills needed to provide effective, acute, preventive, and continuity medical care for the geriatric patient. This will include developing skills in delivering primary care to the geriatric patient in a variety of health care settings, incorporating community and family services into the health care plan, and learning to work as part of an interdisciplinary health care team. The Neurology rotation takes place on at UAM S. On this rotation the resident is expected to demonstrate the ability to provide patient care, to localize the neurological lesions, to communicate effectively, to counsel and educate patients and families about the neurological illness and the prevention of common neurological disorders and to gain knowledge of the basic neurosciences and the pathophysiology of major psychiatric and neurological disorders. The formal didactic curriculum during PGY-1 focuses on fundamental knowledge based upon which subsequent training and education will build on. The curriculum includes lectures, seminars, case conference, grand rounds and workshops. These programs are directed and taught by faculty, many of whom are renowned experts in their areas.

Physical Medicine and Rehabilitation Fundamental Clinical Skills Rotation Level: PGY-1 Contacts: Mickey Burroughs, BHMC, 501-202-2673, Fax/501-202-1159 Preceptors: Thomas Kiser, M.D. Rotation Length: One Month Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1. Recognize typical clinical problems among 1) Global faculty assessment patients with physical medicine and 2) Direct faculty clinic rehabilitation patients in various clinical settings and/or bedside observation and their management. 2. Demonstrate proper history and examination techniques. Medical 1. Recognize typical clinical problems among Global faculty assessment Knowledge patients with physical medicine and rehabilitation patients in various clinical settings and their management. 2. Discuss the management of typical clinical problems among patients with physical medicine and rehabilitation problems. 3. Identify various diseases and conditions that are amenable to rehabilitation efforts. Practice-Based 1. Discuss the management of typical clinical Global faculty assessment Learning and problems among patients with physical medicine Improvement and rehabilitation problems. 2. Describe allied health professionals involved in the rehabilitation team. Interpersonal and 1. Demonstrate proper history and examination Global faculty assessment Communication techniques. Skills Professionalism 1. Demonstrate proper history and examination Global faculty assessment techniques. Systems-Based 1. Recognize typical clinical problems among Global faculty assessment Practice patients with physical medicine and rehabilitation patients in various clinical settings and their management. 2. Discuss the management of typical clinical problems among patients with physical medicine and rehabilitation problems. 3. Describe allied health professionals involved in

the rehabilitation team. General: The purpose of this rotation is to expose the resident to the practice of physical medicine and rehabilitation in various clinical settings including acute care, subacute/recuperative care, acute rehabilitation, and outpatient. The resident will receive instruction and experience in clinical history and examination, identifying and managing clinical problems typical among patients with rehabilitation needs. The resident also will be shown state-of-the-art diagnosis and treatment techniques employed in the diagnosis and management of patients in the outpatient physical medicine and rehabilitation setting. The resident will make daily attending and consultation rounds, will maintain contact (as appropriate) with select patients in physical and occupational therapy, and will see patients in the outpatient setting. Last Review/Revision: 1/8/09

Emergency Medicine Level: PGY-1 Contacts: Mickey Burroughs, BHMC, 501-202-2673, Fax/501-202-1159; Joan Kirkpatrick, St. Vincent, 501-552-3592, JOANK@stvincenthealth.com Preceptors: Elicia Kennedy, M.D., BHMC Rotation Length: One Month Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1) Global faculty assessment 2) Direct faculty clinic and/or bedside observation Medical Global faculty assessment Knowledge Practice-Based Global faculty assessment Learning and Improvement Interpersonal and Global faculty assessment Communication Skills Professionalism Global faculty assessment Systems-Based Global faculty assessment Practice Emergency Medicine is the 23rd recognized medical specialty by the American Board of Medical Specialties. The practice of Emergency Medicine involves the diagnosis and initial treatment interventions of acute medical and surgical conditions in virtually all specialties and subspecialties of medicine. BHMC, a 787-bed tertiary care hospital, is the largest medical center in our state, which operates the only hospital based EMS helicopter system in central Arkansas. Approximately 35,000 Emergency Department patients are treated at BHMC annually, making this a very active rotation and one that is rich in clinical experience. We enjoy a diverse patient mix of acute cardiac, traumatic, medical, surgical, obstetric, neurologic, pediatric, orthopedic, ophthalmic, and psychiatric emergencies. The educational experience of this Emergency Medicine rotation is enhanced by bedside teaching, didactic conferences, and “hands on” training in the technical emergency medical skills such as suture technique, endotracheal intubation, EKG interpretation, static and dynamic arrhythmia recognition, and x-ray interpretation. Emphasis will be placed on Emergency

Department malpractice prevention and recent advances in the specialty of Emergency Medicine and the EMS system. Supervised clinical decision making is a very positive experience gained on this rotation. The Emergency Medicine staff at BHMC is composed of all board certified specialists who are interested in teaching. Housestaff officers are strongly encouraged to complete the American Heart Association’s Advanced Cardiac Life Support course prior to this rotation. Last Review/Revision: 1/8/09

Medicine Wards-VAH Level: PGY-1 Contacts: Michelle Durnal-Kindrex, 501-257-5866, Fax/257-5867 Rotation Length: Three (3) One-Month Rotations Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1. Analyze patients medical problems both new and 1) Global faculty assessment existing through history and physical 2) Direct faculty clinic examination, and monitoring of daily progress of and/or bedside observation the patient. 2. Determine a diagnostic work up plan and treatment of patients. 3. Evaluate a variety of medical emergencies and determine how to stabilize patient, prior to transfer to the intensive care units. Medical 1. Analyze patients medical problems both new and Global faculty assessment Knowledge existing through history and physical examination, and monitoring of daily progress of the patient. 2. Determine a diagnostic work up plan and treatment of patients. 3. Evaluate a variety of medical emergencies and determine how to stabilize patient, prior to transfer to the intensive care units. 4. Evaluate to sub-specialty branches of medicine, by working with the consult services in managing their patients. 5. Determine selection and interpretation of appropriate laboratory tests, radiological and imaging studies, and cardiovascular diagnostic studies. 6. Obtain skills in intervention procedures drawing of blood cultures, bladder catherisations, lumbar punctures, abdomino-paracenthesis, thoracenthesis, insertion of central venous lines. Analyze cardiopulmonary resuscitation codes. Practice-Based 1. Analyze patients medical problems both new and Global faculty assessment Learning and existing through history and physical Improvement examination, and monitoring of daily progress of the patient.

2. Evaluate a variety of medical emergencies and determine how to stabilize patient, prior to transfer to the intensive care units. 3. Evaluate to sub-specialty branches of medicine, by working with the consult services in managing their patients. 4. Obtain skills in intervention procedures drawing of blood cultures, bladder catherisations, lumbar punctures, abdomino-paracenthesis, thoracenthesis, insertion of central venous lines. Interpersonal and Global faculty assessment Communication Skills Professionalism Global faculty assessment Systems-Based Global faculty assessment Practice Last Review/Revision: 1/8/09

Medicine-Ambulatory Care Level: PGY-1 Contacts: Pam Crabtrey, RN, 501-257-5047 Preceptors: Gerry Ezell, M.D. Rotation Length: Two Months Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1. Analyze ambulatory primary care patient 1) Global faculty assessment problems presented to the General Internist 2) Direct faculty clinic based with a knowledge of basic clinical science. and/or bedside observation 2. Determine the appropriate care for patient. 3. Determine treatment for primary care patients who have acute problems. 4. Determine preventive medicine measures required for good medical management of the patient. 5. Analyze each patient with the attending physician and review the patient assessment, laboratory results, x-rays, other tests, and plan of management. Medical 1. Analyze ambulatory primary care patient Global faculty assessment Knowledge problems presented to the General Internist based with a knowledge of basic clinical science. 2. Determine the appropriate care for patient. 3. Determine when appropriate to consult physicians for special services to the patient. 4. Analyze new patients in clinic with a appropriate history and physical examination. Analyze a differential diagnosis, order appropriate tests required to confirm or make a diagnosis, and plan for therapy and follow-up. 5. Determine treatment for primary care patients who have acute problems. 6. Determine preventive medicine measures required for good medical management of the patient. 7. Analyze each patient with the attending physician and review the patient assessment, laboratory results, x-rays, other tests, and plan of management.

Practice-Based 1. Determine when appropriate to consult Global faculty assessment Learning and physicians for special services to the patient. Improvement 2. Analyze new patients in clinic with a appropriate history and physical examination. Analyze a differential diagnosis, order appropriate tests required to confirm or make a diagnosis, and plan for therapy and follow-up. 3. Analyze each patient with the attending physician and review the patient assessment, laboratory results, x-rays, other tests, and plan of management. Interpersonal and Global faculty assessment Communication Skills Professionalism 1. Determine treatment for primary care patients Global faculty assessment who have acute problems. Systems-Based 1. Analyze ambulatory primary care patient Global faculty assessment Practice problems presented to the General Internist based with a knowledge of basic clinical science. 2. Determine treatment for primary care patients who have acute problems. 1. Participate in educational programs held at noon each day for transitional interns and attend the Resident Medicine Conference held each Friday at the VA. Last Review/Revision: 1/8/09

Radiology Level: PGY-1 Contacts: Susan Rose, Residency Coordinator, 501-364-4865, Fax/501-364-4863, Campus Mail #556 or Mickey Burroughs, BHMC, 501-202-2673, Fax/501-202-1159 Preceptors: C. Don Bice, M.D. (UAMS) or Todd M. Smith, M.D. (Baptist) Rotation Length: One Month Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1. Learn the scope of radiology practice and what 1) Global faculty assessment the radiologist can do to aid clinical diagnosis. 2) Direct faculty clinic 2. Gain experience in deciding when and which and/or bedside observation imaging modality is appropriate. 3. Gain some familiarity with the limitations of common imaging modalities 4. Be able to discuss the approach to basic plain film interpretation without necessarily being able to render a detailed reading or diagnosis. Medical 1. Learn the scope of radiology practice and what Global faculty assessment Knowledge the radiologist can do to aid clinical diagnosis. 2. Observing as many imaging studies as possible during the rotation 3. Be able to identify the imaging modality when shown the study images. 4. Gain experience in deciding when and which imaging modality is appropriate. 5. Gain some familiarity with the limitations of common imaging modalities Practice-Based Global faculty assessment Learning and Improvement Interpersonal and 1. Be able to discuss the approach to basic plain Global faculty assessment Communication film interpretation without necessarily being able Skills to render a detailed reading or diagnosis. Professionalism 1. Be able to discuss the approach to basic plain Global faculty assessment film interpretation without necessarily being able to render a detailed reading or diagnosis. 2. Be able to demonstrate the ability to be punctual with respect to attending to clinics and required conferences.

Systems-Based 1. Learn the scope of radiology practice and what Global faculty assessment Practice the radiologist can do to aid clinical diagnosis. Rotation Schedule: First week at University Hospital Reading room, observing CT, US, NM, and plain film reading. This rotation also includes experience in special procedures when cases occur. You should check the schedule or coordinate with the resident assigned to this rotation. Second week at the Outpatient Radiology area where majority of the bone films are read. This is also the place where mammograms are read. When the schedule permits, a rotation in MRI may be included in this week. Third week at the VA Reading room observing CT, US and plain film reading. Special procedures can also be incorporated in this rotation. Coordinate with the VA specials resident. Fourth week is a repeat of the first week. Requirements: 1. Keep a daily log of where you spent each day of the week and record the types of special procedure cases you observed. 2. Submit the log of your activities with your comments on the rotation to Dr. Robert Buchmann, Radiology Program Director. Last Review/Revision: 1/8/09

LOG OF WEEKLY ROTATIONS IN RADIOLOGY ELECTIVE Week 1 Day 1 2 3 4 5 Week 2 Day 1 2 3 4 5 Week 3 Day 1 2 3 4 5 Week 4 Day 1 2 3 4 5 Types of Special Procedure Cases Observed: ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Comments about the rotation: _________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Neurology Level: PGY-1 Contacts: UAMS – Athena Davis, Residency Program Coordinator, 501-296-1165, Fax/501-686-8689; BHMC – Mickey Burroughs, 501-202-2673, Fax/501-202-1159 Rotation Length: One Month Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1) Global faculty assessment 2) Direct faculty clinic and/or bedside observation Medical Global faculty assessment Knowledge Practice-Based Global faculty assessment Learning and Improvement Interpersonal and Global faculty assessment Communication Skills Professionalism Global faculty assessment Systems-Based Global faculty assessment Practice Patient Care The resident is expected to demonstrate the ability to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Accordingly, the resident is expected to develop the following abilities: A.To gather and document an accurate comprehensive history and to perform a complete examination to include as appropriate: 1.chief complaint. 2.history of present illness. 3.past medical/surgical history. 4.review of systems. 5.family history. 6.developmental and social history. 7.medical and neurological complete examination that includes a mental status, cranial nerves, motor system, sensory system, and reflexes examination.

B.To localize the neurological lesion and to generate differential diagnoses based on a sound clinical judgment (namely, through recognizing key elements in the historical data and physical examination). C.To evaluate, recommend and carry out a cost-effective diagnostic and therapeutic management plan based on the clinical context, patient’s preferences, and up-to-date scientific evidence (this includes learning to use effectively information technology). D.To communicate effectively and demonstrate caring and respectful behavior when interacting with patients and their families, using terms adequate to their level of education and culture. E.To counsel and educate patients and their families about their neurological illness and the prevention of common neurological disorders (this includes referring them to reliable electronic and printed sources of patient information). F.To develop and maintain the technical skills: 1.To perform competently lumbar puncture, caloric testing, apnea testing, nerve conduction/electromyographic testing. 2.To identify and describe radiologic abnormalities seen in common neurologic disorders on radiographic testing, including plain films, myelography, angiography, CT, MRI, and PET/SPECT imaging of the neuraxis. 3.To recognize the basic mechanism of operation, the indications, contraindications, and the limitation of investigative procedures and their interpretation in the diagnosis of neurologic diseases, including the following: a)electroencephalogram, b)motor and sensory nerve conduction studies, c)electromyography, d)evoked potentials, e)polysomnography, f)electronystagmogram, g)audiometry, h)perimetry, i)psychometry, j)CSF analysis, k)vascular imaging (Duplex, transcranial Doppler), l)autonomic testing, m)radiographic studies as outlined above. 4.Identify and describe gross and microscopic specimens taken from the normal nervous system and from patients with major neurologic disorders. Medical Knowledge The resident is expected to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Accordingly, the resident shall demonstrate the following: A.Investigatory and analytic thinking approach to clinical situations, including: 1.localizing the neurologic dysfunction based on historical data and physical examination, 2.generating a thorough differential diagnosis, 3.assessing the urgency of clinical presentations and implementing prompt emergent interventions as needed, 4.selecting the most cost-effective yielding diagnostic studies based on knowledge of the potential risks and benefits of such studies, 5.selecting the most cost-effective therapeutic interventions based on knowledge of the potential risks and benefits of such interventions,

6.applying up-to-date medical knowledge to clinical contexts, 7.questioning actively the working diagnosis to insure a thorough clinical judgment. B.Knowledge of all the clinical aspects of major neurological disorders, including: 1.the epidemiology of the disorder, 2.the etiology of the disorder, including contributing medical, genetic, and social factors, 3.the phenomenology of the disorder, 4.diagnostic criteria, 5.appropriate evaluation, 6.course and prognosis, 7.effective treatment strategies. C.The major categories of neurologic disorders include: 1.Cerebrovascular diseases, 2.Epilepsy, 3.Neuromuscular disorders, 4.Movement disorders, 5.Behavioral neurology, 6.Neuro-oncological disorders, 7.Neuro-immunological and inflammoatory disorders, 8.Infectious diseases, 9.Neurological complications of systemic diseases, 10.Developmental disorders, 11.Inborn errors of metabolism, 12.Neurocutaneous disorders, 13.Sleep disorders, 14.Pain disorders, 15.Autonomic disorders, 16.Geriatric neurology, 17.Neurotoxicologic disorders. D.Knowledge of the basic neuroscience and the pathophysiology of major psychiatric and neurological disorders that are critical to the practice of neurology, including: 1.neuroanatomy a)cerebral cortex b)connecting systems c)basal ganglia/ thalamus d)brainstem e)cerebellum f)cranial nerves g)spinal cord h)spinal roots/ peripheral nerves i)ventricular system/ CSF pathways j)central and peripheral nervous system vasculature k)neuromuscular junction/ muscles l)autonomic nervous system m)embryology n)pain pathways 2.neuropathology a)basic patterns of reaction b)cerebrovascular disease

c)trauma (cranial and spinal) d)metabolic/ toxic/ nutritional diseases e)infections f)demyelinating diseases/ leukodystrophies g)neoplasms h)congenital/ developmental disorders i)degenerative/ heredodegenerative disorders j)myopathies k)peripheral nerve disorders l)radiologic pathology pertinent to assigned pathology sections 3.neurochemistry a)carbohydrate metabolism b)lipid metabolism c)protein metabolism d)neurotransmitters e)axonal transport f)energy metabolism g)blood-brain barrier h)biochemistry of membranes/ receptors/ ion channels i)neuronal excitation j)vitamins (general aspects) k)inborn errors of metabolism l)electrolytes and minerals m)neurotoxins n)free radical scavengers o)excitotoxicity 4.neurophysiology a)basic (1)membrane physiology (2)synaptic transmission (3)sensory receptors and perception (4)special senses (5)reflexes (6)segmental and suprasegmental control of movement (7)cerebellar function (8)reticular system/ mechanisms of sleep and arousal/ consciousness/circadian rhythms (9)rhinencephalon/ limbic system/ the visceral brain (10)learning and memory (11)cortical organizations and function (12)pathophysiology of epilepsy (13)cerebral blood flow (14)autonomic function (15)blood-brain barrier b)clinical (1)EEG (2)evoked responses (3)EMG/ nerve conduction studies (4)sleep studies 5.neuropharmacology

a)organization of the major nervous system neurotransmitters: (1)-Dopamine (agonist/antagonist drugs, levodopa…) (2)-Acetylcholine (cholinergic agonist/antagonist drugs and cholinesterase inhibitors) (3)-Serotonin (selective serotonin re-uptake inhibitors) (4)-Epinephrine and Norepinephrine (adrenergic agonist/antogonist drugs and mono-amine oxidase inhibitors) (5)-Endogenous opiods (agonist/antagonist drugs) b)anticonvulsants c)antibiotics/ antimicrobials/antifungals/vaccines d)antioxidants e)vitamins and co-enzymes (clinical aspects) f)neuromuscular junction drugs (Botulinum toxins, peripheral cholinesterase inhibitors…) g)analgesics (non-narcotics, narcotics, and other centrally active agents) h)anticoagulants/ antiplatelets/ thrombolytic agents i)hormones/neuropeptides j)neurologic side effects of systemic drugs k)miscellaneous drugs 6.neuroimmunology/ neurovirology a)molecular pathogenesis of multiple sclerosis b)molecular neurology of prion diseases c)immunology in multiple sclerosis, myasthenia gravis and other neurologic disorders 7.neurogenetics/ molecular neurology and neuroepidemiology a)Mendelian-inherited diseases b)mitochondrial disorders c)trinucleotide repeat disorders d)channelopathies e)genetics of epilepsy f)molecular genetics of brain tumors g)other genetic disorders/ mechanisms h)ischemic penumbra i)molecular approaches to stroke therapy j)polymerase chain reaction k)risk factors in neurologic disease l)demographics of neurologic disease m)concentration in neurogenetics 8.neuroendocrinology 9.neuroimaging a)plain skull/ spineradiology b)Magnetic resonnance imaging (MRI), magentic resonnance angiography (arteriography-MRA and venography-MRV) c)Computed tomography (CT) scan d)Computed tomography (CT) myelography e)Angiography f)Positron Emission Tomography (PET) and Single Photon Emmission Computed Tomography (SPECT) 10.neuro-ophthalmology a)vision and visual pathways

b)visual fields c)pupils d)ocular motility e)fundi/ retina/ optic nerve 11.neuro-otology a)hearing/ auditory function and testing b)vertigo/ vestibular function and testing 12.cerebrospinal fluid a)normal CSF constituents and volume b)pathologic CSF patterns (1)cellular (2)chemical (3)enzymatic (4)immunologic 13.critical care and emergency neurology 14.geriatric neurology 15.headache and facial pain 16.interventional neurology 17.movement disorders 18.neurological rehabilitation 19.issues related to specific sub-specialties such as stroke, neuromuscular disorders, dementia, epilepsy, etc. E.Knowledge of health delivery systems. F.Knowledge of ethics in psychiatry/neurology. G.Ability to reference and utilize electronic and printed information systems to access medical, scientific, and patient information. Interpersonal and Communication Skills The resident is expected to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients, and professional associates. Accordingly, the resident shall demonstrate the following abilities: A.To establish a therapeutically conducive atmosphere with patients and their families through: 1.Creating and maintaining a therapeutic alliance with patients by instilling feelings of trust, openness, and emotional comfort in the relationship with the physician optimizing information exchange. 2.Listening to and understanding patients. 3.Communicating effectively with patients and their families, using verbal, nonverbal, and writing skills that are appropriate to their intellectual/educational level. Such communication should include: a)The results of the resident assessment. b)The risks and benefits of the proposed diagnostic and treatment plan. c)The need for informed consent when ordering investigative procedures. d)Explanations about pertinent psychiatric and neurological disorders, their natural course, their prognosis and their treatment options (both verbally and in written form) that are jargon-free and geared to the educational/intellectual level of patients and their families. e)Preventive education that is understandable and practical. f)Genetic counseling and palliative care when appropriate.

4.Negotiating a health care management plan with patients after offering the clinical options and taking in consideration the patient’s personal and cultural preferences. 5.Understanding the impact of the physician’s own feelings and behavior on treatment. 6.Maintaining medical records and written prescriptions that are legible and up- to-date. These records must capture essential information while simultaneously respecting patient privacy and be useful to health professionals outside psychiatry and neurology. B.To elicit important diagnostic data and data affecting treatment from patients, their families, colleagues and other health care personnel from the full spectrum of ethnic, racial, cultural, age, gender, socio-economic, and educational backgrounds. This will include skills in tolerating and managing high levels of affect in patients. C.To obtain, interpret, and evaluate consultations from other medical specialties. This includes: 1.Knowing when to solicit consultation. 2.Evaluating the consultation findings. 3.Discussing consultation findings with patients and their families. D.To serve as an effective consultant to other medical specialists, mental health professionals, and community agencies. This includes: 1.Communicate effectively with the requesting party to refine the consultation question. 2.Maintain the role of consultant. 3.Communicate clear and specific recommendations. 4.Educating the requesting party about neurological disorders, their treatment and their prevention. 5.Respect the knowledge and expertise of the requesting party. E.To interact effectively with members of a multidisciplinary team as a member, a consultant, and/or a leader. This includes: 1.Listen effectively. 2.Elicit needed information from team members. 3.Integrate information from different disciplines. 4.Manage conflict. 5.Clearly communicate an integrated treatment plan. Practice-Based Learning and Improvement The resident is expected to investigate and evaluate his/her patient care practices, appraise and assimilate scientific evidence, and improve his/her patient care practices. Accordingly, the resident shall demonstrate the following abilities: A.To recognize and accept limitations in his/her own knowledge base and clinical skills, and understand the need for life-long learning. B.To obtain and evaluate up-to- date information from the scientific and practice literature and other sources to assist in the quality care of patients. This includes: 1.Use of medical libraries. 2.Use of information technology, including Internet-based searches and literature databases (e.g., Medline,…). 3.Use of drug information databases (e.g., Physician Drug Reference,…) 4.Active participation, as appropriate, in educational courses, conferences, and other organized educational activities both at the local and national levels. C.To evaluate case-load and practice experience in a systematic manner. This includes: 1.Case-based learning.

2.Use of best practices through practice guidelines or clinical pathways. 3.The review of patient records and outcomes. 4.Obtaining evaluations from patients (e.g., outcomes and patient satisfaction). 5.Obtaining appropriate supervision and consultation. 6.Maintaining a system for examining errors in practice and initiating improvements to eliminate or reduce errors. D.To evaluate critically the relevant medical literature. This includes: 1.To review and critically assess the scientific literature to determine how quality of care can be improved in relation to one’s practice (e.g., reliable and valid assessment techniques, treatment approaches with established effectiveness, practice parameter adherence). Within this aim, the resident shall be able to assess the generalizability or applicability of research findings to his/her patients. 2.Using knowledge of common methodologies employed in psychiatric and neurological research. 3.Conducting and presenting reviews of current research in such formats as journal clubs, grand rounds, and/or original publications. 4.Researching and summarizing a particular problem that derives from the physician’s case load. 5.To develop and pursue effective remediation strategies that are based on critical review of the scientific literature. 6.To accept constructive criticism and learn from colleagues in one’s own and other specialties to improve quality of care. Professionalism The resident is expected to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse patient population. Accordingly, the resident shall demonstrate the following abilities: A.To respond to communications from patients and health professionals reliably and in a timely manner. If unavailable, the resident shall establish and communicate back-up arrangements. The resident shall communicate clearly to patients and their families about how to seek emergent and urgent care when necessary, and shall demonstrate responsibility for his/her patient’s care, including: 1.Responding to communication from patients, their families, and health professionals in a timely manner. 2.Using medical records for appropriate documentation of the course of illness and its treatment. 3.Providing coverage if unavailable, e.g., out of town, on vacation. 4.Coordinating care with other members of the medical and/or multidisciplinary team. 5.Providing continuity of care including appropriate consultation, transfer, or termination. B.To be punctual with respect to attending to clinics and required conferences. C.To present to his/her clinical responsibilities in the appropriate attire. D.To adhere to ethical behavior that is distinguished by integrity, honesty, compassion and confidentiality in the delivery of patient care, including: 1.Obtaining informed consent/assent, and declaring conflict of interest. 2.Genuinely caring about patient’s welfare. E.To demonstrate respect for patients and health care personnel as individuals, by showing sensitivity to their including their age, culture, disabilities, ethnicity, gender, socioeconomic background, religious beliefs, political affiliations, and sexual orientation.

F.To acknowledge the patient’s welfare over personal or professional conflicts, including maintaining a positive attitudes even in unfavorable work-related situations and willingness to “walk the extra mile” for the welfare of patients. G.To demonstrate appreciation of end-of-life care and issues regarding provision or withholding of care. H.To acknowledge responsibility for his/her decisions and demonstrate commitment to the review and remediation of his/her professional conduct. I.To recognize personal failures and imperfections, and be willing to strive for personal and professional maturation. Systems-Based Practice: A.The physician shall be able to articulate the basic concepts system-based practice and how it is used in psychiatry or neurology. The physician should have a working knowledge of the diverse systems involved in treating patients of all ages, and understand how to use the systems as part of a comprehensive system of care, in general, and as part of a comprehensive, individualized treatment plan. This will include the: 1.Use of practice guidelines and parameters, community, national and allied health professional resources which may enhance the quality of life of patients with psychiatric and neurological illnesses 2.Development of the ability to lead and delegate authority to health care teams needed to provide comprehensive care for patients with psychiatric and neurological disease 3.Development of skills for the practice of ambulatory medicine, including time management, clinic scheduling, and efficient communication with referring physicians 4.Utilization of appropriate consultation and referral for the optimal clinical management of patients with complicated medical illness (strengthen wording) 5.Demonstration of awareness of the importance of accurate medical data in the communication with and efficient management of patients B.In the community system, the physician shall: 1.Recognize the limitation of resources for health care and demonstrate the ability to act as an advocate for patients within their social and financial constraints 2.Demonstrate knowledge of the resources available both publicly and privately for the treatment of psychiatric and neurological problems impacting a patient’s ability to enjoy relationships and gain employment 3.Demonstrate knowledge of legal aspects of psychiatric and neurological diseases as they impact patients and their families C.The physician shall demonstrate knowledge of and interact with managed health systems, including: 1.Participating in utilization review communications and, when appropriate, advocating for quality patient care 2.Educating patients concerning such systems of care D.The physician shall demonstrate knowledge of community systems of care and assist patients to access appropriate care and other support services. This requires knowledge of treatment settings in the community, which include ambulatory, consulting, acute care, partial hospital, skilled care, rehabilitation, and substance abuse facilities; halfway houses; nursing homes; and home care and hospice organizations. The physician should demonstrate knowledge of the organization of care in each relevant delivery setting and the ability to integrate the care of patients across such settings. Last Review/Revision: 1/8/09

Pediatric Wards ACH Level: PGY-1 Contacts: Lori Miloni, Residency Coordinator, 501-364-1874 Rotation Length: One Month Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1. Proficiency in acquisition of in-depth historical 1) Global faculty assessment and objective information about the pediatric 2) Direct faculty clinic patient, enabling cogent determination of the and/or bedside observation major problem. 2. Use of clinical and research laboratory support. 3. Proficiency in common pediatric procedures; venous cannulations, lumbar puncture, subdural tap, bone marrow, aspiration, etc. 4. Approach to solving clinical problems. 5. Specific information about those illnesses manifested by patients assigned i.e., obtain the most recent knowledge available from tests and journals regarding their patient. Medical 1. Proficiency in acquisition of in-depth historical Global faculty assessment Knowledge and objective information about the pediatric patient, enabling cogent determination of the major problem. 2. Use of clinical and research laboratory support. 3. Proficiency in common pediatric procedures; venous cannulations, lumbar puncture, subdural tap, bone marrow, aspiration, etc. 4. Methods of continuing self-education concerning clinical problems. 5. Knowledge necessary in working up and handling the child with an acute or chronic illness, i.e., how to recognize, diagnose and formulate a therapeutic regimen for the sick child. 6. Approach to solving clinical problems. 7. Specific information about those illnesses manifested by patients assigned i.e., obtain the most recent knowledge available from tests and journals regarding their patient. Practice-Based 1. Methods of continuing self-education concerning Global faculty assessment

Learning and clinical problems. Improvement 2. Knowledge necessary in working up and handling the child with an acute or chronic illness, i.e., how to recognize, diagnose and formulate a therapeutic regimen for the sick child. 3. Specific information about those illnesses manifested by patients assigned i.e., obtain the most recent knowledge available from tests and journals regarding their patient. Interpersonal and Global faculty assessment Communication Skills Professionalism Global faculty assessment Systems-Based 1. Proficiency in acquisition of in-depth historical Global faculty assessment Practice and objective information about the pediatric patient, enabling cogent determination of the major problem. 2. Approach to solving clinical problems. Last Review/Revision: 1/8/09

Geriatric Wards Level: PGY-1 Contacts: Scott Cheek, APN, 257-2002, Jeffrey.cheek@med.va.gov and Laurie Becker, 257-2663 Preceptors: Muhannad Heif, M.D. Rotation Length: One Month Clinical Settings: This rotation includes primarily outpatient clinic experience but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and to notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1. Analyze geriatric patients medical problems both 1) Global faculty assessment new and existing through history and physical 2) Direct faculty clinic examination, and monitoring of daily progress of and/or bedside observation the patient. 2. Determine a diagnostic work up plan and treatment of patients. 3. Evaluate a variety of medical emergencies and determine how to stabilize patients. Medical 1. Analyze geriatric patients medical problems both Global faculty assessment Knowledge new and existing through history and physical examination, and monitoring of daily progress of the patient. 2. Determine a diagnostic work up plan and treatment of patients. 3. Evaluate a variety of medical emergencies and determine how to stabilize patients. 4. Evaluate to sub-specialty branches of medicine, by working with the consult services in managing their patients. 5. Determine selection and interpretation of appropriate laboratory tests, radiological and imaging studies, and cardiovascular diagnostic studies. 6. Obtain skills in intervention procedures drawing of blood cultures, bladder catherisations, lumbar punctures, abdomino-paracenthesis, thoracenthesis, insertion of central venous lines. 7. Analyze cardiopulmonary resuscitation codes. Practice-Based 1. Analyze geriatric patients medical problems both Global faculty assessment Learning and new and existing through history and physical Improvement examination, and monitoring of daily progress of the patient.

2. Evaluate a variety of medical emergencies and determine how to stabilize patients. 3. Evaluate to sub-specialty branches of medicine, by working with the consult services in managing their patients. 4. Obtain skills in intervention procedures drawing of blood cultures, bladder catherisations, lumbar punctures, abdomino-paracenthesis, thoracenthesis, insertion of central venous lines. Interpersonal and Global faculty assessment Communication Skills Professionalism Global faculty assessment Systems-Based Global faculty assessment Practice Last Review/Revision: 1/8/09

Rheumatology, BMC or VA Level: PGY-1 Contacts: Mickey Burroughs, BHMC, 501-202-2673, Fax/501-202-1159 and Stacey Major, VA, 501-686-6770 Preceptors: Jasen Chi, M.D., BHMC; Zainab Siddiqui, M.D., VA Rotation Length: One Month Clinical Settings: Depending on the clinical site, this rotation includes primarily outpatient clinic experience (VA, BHMC-LR, UAMS), but when available inpatient rheumatology consultations will be included. Performance Expectations: Residents are expected to arrive to their clinical assignments promptly and top notify their attending faculty preceptor in advance of any schedule changes. Department leave/vacation policy will apply. Educational Objectives: Competency Objectives Evaluation Method Patient Care 1) Hospital and clinic consults and follow up visits 1) Global faculty assessment will be performed, staffed, and documented in the 2) Direct faculty clinic medical record or the clinic chart by the resident and/or bedside observation 2) Understand risk assessment and choose appropriate testing (including indications, contraindications, and benefits of arthrocentesis) Medical Review core topics noted below using patient care Global faculty assessment Knowledge and didactic opportunities and supplement with independent reading Practice-Based 1) Demonstrate insight into rheumatology Global faculty assessment Learning and knowledge deficiencies and limitations Improvement 2) Identify opportunities for increasing knowledge and skills 3) Use information technology, imaging and appropriate laboratory studies to answer clinical questions Interpersonal and 1) Develop skills necessary to present patients and Global faculty assessment Communication topics informally and formally to another physician Skills or group Professionalism 1) Clinics: The resident is expected to see all Global faculty assessment assigned patients and to present/discuss the patients with the faculty. 2) Consults: The resident is expected to perform consults as assigned, to present/discuss the patients with the faculty; to follow up on previously seen patients and write follow up notes Systems-Based 1) Understand systems unique to the subspecialty of Global faculty assessment Practice rheumatology and to understand the role of rheumatology relative to PM&R and other medical specialties and systems available to the patient with

rheumatologic/musculoskeletal disease or disorders Core Topics (to be covered by patient care, didactic lectures, or independent reading) include the evaluation, diagnosis and treatment of: • Rheumatoid arthritis • Systemic lupus erythematosis • Mixed connective tissue disease • Scleroderma • Seronegative Spondyloarthropathies • Osteoarthritis • Crystalline arthropathies • Infectious arthritis • Systemic vasculitides • Fibromyalgia • Poly/Dermatomyositis • Osteoporosis, bursitis, joint pain, back pain Procedures: arthrocentesis, trigger point injections Last Review/Revision: 1/8/09

Sample Residency Rotation Schedules This Program PGY-1 Jul Aug Sep Oct Dec NovJan Feb Mar April May Jun Ambul Ambul Sample Geriatric Med Peds Rheum Med Emerg Med PM&R Neuro Wards Care Radiol Care Assignment Wards Wards Clinic Wards Med Wards Clinic Clinic Institution* 3 1/3 2 2 4 2 2/3 1/3 2 1/3 2 2 PGY-2 Jul Aug Sep Oct Nov Dec Jan Feb Mar April May Jun Sample Inpatient PM&R Inpatient PM&R PM&R Outpatient Inpatient PM&R Assignment Institution* 1/2/3/4 1/2/3/4 1/2/4 1/2/3/4 PGY- 3 Jul Aug Sep Oct Nov Dec Jan Feb Mar April May Jun Sample Inpatient PM&R EMG Inpatient PM&R PM&R Outpatient Assignment Institution* 1/2/3/4 1/2/4 1/2/3/4 1/2/4 PGY-4 Jul Aug Sep Oct Nov Dec Jan Feb Mar April May Jun Sample PM&R Outpatient PM&R Outpatient Inpatient PM&R PM&R Outpatient Assignment Institution* 1/2/4 1/2/4 1/2/3/4 1/2/4 Overall Sample Assigned Rotations for Training Year Training PGY-1 PGY-1 PGY-2-4 Template Months Rotations Months PGY-2 PGY-3 PGY-4 Jul PM&R PM&R PM&R Aug Fundamental July-Sept Inpatient Inpatient Outpatient Sept Clin. Skills: Med / Peds Oct-Dec Oct PM&R PM&R Inpatient EMG / Selective Nov Inpatient Outpatient Sample Dec Assignment Jan PM&R PM&R PM&R Feb Jan-Mar Outpatient Inpatient Inpatient Fundamental Mar Clin. Skills: Apr-Jun Apr Other PM&R PM&R PM&R May Specialties Inpatient Outpatient Outpatient Jun Institution* 1/2/3/4 1/2/3/4 1/2/3/4 1/2/3/4 * Institution Key: 1 = University Hospital; 2 = VA; 3 = BHRI; 4 = Arkansas Children’s Hospital

UAMS PM&R Resident Rotation Schedule 2009/2010 NAME PG JULY - OCTOBER- JANUARY- APRIL- Year SEPTEMBER DECEMBER MARCH JUNE Hobart UAMS Outpatient 4 Awoniyi VA Inpatient VA Outpatient UAMS VA Outpatient Outpatient 4 Clayborne UAMS EMG BHRI VA Outpatient Outpatient Inpatient 3 Haley EMG UAMS VA Inpatient ACH Outpatient Outpatient 3 Toweh BHRI Inpatient VA Outpatient EMG VA Inpatient 3 Sawkar VA Outpatient VA Inpatient ACH ACH Inpatient Oupatient 3 Adams ACH Outpatient BHRI Inpatient VA Outpatient EMG 3 Buck ACH Inpatient ACH Outpatient UAMS BHRI Outpatient Inpatient 2 Harrison UAMS BHRI Inpatient ACH Inpatient UAMS Outpatient Outpatient 2 Swenson BHRI Inpatient UAMS VA Outpatient BHRI Outpatient Inpatient 2 Wilson VA Med Wards ACH Inpatient BHRI UAMS (July)/VA Inpatient Outpatient 2 Outpatient Revised 6/16/09

Introduction for Rotation Objectives To meet educational objectives there are at least 12 months of Inpatient and 12 months of Outpatient rotations in PM&R. For each rotation, there are objectives tied to general competencies. These are general and PM&R content specific objectives. Residents use the rotation overviews to determine what is to be achieved, how to do it, and how it will be evaluated. The overall goal of the PM&R residency training program is to develop physiatrists who are ethical, competent, caring, knowledgeable and skilled in the diagnosis, management, prevention, and rehabilitation for conditions resulting or potentially resulting in impairment and disability. To achieve this goal, educational objectives have been established for each level of training in the program. These objectives comprise both cognitive and psychomotor elements (i.e., physical examination skills, procedural skills, etc.). The objectives direct the faculty teaching and the resident learning experiences during each rotation.

Department of Physical Medicine and Rehabilitation Resident Signs of Fatigue Fatigue Definition: Fatigue is defined as a weariness, tiredness, or lack of energy and motivation. Fatigue can be a normal and important response to physical exertion, or emotional stress and fatigue can occur with long working hours and sleep deprivation. Physical Signs and Symptoms of fatigue may include: • exhaustion • lethargy • drowsiness • somnolence Psychological and Behavioral Signs and Symptoms of fatigue may include: • inappropriate affect • feelings of apathy, depression, anger, hostility, anxiety, tension, confusion, or irritability Performance Signs and Symptoms of fatigue may include: • memory deficits • difficulty thinking clearly • inattention or lack of concentration • difficulty performing manual tasks If you observe any of these signs or you suspect fatigue in a resident: 1. Monitor the resident closely, if possible. 2. Question the resident about his/her physical, mental, and emotional state and their ability to perform their job. 3. If necessary, relieve the resident (or ask the appropriate clinical supervisor to have the resident relieved) of any direct patient care responsibilities until further evaluation. 4. Report all incidents to the program director immediately. For further reading on resident fatigue as it relates to ACGME Work Hours Policy: 1. Halbach MM. Spann CO. Egan G. Effect of sleep deprivation on medical resident and student cognitive function: A prospective study. American Journal of Obstetrics & Gynecology. 188(5):1198-201, 2003 May. 2. Rosen IM. Shea JA. Bellini LM. Residents' work hours. New England Journal of Medicine. 348(7):664-6; author reply 664-6, 2003 Feb 13. 3. Philibert I. Barach P. Residents' hours of work. BMJ. 325(7374):1184-5, 2002 Nov 23. 4. Steinbrook R. The debate over residents' work hours. New England Journal of Medicine. 347(16):1296-302, 2002 Oct 17. 5. Gaba DM. Howard SK. Patient safety: fatigue among clinicians and the safety of patients. New England Journal of Medicine. 347(16):1249-55, 2002 Oct 17. 6. Steinbrook R. The debate over residents' work hours. New England Journal of Medicine. 347(16):1296-302, 2002 Oct 17

7. Gaba DM. Howard SK. Patient safety: fatigue among clinicians and the safety of patients. New England Journal of Medicine. 347(16):1249-55, 2002 Oct 17. 8. Veasey S. Rosen R. Barzansky B. Rosen I. Owens J. Sleep loss and fatigue in residency training: a reappraisal. JAMA. 288(9):1116-24, 2002 Sep 4. 9. Lamberg L. Long hours, little sleep: bad medicine for physicians-in-training? JAMA. 287(3):303-6, 2002 Jan 16. 10. Sloan VS. Reducing sleepiness on the roads and on the wards. JAMA. 281(2):134-5, 1999 Jan 13. 11. Green MJ. The sleep of long-haul truck drivers. New England Journal of Medicine. 338(6):390-1, 1998 Feb 5. 12. Green MJ. What (if anything) is wrong with residency overwork? Annals of Internal Medicine. 123(7):512-7, 1995 Oct . 7/18/03

PM&R RESIDENT ROTATION Inpatient Goals & Objectives (includes ACH Inpatient, BHRI Inpatient, & VA Inpatient Rotations) PATIENT CARE- INPATIENT ROTATIONS PGY 3 Patient Care: To provide PGY 4 Patient Care: To PGY 2 Patient Care: To compassionate, appropriate, provide compassionate and provide compassionate, and effective treatment for appropriate treatment for patients admitted to the patients admitted to the appropriate, and effective hospital. hospital. treatment for all patients to be admitted to the hospital. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Resident will obtain a. Resident will obtain and a. Resident will obtain and and record accurate and record accurate and record accurate and comprehensive medical comprehensive medical history. comprehensive medical history. history. b. Resident will perform b. Resident will perform and b. Resident will perform and and record complete record complete medical exam. record complete medical medical exam. exam. c. Resident will determine c. Resident will determine and c. Resident will determine and analyze the analyze the rehabilitation goals and analyze the rehabilitation rehabilitation goals of a of a patient. goals of a patient. patient. d. Resident will prescribe d. Resident will prescribe d. Resident will prescribe realistic rehabilitation realistic rehabilitation goals for realistic rehabilitation goals goals for a patient. a patient. for a patient. e. Resident will prescribe e. Resident will prescribe a e. Resident will prescribe a a rehabilitation program rehabilitation program for a rehabilitation program for a for a patient. patient. patient. f. Resident will evaluate f. Resident will evaluate the f. Resident will evaluate the the need for self-help need for self-help aids, need for self-help aids, aids, including wheelchair including wheelchair and including wheelchair and and patient's home patient's home modifications. patient's home modifications. modifications. g. Resident will accurately determine the neuromuscular and functional deficits of a patient and explain these to the patient. h. Resident will formulate appropriate precautions for the rehabilitation team, as necessary.

MEDICAL KNOWLEDGE- INPATIENT PGY 2 Medical PGY 3 Medical Knowledge: To PGY 4 Medical Knowledge: Knowledge: To understand biomedical, clinical, To understand biomedical, understand biomedical, and socio-behavioral clinical, and socio-behavioral clinical, and socio- knowledge about patient care in knowledge about patient care behavioral knowledge a hospital setting. in a hospital setting. about patient care in a hospital setting. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will develop a. Residents will demonstrate a. Residents will demonstrate clinically applicable the ability to provide clinically the ability to assess the knowledge of basic & appropriate articles or other scientific merit and clinical science that make publications to the PGY-2 generalizeability of published up Physical Medicine and residents to improve their medical research. Rehabilitation. medical knowledge. b. Residents will apply b. Residents will develop b. Residents will develop in- this knowledge (as advanced clinically applicable depth and detailed above) in developing knowledge of basic and clinical knowledge of basic and critical thinking, clinical science that makes up Physical clinical science that makes up problem solving, and Medicine & Rehabilitation. Physical Medicine & decision making skills. Rehabilitation. c. Residents will c. Residents will apply this c. Residents will be proficient demonstrate the ability to knowledge (as above) in in the application of this apply the methods of developing critical thinking, knowledge (as above) in Evidence-Based Medicine clinical problem solving, and developing critical thinking, to the analysis of the decision making skills. clinical problem solving, and medical literature. decision making skills. d. Residents will d. Residents will demonstrate d. Residents will demonstrate demonstrate the ability to the ability to interpret Evidence- the proficiency in the conduct clinically Based Medicine of the medical interpretation of Evidence- appropriate literature literature and apply this to aid in Based Medicine of the searches. patient care. medical literature to aid in patient care. e. Residents will e. Residents will demonstrate a e. Residents will demonstrate demonstrate the ability to basic knowledge of research an advanced knowledge of find practice-relevant design. research design. information on the Internet. f. Residents will f. Residents will demonstrate f. Residents will demonstrate demonstrate basic skills competence in applying proficiency in applying in applying scientific scientific principles in clincial- scientific principles in clincial- principles in clinical decision making. decision making. decision-making. g. Residents will g. Residents will formulate a g. Residents will formulate a participate in the active diagnosis and provide a list of diagnosis and provide a list of review and dissemination differential diagnoses differential diagnoses of current developments in medical knowledge.

PRACTICE-BASED LEARNING- INPATIENT PGY 2 Practice-Based PGY 3 Practice-Based PGY 4 Practice-Based Learning and Learning and Improvement: Learning and Improvement: Improvement: Systematically analyze resident Systematically analyze Systematically analyze inpatient practice using quality resident inpatient practice resident inpatient practice improvement methods, and using quality improvement using quality implement changes with the methods, and implement improvement methods, goal of practice improvement. changes with the goal of and implement changes practice improvement. with the goal of practice improvement. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will a. Residents will demonstrate a. Residents will demonstrate demonstrate an the ability to apply PBLI tools skill in incorporating novel understanding of the tools and methods their own PBLI tools and methodology and methodology for practices. in the practices of all the assessing their own members of the inpatient inpatient practices. team. b. Residents will b. Residents will demonstrate b. Residents will demonstrate demonstrate skill in the ongoing application of PBLI in proficiency in monitoring and utilization of the results of order to achieve continuous improving the performance practice analysis in quality improvement in their measures of the inpatient improving the quality of inpatient practice. team. their inpatient care. c. Residents at the VA will c. Residents at the VA will c. Residents at the VA will demonstrate basic skill in demonstrate competence in demonstrate proficiency in utilizing CPRS for utilizing CPRS for practice utilizing CPRS for monitoring practice anaylsis; anaylsis; residents at University the performance measures of residents at University Hospital will demonstrate the inpatient team; residents Hospital will demonstrate competence in utilizing Sunrise at University Hospital will basic skill in utilizing Clinical Manager (SCM) for demonstrate proficiency in Sunrise Clinical Manager practice analysis. utilizing Sunrise Clinical (SCM) for practice Manager (SCM) for or analysis. monitoring the performance of the inpatient team. d. Residents at the VA d. Residents at the VA will d. Residents will demonstrate will demonstrate demonstrate competence in an understanding of using knowledge of VA achieving VA performance outcomes research in performance measures measures in the course of formulating new performance as they pertain to practice inpatient care; residents at measures. improvement; residents at University Hospital will University Hospital will demonstrate competence in demonstrate knowledge achieving University Hospital of University Hospital core measures as they pertain core measures as they to practice improvement. pertain to practice improvement.

Systems-Based Practice- INPATIENT DO WE NEED TO ADD ACH ?? PGY 2 Systems-Based PGY 3 Systems-Based PGY 4 Systems-Based Practice: Understand and Practice: Understand and Practice: Understand and access the systems access the systems based access the systems based based practice of UAMS practice of UAMS and CAVHS practice of UAMS and and CAVHS in order to in order to provide optimal care. CAVHS in order to provide provide optimal care. optimal care. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will a. Residents will demonstrate a. Residents will demonstrate demonstrate an skill in advocating and proficiency in advocating and understanding of the facilitating patients' facilitating patients' contexts and systems in engagement with the health engagement with the health which health care is care system in all of its care system in all of its provided, and dimensions. dimensions. demonstrate the ability to apply this knowledge to improve and optimize health care. b. Residents will b. Residents will demonstrate b. Residents will demonstrate understand the process skill in selecting appropriate skill in evaluating and for requesting and consulting services for specific implementing the providing appropriate clinical problems. recommendations of differing consultations for their consultants. patients. c. Residents will c. Residents will demonstrate c. Residents will demonstrate demonstrate the ability to skill in utilizing health care skill in maximizing patient apply evidence-based resources efficiently and flow while maintaining high strategies to prevention, prudently. quality care. diagnosis, and disease management. d. Residents will d. Residents will demonstrate d. Residents will demonstrate understand the skill in coordinating the skill in identifying and appropriate roles of all the functions of the multi- resolving conflicts within the members of the multidisciplinary team. multi-disciplinary process. disciplinary health care team. e. Residents will e. Residents will demonstrate e. Residents will demonstrate demonstrate skill in skill in facilitating and skill in monitoring and performing daily coordinating complex discharge modeling best practices in discharge and functions. patient discharge as it relates predischarge duties. to patient safety and continuity of care. f. Residents will f. Residents will demonstrate f. Residents will demonstrate demonstrate ability to skill in modeling and teaching skill in monitoring the quality maintain timely and the appropriate maintenance of and timeliness of medical accurate medical records. medical records. records entered by those under their supervision. g. Residents will g. Residents will demonstrate g. Residents will demonstrate demonstrate accuracy skill in teaching and modeling skill in monitoring and and thoroughness in appropriate sign out/hand off maintaining handoff safety. patient sign outs/hand techniques. offs. h. Resident will explain h. Residents will demonstrate h. Residents will demonstrate the importance of the role knowledge of the sources of knowledge of the sources of of each rehabilitation financing for patients as financing for patients as team member to the appropriate to the medical appropriate to the medical patient and family context. context and will display skill in members. teaching members of their team about these issues.

INTERPERSONAL AND COMMUNICATION SKILLS- INPATIENT PGY 2 Interpersonal and PGY 3 Interpersonal and PGY 4 Interpersonal and Communication Skills: To Communication Skills: To have Communication Skills: To have communication with communication with patients, have communication with patients, families, and families, and other health care patients, families, and other other health care professionals in the hospital. health care professionals in professionals in the the hospital. hospital. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will sustain a. Residents will teach and a. Residents will monitor and effective and professional model effective and guide effective and relationships with professional relationships with professional communication patients, families, and patients, families, and for all members of the house colleagues. colleagues, including listening staff team, including listening skills. skills. b. Residents will b. Residents will demonstrate b. Residents will demonstrate demonstrate the ability to competency in the use of proficiency in the use of use effective listening, effective listening, nonverbal, effective listening, nonverbal, nonverbal, questioning, questioning, and narrative skills questioning, and narrative and narrative skills to to communicate with patients skills to communicate with communicate with and families. patients and families. patients and families. c. Residents will c. Residents will demonstrate c. Residents will demonstrate demonstrate the ability to competence in providing their proficiency in providing their provide their patients and health care team, patients and health care team, patients families with clear families with clear information and families with clear information about their about their treatment programs information about their treatment programs and and accepted alternatives. treatment programs and accepted alternatives. accepted alternatives in guiding patients and families in making difficult decisions. d. Residents will d. Residents will demonstrate d. Residents will demonstrate demonstrate the ability to the ability to teach members of proficiency in teaching convey bad news while their team to convey bad news members of their team to supporting the emotional while supporting the emotional convey bad news while needs of the recipients needs of the recipients and supporting the emotional and their families. their families. needs of the recipients and their families. e. Residents will e. Residents will demonstrate e. Residents will demonstrate demonstrate the ability to competence in teaching their proficiency in teaching their write clear medical notes, team members to write clear team members to write clear orders in the medical medical notes, orders in the medical notes, orders in the chart, and requests for medical chart, and requests for medical chart, and requests consultation. consultation. for consultation. f. Resident will accurately determine the neuromuscular and functional deficits of a patient and explain these to the patient. g. Resident will formulate appropriate precautions for the rehabilitation team, as necessary.

h. Resident will explain the importance of the role of the family in the rehabilitation team to the patient and family members. i. Resident will discuss medical, social, and psychological problems that will affect rehabilitation efforts with the patient and family members.

PROFESSIONALISM- INPATIENT PGY 2 Professionalism: PGY 3 Professionalism: To PGY 4 Professionalism: To To carry out carry out responsibilities in a carry out responsibilities in a responsibilities in a professional manner. professional manner. professional manner. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will a. Residents will demonstrate a. Residents will demonstrate demonstrate respect, the ability to teach and model proficiency in maintaining an compassion, and integrity respect, compassion, and atmosphere of respect, in relationships with integrity in relationships with compassion, and integrity in patients, families, and patients, families, and relationships with patients, colleagues. colleagues. families, and colleagues within the house staff team. b. Residents will adhere b. Residents will adhere to b. Residents will adhere to to principles of principles of confidentiality, principles of confidentiality, confidentiality, scientific scientific and academic scientific and academic and academic integrity, integrity, and informed consent. integrity, and informed and informed consent. consent. c. Residents will c. Residents will demonstrate c. Residents will demonstrate demonstrate sensitivity the willingness to provide the willingness to provide and responsiveness to needed care with the same needed care with the same patients and colleagues in standards to all patients standards to all patients consideration of sex, age, regardless of race, sex, regardless of race, sex, culture, religion, sexual religious beliefs, type of religious beliefs, type of preference, and beliefs. reimbursement, or ability to reimbursement, or ability to pay. pay. d. Residents will d. Residents will demonstrate d. Residents will demonstrate demonstrate the ability to the ability to teach their team proficiency in teaching their interact with other health members about appropriate team members about care members and peers and inappropriate interations appropriate and inappropriate in a professional manner. with their patients and patients' interations with their patients families. and patients' families. e. Residents will e. Residents will model e. Residents will monitor and demonstrate the ability to professional behavior with other guide the professional interact with patients and members of the health care behavior of all members of patients' families in a team, their peers, patients and the house staff team. professional manner. patients' families.

Outpatient Goals & Objectives PATIENT CARE- OUTPATIENT PGY 3 Patient Care: To provide PGY 4 Patient Care: To PGY 2 Patient Care: To compassionate, appropriate, provide compassionate and provide compassionate, and effective treatment for appropriate treatment for patients admitted to the patients admitted to the appropriate, and effective hospital. hospital. treatment for all patients to be admitted to the hospital. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will obtain a. Residents will obtain concise a. Residents will obtain concise and pertinent and pertinent medical history of concise and pertinent medical medical history of the chief the chief complaint(s). history of the chief complaint(s). complaint(s). b. Residents will obtain b. Residents will describe b. Residents will describe accurate and pertinent co- accurate and comprehensive accurate and comprehensive morbid medical history co-morbid medical history co-morbid medical history c. Residents will conduct a c. Residents will determine c. Residents will determine concise, competent, and concise, competent, and concise, competent, and pertinent physical exam pertinent physical exam pertinent physical exam relevant to the chief relevant to the chief relevant to the chief complaint(s). complaint(s). complaint(s). d. Residents will select d. Residents will select d. Residents will select appropriate radiological appropriate radiological appropriate radiological imaging, interpret imaging imaging, interpret imaging imaging, interpret imaging studies & reports, and utilize studies & reports, and utilize studies & reports, and utilize information to determine or information to determine or information to determine or adjust the rehabilitation adjust the rehabilitation adjust the rehabilitation diagnosis and plan. diagnosis and plan. diagnosis and plan. e. Residents will evaluate the e. Residents will determine and e. Residents will determine need for self-help aids, analyze the rehabilitation goals and analyze the rehabilitation including wheelchair and and develop a rehabilitation goals and develop a patient’s home modifications. program including appropriate rehabilitation program monitoring and follow up for the including appropriate patient monitoring and follow up for the patient f. Residents will demonstrate f. Residents will formulate a f. Residents will formulate a essential elements to be diagnosis and provide a list of diagnosis and provide a list of included in a physiatric differential diagnoses differential diagnoses evaluation. g. Residents will evaluate the g. Residents will evaluate the need for self-help aids, need for self-help aids, including wheelchair and including wheelchair and patient’s home modifications. patient’s home modifications. h. Residents will demonstrate h. Residents will demonstrate essential elements to be essential elements to be included in a physiatric included in a physiatric evaluation. evaluation.

MEDICAL KNOWLEDGE- OUTPATIENT PGY 2 Medical Knowledge: PGY 3 Medical Knowledge: To PGY 4 Medical Knowledge: To understand biomedical, understand biomedical, clinical, To understand biomedical, clinical, and socio-behavioral and socio-behavioral clinical, and socio-behavioral knowledge about patient care knowledge about patient care in knowledge about patient care in a hospital setting. a hospital setting. in a hospital setting. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will develop a. Residents will demonstrate a. Residents will demonstrate clinically applicable the ability to provide clinically the ability to assess the knowledge of basic & clinical appropriate articles or other scientific merit and science that make up publications to the PGY-2 generalizeability of published Physical Medicine and residents to improve their medical research. Rehabilitation. medical knowledge. b. Residents will apply this b. Residents will develop b. Residents will develop in- knowledge (as above) in advanced clinically applicable depth and detailed developing critical thinking, knowledge of basic and clinical knowledge of basic and clinical problem solving, and science that makes up Physical clinical science that makes up decision making skills. Medicine & Rehabilitation. Physical Medicine & Rehabilitation. c. Residents will demonstrate c. Residents will apply this c. Residents will be proficient the ability to apply the knowledge (as above) in in the application of this methods of Evidence-Based developing critical thinking, knowledge (as above) in Medicine to the analysis of clinical problem solving, and developing critical thinking, the medical literature. decision making skills. clinical problem solving, and decision making skills. d. Residents will demonstrate d. Residents will demonstrate d. Residents will demonstrate the ability to conduct clinically the ability to interpret Evidence- the proficiency in the appropriate literature Based Medicine of the medical interpretation of Evidence- searches. literature and apply this to aid in Based Medicine of the patient care. medical literature to aid in patient care. e. Residents will demonstrate e. Residents will demonstrate a e. Residents will demonstrate the ability to find practice- basic knowledge of research an advanced knowledge of relevant information on the design. research design. Internet. f. Residents will demonstrate f. Residents will demonstrate f. Residents will demonstrate basic skills in applying competence in applying proficiency in applying scientific principles in clinical scientific principles in clincial- scientific principles in clincial- decision-making. decision making. decision making. g. Residents will participate g. Residents will formulate a g. Residents will formulate a in the active review and diagnosis and provide a list of diagnosis and provide a list of dissemination of current differential diagnoses differential diagnoses developments in medical knowledge.

PRACTICE-BASED LEARNING-OUTPATIENT PGY 2 Practice-Based PGY 3 Practice-Based PGY 4 Practice-Based Learning and Improvement: Learning and Improvement: Learning and Improvement: Systematically analyze Systematically analyze resident Systematically analyze resident inpatient practice inpatient practice using quality resident inpatient practice using quality improvement improvement methods, and using quality improvement methods, and implement implement changes with the methods, and implement changes with the goal of goal of practice improvement. changes with the goal of practice improvement. practice improvement. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will demonstrate a. Residents will demonstrate a. Residents will demonstrate an understanding of the tools the ability to apply PBLI tools skill in incorporating novel and methodology for and methods their own PBLI tools and methodology assessing their own inpatient practices. in the practices of all the practices. members of the inpatient team. b. Residents will demonstrate b. Residents will demonstrate b. Residents will demonstrate skill in the utilization of the ongoing application of PBLI in proficiency in monitoring and results of practice analysis in order to achieve continuous improving the performance improving the quality of their quality improvement in their measures of the inpatient inpatient care. inpatient practice. team. c. Residents at the VA will c. Residents at the VA will c. Residents at the VA will demonstrate basic skill in demonstrate competence in demonstrate proficiency in utilizing CPRS for practice utilizing CPRS for practice utilizing CPRS for monitoring anaylsis; residents at anaylsis; residents at University the performance measures of University Hospital will Hospital will demonstrate the inpatient team; residents demonstrate basic skill in competence in utilizing Sunrise at University Hospital will utilizing Sunrise Clinical Clinical Manager (SCM) for demonstrate proficiency in Manager (SCM) for practice practice analysis. utilizing Sunrise Clinical analysis. Manager (SCM) for or monitoring the performance of the inpatient team. d. Residents at the VA will d. Residents at the VA will d. Residents will demonstrate demonstrate knowledge of demonstrate competence in an understanding of using VA performance measures achieving VA performance outcomes research in as they pertain to practice measures in the course of formulating new performance improvement; residents at inpatient care; residents at measures. University Hospital will University Hospital will demonstrate knowledge of demonstrate competence in University Hospital core achieving University Hospital measures as they pertain to core measures as they pertain practice improvement. to practice improvement.

Systems-Based Practice- OUTPATIENT DO WE NEED TO ADD ACH ?? PGY 2 Systems-Based PGY 3 Systems-Based PGY 4 Systems-Based Practice: Understand and Practice: Understand and Practice: Understand and access the systems based access the systems based access the systems based practice of UAMS and practice of UAMS and CAVHS practice of UAMS and CAVHS in order to provide in order to provide optimal care. CAVHS in order to provide optimal care. optimal care. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will demonstrate a. Residents will demonstrate a. Residents will demonstrate an understanding of the skill in advocating and proficiency in advocating and contexts and systems in facilitating patients' facilitating patients' which health care is engagement with the health engagement with the health provided, and demonstrate care system in all of its care system in all of its the ability to apply this dimensions. dimensions. knowledge to improve and optimize health care. b. Residents will understand b. Residents will demonstrate b. Residents will demonstrate the process for requesting skill in selecting appropriate skill in evaluating and and providing appropriate consulting services for specific implementing the consultations for their clinical problems. recommendations of differing patients. consultants. c. Residents will demonstrate c. Residents will demonstrate c. Residents will demonstrate the ability to apply evidence- skill in utilizing health care skill in maximizing patient based strategies to resources efficiently and flow while maintaining high prevention, diagnosis, and prudently. quality care. disease management. d. Residents will understand d. Residents will demonstrate d. Residents will demonstrate the appropriate roles of all skill in coordinating the skill in identifying and the members of the multi- functions of the multi- resolving conflicts within the disciplinary health care team. disciplinary team. multi-disciplinary process. e. Residents will demonstrate e. Residents will demonstrate e. Residents will demonstrate skill in performing daily skill in facilitating and skill in monitoring and discharge and predischarge coordinating complex discharge modeling best practices in duties. functions. patient discharge as it relates to patient safety and continuity of care. f. Residents will demonstrate f. Residents will demonstrate f. Residents will demonstrate ability to maintain timely and skill in modeling and teaching skill in monitoring the quality accurate medical records. the appropriate maintenance of and timeliness of medical medical records. records entered by those under their supervision. g. Residents will demonstrate g. Residents will demonstrate g. Residents will demonstrate accuracy and thoroughness skill in teaching and modeling skill in monitoring and in patient sign outs/hand offs. appropriate sign out/hand off maintaining handoff safety. techniques. h. Determine consultations h. Residents will demonstrate h. Residents will demonstrate and make recommendations knowledge of the sources of knowledge of the sources of based on the financing for patients as financing for patients as musculoskeletal appropriate to the medical appropriate to the medical diagnosis(es), and co- context. context and will display skill in morbidities within the context teaching members of their of optimizing benefit from the team about these issues. prescribed rehabilitation program.

i. Formulate precautions for the rehabilitation team, as necessary. j. Educate the patient on complementary community- based exercise programs to optimize and maintain goals from the prescribed rehabilitation program. k. Organize a team of rehabilitation professionals essential in patient management of a patient's illness. l. Prescribe a rehabilitation program for a patient. m. Explain to patients and families how to access assistive devices and their maintenance and repairs.

INTERPERSONAL AND COMMUNICATION SKILLS- OUTPATIENT PGY 2 Interpersonal and PGY 3 Interpersonal and PGY 4 Interpersonal and Communication Skills: To Communication Skills: To have Communication Skills: To have communication with communication with patients, have communication with patients, families, and other families, and other health care patients, families, and other health care professionals in professionals in the hospital. health care professionals in the hospital. the hospital. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will sustain a. Residents will teach and a. Residents will monitor and effective and professional model effective and guide effective and relationships with patients, professional relationships with professional communication families, and colleagues. patients, families, and for all members of the house colleagues, including listening staff team, including listening skills. skills. b. Residents will demonstrate b. Residents will demonstrate b. Residents will demonstrate the ability to use effective competency in the use of proficiency in the use of listening, nonverbal, effective listening, nonverbal, effective listening, nonverbal, questioning, and narrative questioning, and narrative skills questioning, and narrative skills to communicate with to communicate with patients skills to communicate with patients and families. and families. patients and families. c. Residents will demonstrate c. Residents will demonstrate c. Residents will demonstrate the ability to provide their competence in providing their proficiency in providing their patients and families with health care team, patients and health care team, patients clear information about their families with clear information and families with clear treatment programs and about their treatment programs information about their accepted alternatives. and accepted alternatives. treatment programs and accepted alternatives in guiding patients and families in making difficult decisions. d. Residents will demonstrate d. Residents will demonstrate d. Residents will demonstrate the ability to convey bad the ability to teach members of proficiency in teaching news while supporting the their team to convey bad news members of their team to emotional needs of the while supporting the emotional convey bad news while recipients and their families. needs of the recipients and supporting the emotional their families. needs of the recipients and their families. e. Residents will demonstrate e. Residents will demonstrate e. Residents will demonstrate the ability to write clear competence in teaching their proficiency in teaching their medical notes, orders in the team members to write clear team members to write clear medical chart, and requests medical notes, orders in the medical notes, orders in the for consultation. medical chart, and requests for medical chart, and requests consultation. for consultation. f. Obtain concise and pertinent medical history of the chief complaint(s). g. Describe accurate and comprehensive co-morbid medical history. h. Determine and analyze the rehabilitation goals of a patient.

i. Determine consultations and make recommendations based on the musculoskeletal diagnosis(es), and co- morbidities within the context of optimizing benefit from the prescribed rehabilitation program. j. Analyze patient on complementary community- based exercise programs to optimize and maintain goals from the prescribed rehabilitation program.

PROFESSIONALISM- OUTPATIENT PGY 2 Professionalism: To PGY 3 Professionalism: To PGY 4 Professionalism: To carry out responsibilities in a carry out responsibilities in a carry out responsibilities in a professional manner. professional manner. professional manner. MethodsTeaching MethodsTeaching MethodsTeaching Assessments Assessments Assessments Objectives Objectives Objectives a. Residents will demonstrate a. Residents will demonstrate a. Residents will demonstrate respect, compassion, and the ability to teach and model proficiency in maintaining an integrity in relationships with respect, compassion, and atmosphere of respect, patients, families, and integrity in relationships with compassion, and integrity in colleagues. patients, families, and relationships with patients, colleagues. families, and colleagues within the house staff team. b. Residents will adhere to b. Residents will adhere to b. Residents will adhere to principles of confidentiality, principles of confidentiality, principles of confidentiality, scientific and academic scientific and academic scientific and academic integrity, and informed integrity, and informed consent. integrity, and informed consent. consent. c. Residents will demonstrate c. Residents will demonstrate c. Residents will demonstrate sensitivity and the willingness to provide the willingness to provide responsiveness to patients needed care with the same needed care with the same and colleagues in standards to all patients standards to all patients consideration of sex, age, regardless of race, sex, regardless of race, sex, culture, religion, sexual religious beliefs, type of religious beliefs, type of preference, and beliefs. reimbursement, or ability to reimbursement, or ability to pay. pay. d. Residents will demonstrate d. Residents will demonstrate d. Residents will demonstrate the ability to interact with the ability to teach their team proficiency in teaching their other health care members members about appropriate team members about and peers in a professional and inappropriate interations appropriate and inappropriate manner. with their patients and patients' interations with their patients families. and patients' families. e. Residents will demonstrate e. Residents will model e. Residents will monitor and the ability to interact with professional behavior with other guide the professional patients and patients' families members of the health care behavior of all members of in a professional manner. team, their peers, patients and the house staff team. patients' families. Responsibilities of VA Outpatient Residents: A.Attend all assigned clinics – to include but not limited to: a)PM&R General Outpatient Clinic b)PM&R Brace/Wheelchair Clinic c)PM&R Amputee Clinic d)PM&R General Outpatient Clinic e)PACT F/U Clinic – Wednesday AM (LR Division) f)PM&R General Outpatient Clinic B.Follow all assigned patients through their course of treatment/therapy including observation during therapy sessions, conducting formal F/V evaluations, etc., with appropriate documentation. C.Review assigned educational objectives. D.Complete all assigned readings. E.Attend all teaching sessions as scheduled.

EMG Goals & Objectives Patient Care Residents are expected to: • Perform a comprehensive history and physical evaluation of each patient and to provide a concise differential diagnosis and EDX evaluation plan • Describe the variety of conditions frequently encountered in electrodiagnostic medicine • Determine a logical approach of testing for each individual condition • Discuss the electrophysiology of common normal and abnormal findings encountered in Electromyography and Nerve conduction studies (EMG/NCS) • Familiarize oneself with the EMG/NCS machine and be able to troubleshoot common errors and problems encountered in EMG/NCS testing • Identify patient and family concerns associated with the testing process as well as the results • Define the patient safety issues with EMG/NCS including proper maintenance, inspection of the machine with implanted cardiac devices (e.g. pacemaker), risk of blood borne pathogen exposure, and safety in patients • Obtain appropriate informed consent for the procedure • Respect that the patient is experiencing an uncomfortable procedure Medical Knowledge Residents are expected to: Anatomy & Physiology: • Define the components of the motor unit • Develop an extensive knowledge base of neuromuscular anatomy • Draw the Brachial Plexus, including the terminal nerves • List the nerve root level and peripheral nerve innervation of upper and lower extremity muscles frequently undefined in EDX study • Describe the nerve root and peripheral nerve innervation of the skin in both the upper and lower extremity • Compare the structure of myelinated and unmyelinated nerves • Identify the microanatomy of muscle, i.e., sarcomere, T-tubules, action, myosin, etc • Describe nerve and muscle membrane physiology such as potential and permeability • Compare impulse propagation in myelinated and unmyelinated nerves • Describe the response of the peripheral nervous system to injury Instrumentation: • Describe the purpose of the EMG/NCV recording device

• Identify the relative contraindications to electrodiagnosis • Identify the complications of electrodiagnosis • List the components of the EMG machine and their purpose • Discuss the concept of differential amplification and the purpose of G1 and G2 electrodes • Define sensitivity and gain • Describe the differences between monopolar and concentric needles in terms of recording area, noise and wave form characteristics • List at least three ways to reduce stimulus artifact • Give examples of high and low frequency responses commonly seen during Electrodiagnostic studies • Discuss the effects of inadequate or excessive stimulus intensity • List five causes of electrical interference and how to minimize them Nerve conduction Studies (NCS): • Demonstrate the proper placement of recording, reference and ground electrodes for common NCS; recognize proper stimulation sites; measure the latencies and calculate conduction velocities • State the various physiological factors, which can influence the electrodiagnostic results, e.g., age, body temperature, volume conduction, electrical interferences, and measurement error • Memorize normal values for distal latencies amplitudes and conduction velocities of commonly performed motor and sensory NCS • Measure sensory latencies and amplitudes of median, ulnar, radial, superficial peroneal, dorsal ulnar cutaneous nerve, and medial/lateral antebrachial cutaneous nerves. • Measure motor latencies, amplitude and conduction velocities of median, ulnar, radial, peroneal, and tibial nerves • Distinguish between the late responses (H, F, A) waves, their etiology and clinical significance • Demonstrate the ability to perform H reflex and F wave studies and interpret the results. • Differentiate between axon loss and conduction block • Demonstrate the ability to perform and diagnose upper and lower extremity nerve entrapments and radiculopathies • Differentiate axonal versus demyelinating type of peripheral neuropathies • Demonstrate the ability to diagnose neuropraxia versus axonotmetic and neurotmetic nerve lesion in mononeuropathies Needle Electromyography (EMG): • Analyze a normal motor unit potential’s morphology (shape, size, and phases) and recruitment pattern on needle EMG exam • Define the initial deflection, duration, amplitude, rate, rhythm, origin, and diagnostic significance of these potentials: miniature endplate potentials, end plate potentials, fibrillations, positive waves, fasciculations, myotonia, myokymia, complex repetitive discharges, pseudomyotonia, tremor and cramp discharges, 60 cycle interference and artifacts • Explain the reason why fibrillations and positive sharp waves are commonly seen in myopathy • Describe typical electromyographic findings in muscle disease • Describe the electromyographic findings in neuropraxia, axonotmesis, and neuronotmesis over time in terms of spontaneous activity, recruitment, and motor unit action potential

morphology • Know key muscles for examination by EMG cervical and lumbar radiculopathy Practice-Based Learning and Improvement Residents are expected to: • Review the literature for electrodiagnostic medicine “Best Practices” for neuromuscular disorders • Disseminate these “Best Practices” to patients, consultants, and staff Interpersonal and Communication Skills Residents are expected to: • Interact with patients in a sensitive manner • Communicate on a given patient’s intellectual/educational level • Produce concise, accurate documentation of the consultation, electrodiagnostic findings, and recommendations • Complete all chart notes in a timely manner • Participate in teaching discussions Professionalism Residents are expected to: • Promote respect, dignity, and compassion for patients • Accept responsibility for their own actions and decisions • Demonstrate reliability and punctuality • Understand and adhere to HIPPA regulations System-Based Practice Residents are expected to: • Appreciate when electrodiagnostic medicine procedures are most appropriately rendered to maximize information gain and patient outcome • Appreciate when electrodiagnostic medicine procedures are/are not cost-effective for the patient and health care system • Understand where electrodiagnostic medicine testing “fits” in the continuum-of-care for persons with neurologic disorders

Scheduled Educational Activities for PM&R Residents 2009-2010 Updated on the PM&R web-site www.uams.edu/pmr Below is a general schedule, however, events are changed & updated on the PM&R web-site calendar noted above. Day/Time Activity Location Sunday Monday Tuesday 7:00-8:00 a.m. Resident Led Training PM&R Spine (Each Tuesday) (EMG, Radiology, etc.) 7th Floor Conference Room 8:00-9:00 a.m. PM&R Lecture Series PM&R Spine (Each Tuesday) 7th Floor Conference Room Wednesday Thursday 7:00-8:00 a.m. Board/Chapter Review PM&R Spine (Each Thursday) 7th Floor Conference Room 8:00-9:00 a.m. Seminar PM&R Spine 1st, 2nd, & 3rd Thursdays 7th Floor Conference Room 7:00-8:00 a.m. PM&R Faculty Supervised PM&R Spine 4th Thursday Board Review 7th Floor Conference Room 8:00-9:00 a.m. Grand Rounds PM&R Spine 4th Thursday 7th Floor Conference Room 6:00 p.m. Journal Club PM&R Faculty Homes 3rd Thursday Friday 12:00–1:00 p.m. Invitation Lecture Series PM&R Spine 3rd or 4th Friday 7th Floor Conference Room

Master Schedule 2009-2010 http://www.uams.edu/pmr/calendar/20092010EducationalYear.doc

Grand Rounds FREQUENCY: Monthly (4th Thursday) from 8:00 – 9:00 A.M. LOCATION: PM&R Spine, 7th Floor Conference Room OBJECTIVES: 1. To address current concepts in PM&R. 2. To teach PM&R issues to residents, faculty, and community physicians. 3. Illustrate areas needing further study that physicians should be aware of. FORMAT: The resident (in consultation with the attending physician) will select an appropriate patient to present. Preferably one with positive physical findings that can be demonstrated to the audience. Cases may be chosen for several reasons. 1. An unusual or complex problem. 2. A typical example of a common condition to review current management strategy. 3. An interesting or novel approach in management. 4. An aspect of care not covered through other didactic means. The preparation for Grand Rounds should include a pertinent literature review, but not in the depth required for seminar presentation. Physical Medicine and Rehabilitation faculty or others who have expertise in the subject to be presented can be asked to prepare comments about the subject. It is best to speak to these discussants sufficiently in advance so they may prepare their remarks. The sequence of presentation should be: 1. Brief outline of the pertinent history and physical (it is helpful if a brief outline is given as a handout). 2. Presentation of the patient with demonstration of physical findings. 3. Review of the topic by the resident 4. Group discussion. 5. Evaluation form. Pertinent handouts should be prepared to include a bibliography (2-3 references), which residents may keep on file for future reference. Label handouts: Grand Rounds Resident name Date Reviewed/Revised: 4/28/06

Resident Seminars TIME: 8:00 - 9:00 A.M. DAY: Weekly following the Anatomy Series; 1st, 2nd, & 3rd Thursday’s LOCATION: PM&R Spine, 7th Floor Conference Room OBJECTIVES: 1. Analyze in-depth specific topics in PM&R. 2. Demonstrate effective teaching and presentation skills. WHO SHOULD ATTEND: All Residents and Faculty FORMAT: Each resident will be expected to present two formal seminars per year. The seminar should be an in-depth report on a subject pertinent to Physical medicine and Rehabilitation. There will be a general theme for each quarter (which may be basic science or clinical oriented) and the subject selected must relate to this theme. Seminars are not intended to be a broad review of a subject. Unacceptable examples: • Stroke rehabilitation • Rheumatoid arthritis • Orthotics for the lower extremities Acceptable examples: • Heat regulation and the effects of ultra-sound vs. superficial heat • Cerebral blood flow • Pathophysiology of the myoneural junction • Cerebral lateralization • Pathophysiology and management of decubitus ulcers • Neurologic outcomes in low birth weight and very low birth weight infants • C1-C2 dislocation in rheumatoid arthritis • Steroid myopathy* * A specific entity (diagnosis) may be used as a subject when it is narrow by itself and can be covered in-depth by virtue of its limited focus and scarcity of literature. In general, a relatively narrow focus will yield an in-depth study of a subject. As a guideline the content of a seminar should be at a quality suitable for publication in a refereed journal. Residents should review their subject with a faculty member, program director or department head for advice about seminar preparation and approval of the selected topic.

Residents should provide handouts at the time of the seminar to include: 1. An outline of the presentation (with title, date, and name of the presenter at the top of the page). 2. A bibliography with at least 10 references used as part of the presentation. 3. Any pertinent supplements which will help the audience to understand, such as graphs, tables, etc. All seminar attendees will complete an evaluation of the presentation. Results of the seminar evaluation will be made available to the presenter from the Residency Program Coordinator. Reviewed/Revised: 6/16/09

Department of Physical Medicine and Rehabilitation Seminar Evaluation Topic: _______________________________________________________________________ Presenter:_______________________________________ Date: _______________________ Faculty Mentor (if applicable): ___________________________________________________ Ratings: 5 – Superior Exceeds all requirements – A great job! 4 – Very Good Exceeds minimum expectations; above average. 3 – Average Meets all stated objectives; satisfactory. 2 – Fair Meets most stated objectives, but needs improvement – acceptable. 1 – Poor Definitely does not meet standards – needs improvement. A) Content 1) Choice of topic 5 4 3 2 1 2) Overall depth of knowledge in subject areas 5 4 3 2 1 3) Organization of material 5 4 3 2 1 4) Thoroughness of literature review 5 4 3 2 1 B) Appropriate use of Audio-Visual materials 5 4 3 2 1 C) Presentation 1) Oratorical style 5 4 3 2 1 2) Ability to respond to questions 5 4 3 2 1 D) Quality of handout materials 5 4 3 2 1 E) Overall effectiveness of the seminar 5 4 3 2 1 Rater (circle one): PM&R Resident: PGY-1 PGY-2 PGY-3 PGY-4 Student Faculty Other: ___________ Constructive Comments (use back of form if needed): ________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Journal Club TIME: Monthly, (3rd Thursday) at 6:00 p.m. LOCATION: PM&R Faculty Member Home OBJECTIVES: 1. Demonstrate skills in clinically appraising the PM&R literature. 2. Apply findings to current patient care. 3. Illustrate areas needing further study that physicians should be aware of. 4. Demonstrate effective teaching and presentation skills. FORMAT: Session II One resident physician assigned to each journal club with one faculty advisor. Prior information is faxed, given, or mailed to the resident and faculty physicians at least one week prior to the date of the journal club. Keep in mind that if the information is handed out during the Thursday AM seminar on the second Thursday of the month, it must still be mailed or faxed to those individuals not present. The resident physicians are required to chose a journal article, but is NOT to be chosen from the American Journal of PM&R or the Archives of PM&R. The journal article must be reviewed and approved by the faculty advisor. There will be two Journal Club formats: Format 1: Hypothesis/Research Design, Methods Journal Club on even months (February, April, June, August, October, December) The article is “cut and pasted” into Hypothesis/Research Design, Methods. (This includes the information given to the Hypothesis/Research Design team) and Results. Also, extra copies of the Methods should be available during the presentation to give to the Hypothesis/research Design team when they are finished. Any information concerning the journal and source of the study should be removed. The title and authors’ names should be provided. The hypothesis/research team should only have the title and introduction to read prior to answering their questions. The methods team should only have the title, Introduction, and methods section to review prior to answering their questions. Two to five appropriate questions for section should be identified and approved by the faculty advisor. They are then attached to the appropriate section.

The faculty and resident staff are randomly assigned to either the Hypothesis/Research Design team or the Methods team and the appropriate information is forwarded to them at least one week prior to the journal club. Each individual is required to answer the questions prior to the journal club. At the beginning of the journal club, the attendees are split in their respective groups (Hypothesis/Research Design and Methods) and the assigned residents act as facilitators of the groups. The faculty advisor assists in facilitation. The groups spend approximately 15 to 20 minutes answering the questions. The two groups then present to each other. The Results section is then passed out to the whole group and the remainder of time (approximately 1/2 hour) is spent completing the last section. Format 2: Problem Based Journal Club on odd months (January, March, May, July, September, November). Six topics per year for informational use-SAE categories (CVA, SCI, TBI, etc.). Three to five articles will be discussed briefly. Recent clinical relevant articles. Permissible Journals: NEJM; JAM; Muscle and Nerve; JBJS; Lancet; British Medical Journal; Spine; Stroke; Spinal Cord; J of Spinal Cord Medicine; Am J of Orthopedics; Annal of Neurology; J of Neurology; Neurosurgery, and Psychiatry; Neurology; J of Neurotrauma; Rheumatology; Annals of Rheumatic Disease; and Pain. Reviewed/Revised: 6/16/09

ATTACHMENT 1 Suggested Guideline for Review of a Research Article Introduction • What is the investigator's objective? • Does the objective clearly identify the study sample and the method of measuring response? Methods • What is the research design (cross-sectional, retrospective, prospective)? • How are the subjects selected? Are the entry and exclusion criteria sufficient to describe the target population? • What is the nature of the control group (concurrent, paired, placebo and/or active treatment)? • How is treatment assigned? Is randomization used? • Are blinding procedures used and are they adequate? • How is treatment given (single or multiple dose, standard or titrated dose, route)? • What is the index of accomplishment, and is it adequate? What parameters are measured to assess outcome? • Are the statistical tests for analyzing results stated? Are they appropriate for the type of data to be collected (nominal, ordinal, or interval level; paired or independent)? Results • Are the characteristics of the study groups summarized? Are the groups similar in prognostically important variables? • Are withdrawals clearly accounted for? • Are there sufficient data to enable the reader to interpret the results? Are descriptive statistics provided for all indices of accomplishment as stated in the Methods? • Are the P values given? Discussion • Are the author's comments justified by the results? • Are the conclusions consistent with the study objectives? • What is the clinical importance of the study?

PM&R Resident Self-Assessment Examination (Reviewed 2/5/04) Each year in January the AAPM&R provides a Self Assessment Examination for residents. All residents in PM&R throughout the U.S. take the exam on the same day. All scoring is done using a code number and no record is kept by the Academy of how any individual performed. The examination is divided into the same 10 categories as the Study Guide, and scores are calculated separately for each individual section. All participants in the examination are compared according to the year in training (i.e., 1st year residents are compared to other 1st year residents) as well as to all participants. The question booklet can be retained by the resident after completion, and can be used as a study tool because the source for the correct answer is given with each question. ALL UAMS PM&R RESIDENTS WILL BE REQUIRED TO TAKE THIS ANNUAL EXAMINATION, AND WILL BE REQUIRED TO GIVE PERMISSION FOR THE RESULTS TO BE SENT TO THE PROGRAM DIRECTOR. OBJECTIVES: 1. To familiarize residents with the type of questions which will be used on Part I of the Board examination. 2. For each resident to see how well he/she compares to residents in the same year of training in other programs. 3. For the Program Director to evaluate strengths and weaknesses of the training program so appropriate modifications can be made. 4. So residents can evaluate their study methods and modify as needed. 5. For residents to see how well they are improving from one year to the next. 6. For the Program Director to recognize early the residents who are not doing well so that appropriate assistance can be given. 7. The results of the examination will be made available to all Faculty as part of the training program evaluation.

PM&R Resident Scholarly Activity Program Revised 4/23/2009 A) Goals: To develop an educated consumer of research and the scientific literature, through scholarship; and to promote the involvement of the Department of PM&R in scholarly activities. B) Participation: Mandatory for all residents entering their PGY-2 year. C) Outcome: 1) A professional presentation acceptable for presentation at a specific meeting. 2) A paper which is appropriate for submission to a scientific journal. Scientific research projects are strongly encouraged; review papers and case reports are acceptable. D) General Timetable: 1) Early During the PGY-2 year (by September 30th), residents will: a. Consult informally with PM&R faculty to develop ideas; b. Identify a prospective faculty member for this project. If necessary, research mentors may be selected from outside the Department of PM&R, but this should be discussed with the Research Committee first; c. Consult with the mentor and decide on a topic for the scholarly project. 2) By midway through the PGY-2 year (by December 31st), residents will: a. Submit the name of the mentor; b. Submit the topic of their scholarly project to the Residency Program office. This information will be distributed to and reviewed within 2 weeks by the Research Committee. Appropriate feedback will be provided to the resident. c. Complete required WebCT course(s). 3) By the end of the PGY-2 year (by June 30th), the resident will submit 150-300 word proposal in IRB format to the Residency Program office. This proposal will contain information about: a. A final decision on a mentor; b. A definitive topic; c. Objectives (specific purpose or questions to be answered) by doing the project; d. Methods to be used (hypothesis, subjects, procedures, analysis, etc.); e. Timetable; f. Budget, if applicable. Prior examples are available to assist as a guide in preparing this proposal. Mentors should play a major role in helping the resident to develop the proposal. g. PowerPoint presentation is required at Annual PM&R Research Forum. 4) The PM&R Residency Coordinator will distribute the proposals to all members of the Research Committee. The Research Committee chair will assign two members as primary reviewers for each proposal. Primary reviewers will provide written comments. All committee members read each proposal and vote to approve as is, approve contingent upon specific changes, or to recommend revision. Research Committee feedback will be provided to the resident and mentor within 2

weeks. 5) Within 30 days of receiving Research Committee feedback, residents should meet with the mentor, review the proposal feedback, make necessary revisions and if necessary, submit a revised proposal to the Research Committee through the Residency Program office. The above review process is repeated, as necessary. 6) During the PGY-3 year, the resident should proceed with a scholarly project, according to the established timetable. Frequent communication with the mentor during this time period is strongly advised. The project should be started and completed in enough time to allow for analysis of the data (if necessary) and preparation of the final report. The resident and mentor should plan well in advance, what meeting the work will be presented at and/or what journal it will be submitted to. 7) By the end of the PGY-3 year (June 30th), the resident should submit a manuscript or poster, an abstract and a written report to the PM&R Residency Coordinator who will distribute this material to all members of the Research Committee Within 30 days (July 30th), the Research Committee will review the reports and vote to approve or not approve. This information is provided to the PM&R Residency Program Director for inclusion in the resident’s education records. Reports not approved will need immediate corrective action taken with resubmission of a revised report to the Research Committee as soon as possible. This must be completed by December 31st – graduation may be delayed if not fulfilled. 8) As soon as possible after completing the project and writing up the results, the resident should submit their work to a scientific meeting committee (in abstract form for presentation), or to a journal (in manuscript form for publication). Note: Abstract submission deadlines may occur and should be met, before the final report will be due in the Residency Program office. a. The resident should be listed as first author if they completed at least the initial draft of the manuscript, although this should be discussed with the mentor. Authorship guidelines are available from several sources including the Journal of the American Medical Association (See JAMA Attachment on Sharepoint)

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION Resident Mid-Rotation Evaluation by Faculty (Revised 11/7/02) Resident: _________________________ Attending Physician: _____________________ Rotation: _________________________ Dates: ____________ Year of Training: 2 3 4 COMMENTS: (Strengths, Weaknesses, Recommendations) (Use additional page if needed) % of time during this rotation in each of the following activities: Inpatient PM&R __________ ____________________________________ Attending Physician (Date) Outpatient PM&R __________ Research __________ Resident notified______________________ (Date) Non PM&R (Neurol, __________ Orth, Rheumat., etc.) ____________________________________ Resident signature Other (specify): __________ _________________ _________________ __________ Total 100%

Objective Structured Clinical Examination (OSCE) (Revised 6/18/2009) I. History of the OSCE Developed about 8 years ago (around 1994). Was given every other year. Now to be given yearly in association with the Functional Anatomy and Physical Diagnosis course blocks. II. Reasons for Development of the OSCE A) Skills assessment of musculoskeletal and peripheral nerve exam – we desire that our residents be the best in these areas because these exam skills form the basis for the treatment plan for patients. B) Functional assessment and musculoskeletal exam, in general, are not well taught in medical schools. C) Assessment using the OSCE has evolved to be coordinated and given at the end of the Functional Anatomy and Physical Diagnosis course blocks. These blocks are given yearly to strengthen our residents’ ability to be highly proficient in the musculoskeletal and peripheral nerve examination. D) Motivation for the residents to study these important parts of our specialty. E) Be able to evaluate the need for remediation. III.Nuts and Bolts of the OSCE There are 5-6 patient assessment stations which include faculty with or without simulated patients. The residents are given a brief history. They are then to do a focused physical examination (either just watched/observed or told what to assess) or evaluated a videotape of a patient. They have 6 minutes at each station (but this time may be increased to 10 minutes). Prior to the OSCE, the faculty decide what parts of the physical exam the resident should complete at each station. The OSCE is scored as follows: A) Not done B) Done but incorrectly C) Done correctly At the end, the faculty give feedback to the residents as to what was expected at each station.

Policies of GME Committee www.uams.edu/gme/policies.htm UAMS Administrative Guide http://www.uams.edu/AdminGuide/index.html UAMS Physical Medicine and Rehabilitation web-site http://www.uams.edu/pmr. UAMS PM&R Program Policies & Procedures

Department of Physical Medicine and Rehabilitation Residency Program Policy - Resident Selection Criteria and Recruitment Process Number P.1 Date Developed 6/5/99 Last Review/Revision: 6/18/2009 In accordance with the UAMS COM GME Committee Policy on Recruitment and Appointment the following describes the eligibility requirements, the selection criteria and the procedure for appointment to the PM&R program. The PM&R Residency program uses both objective and subjective criteria to select applicants. The Program Director and Departmental Chairperson are responsible for selection and appointment of residents to the program. The application process meets all requirements of the Equal Employment Opportunity and the Americans with Disability Acts and does not discriminate with regard to sex, race, age, religion, color, national origin, disability or veteran’s status. The criteria and processes for resident selection follow: Application Process 1. Applicants should visit our web-site at www.uams.edu/pmr - click the Application for Residency link. 2. The program only accepts applications via Electronic Residency Application Service (ERAS) from applicants who are participating in the PM&R matching program (e.g., National Resident Matching Program (NRMP)). 3. Only applications submitted through ERAS, which submits application materials from applicants and medical schools to the program director using the Internet, will be considered. PGY-2 Process 1. Applicants should visit our web-site at www.uams.edu/pmr - click the Application for Residency link. 2. The program only accepts applications via Electronic Residency Application Service (ERAS) from applicants who are participating in the PM&R matching program (e.g., National Resident Matching Program (NRMP)). 3. Resident Selection and Evaluation Committee reviews all information and decides which applicant(s) are qualified for the position. 4. Committee determines priority order for offers. Eligibility All applicants must meet the following eligibility requirements: 1. Ability to carry out the duties as required of the PM&R program. 2. Proficient in the English language to include reading printed and cursive English, writing (printing or typing) English text, understanding spoken English on conversational and medical topics, speaking English on conversational and medical topics as determined by the program director and/or selection committee. 3. Meet one of the following qualifications: a. Graduate of a medical school in the United States or Canada accredited by the Liaison Committee on Medical Education (LCME). b. Graduate of a college of osteopathic medicine in the United States or Canada accredited by the American Osteopathic Association (AOA).

c. Graduate of medical school outside the United States who has completed a Fifth Pathway program provided by an LCME-accredited medical school. d. Graduate who holds a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction e. Graduate of a medical school outside the United States or Canada with the following qualifications: A currently valid certificate from the Education Committee for Foreign Medical Graduates (ECFMG), or A full and unrestricted license to practice medicine in a U.S. licensing jurisdiction 4. The ability to reside continuously in the U.S. for the length of training. Selection 1. Applications are downloaded from ERAS and reviewed for eligibility and completion by the program coordinator. The following information must be received before the application will be considered and before an applicant is invited for an interview: medical school transcript, personal statement, curriculum vitae, citizenship status, and three letters of recommendation. 2. Once an applicant has been found to meet minimal selection criteria, the program coordinator distributes applicant information to selection committee members for review. 3. The selection committee selects applicants to interview. 3. An applicant invited for an interview should review and be familiar with the terms, conditions and benefits of appointment (and employment) including financial support, vacation, professional leave, parental leave, sick leave, professional liability insurance, hospital and health insurance, disability insurance, and other insurance benefits for the resident and their family, and conditions under which living quarters, meals and laundry or the equivalents are provided. This information will be provided to all interviewed candidates on the date of interview. Applicants can also access much of this information through the UAMS Resident Handbook at www.uams.edu/gme/toc.htm. 4. The interview consists of at least a half day with a minimum of two one-on-one interviews with faculty members, tours of UAMS and/or other facilities where residents will rotate, and at least two resident representatives meet with the applicant during dinner or lunch or during tours of the facilities. 5. Residents and faculty who interact with the applicant are encouraged to complete a written evaluation form to assess communication skills, clinical performance (if applicable), and personal qualities. 6. Criteria for selection include: Confirmation of eligibility requirements Performance on standardized medical tests Overall academic performance in medical school (or in former/current residency for PGY-2 and above) Recent clinical training or experience Demonstrated ability to choose goals and complete the tasks necessary to achieve those goals Maturity and emotional stability Honesty, integrity and reliability Lack of history of drug or alcohol abuse Demonstrated interest and motivation to pursue a career in the specialty of PM&R Prior research and publication experience Verbal and written communication skills To determine whether and to what degree applicants meet the above selection criteria, several sources of information are reviewed and considered including:

A. Letters of recommendation from faculty or former/current Program Director for PGY-2 and above B. Dean’s letter C. Medical school transcript D. Personal statement E. Communications with the residency program coordinator, program director, and faculty interviews F. The ability to reside continuously in the US for the length of the training 7. Following the interview, the Program Selection Committee (Program Director, Program Coordinator, at least 2 members of the Faculty, and Chief Resident(s)) reviews the applicant’s file and written interview evaluations and ranks the applicant based on the criteria above. 8. Following completion of discussion by the Program Selection Committee, the Program Director compiles a final rank list in priority order for submission to the NRMP. Upon verification by the Program Director that the applicant has met eligibility requirements, completed the application process, and been selected according to established criteria, the applicant will begin the process of appointment and registration with the College of Medicine. An applicant is considered fully appointed and registered only after all of the following documents have been completed and returned to the Director of Housestaff Records. Once the Director of Housestaff Records has received all the documents, the applicant is registered in the payroll system to receive a stipend and may begin the residency program. 1. Documentation of a negative drug test 2. Verification of successful graduation if previously anticipated (e.g., final transcript, letter from registrar, copy of diploma, currently valid ECFMG certificate, if applicable) 3. All of the following with valid signature: a. Resident Agreement of Appointment (contract) b. Medical Records Agreement c. Attestation acknowledging receipt of GME Committee policies and procedures d. Confidential Practitioner Health Questionnaire e. Employee Drug Free Awareness Statement f. Housestaff Medical Screening Form g. Post Doctoral Medical Education Biographical Form Accepted/Appointed residents should report to UAMS by the start of the new resident orientation. Residents that cannot report to start their residency by July 1 of the academic year will forfeit their appointment.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Resident Evaluations Number: P.2 Date Developed: 6/15/99 Last Review/Revision: 6/16/2009 Quarterly: At the end of each rotation, the supervising faculty member must complete an evaluation and review it with the resident before submitting it to the Residency Program Director. Each resident should be evaluated halfway (mid-rotation) through the rotation so that strengths and weaknesses can be pointed out and the resident given an opportunity to improve before the official evaluation at the completion of the rotation. Criticisms should be made in a constructive manner whenever possible so the resident will know exactly what needs to be done to meet acceptable standards. The resident should request the mid-rotation review if not initiated by the attending physician. Constructive criticism is difficult for most people to do and there is a tendency to avoid it whenever possible. A copy of the evaluation is located in the Appendix. Semi-Annual: Each resident will meet with the residency program director twice a year (generally during January and July of each year of training) to discuss the resident's progress, identify any problems and set goals/plans for the resident's training program. This meeting will also be an opportunity to discuss any problem areas within the Department's educational programs. Annual: The American Board of PM&R requires that an annual evaluation form be completed on each resident in the program. The information provided will be a summary of the quarterly reports submitted at the end of each rotation by the supervising faculty member.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Faculty Evaluations by Residents Number: P.2a Date Developed: 7/1/99 Last Review/Revision: 6/18/2009 Evaluations of faculty by residents are carried out twice a year and are coordinated by the Program Coordinator using confidential evaluations in New Innovations. Faculty are rated in a number of areas (copy of the evaluation is located in the Appendix). In addition to the specific ratings there is also the opportunity for comments. Compilations of these individual evaluations are forwarded to the Chairman of the department who in turns discusses results with the individual faculty members at the annual appreciative inquiry meeting. Strict confidentiality is maintained throughout and all resident responses are made anonymously.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Resident Leave Number: P.3 Date Developed: 6/27/00 Last Review/Revision: 6/18/09 Vacation 1. Residents receive 21 days (15 work days plus weekend days) of paid vacation during each year of training. 2. Vacation cannot be "carried over" from one year to the next. 3. Residents may take no more than 1 week (7 days) of vacation during each rotation. 4. Vacation will be requested in writing by June 1 prior to the beginning of the upcoming academic year or at least 30 days in advance of the vacation request. The form to request leave is included in this policy. 5. No more than ONE resident may be absent at any time. (The Program Director will consider exceptions for seniors attending a Board review course, AAPM&R Annual Meeting, AAP Annual Meeting, or other extenuating circumstances.) 6. Residents graduating from the program may request vacation during the last week of June. These requests will be considered IF the resident has obtained approval IN ADVANCE from their attending faculty. 7. Vacation days taken the day before or day after a weekend/holiday will require that the weekend days also be charged to vacation, when the resident is not available for urgent/emergent call requests from the PM&R Chief(s) on those days. For example, if a resident will be out of town on a weekend and is using vacation the day before or day after the weekend – the entire weekend will be charged against vacation. 8. No vacation will be granted during the week of Christmas or New Year’s Day. In general, when conflicts occur vacation requests will be given priority based on seniority, then the date received. The final decision or exceptions to the above statements will be made by the Department Chairman/Program Director. Holidays Resident physicians are not given holidays or compensatory time off for holidays worked. However, if a holiday occurs during a rotation, it will be at the discretion of the attending physician as to whether the resident will or will not report for duty on this day. Leave Without Pay The American Board of PM&R Booklet of Information states "a resident should not be absent from the residency training for more than six weeks yearly”. This includes sick leave, vacation, maternity leave, military leave, leave for locum tenens, clinical trips, or work in another

institution that is not an ACGME accredited residency." Regardless of institutional policies regarding absences, any leave time beyond six weeks would need to be made up by arrangement with the Program Director. Under exceptional circumstances, leave without pay can be granted at the discretion of the Department Chairman. However, in order to be Board eligible at the end of training, it will be necessary to make up any absence exceeding six weeks per year. This is not easy to do because of funding restrictions, therefore this practice is to be discouraged unless absolutely necessary. Sick Leave 1. Residents are provided up to 12 days of sick leave (including weekend days) for medical reasons during each year of training. Appropriate uses of sick leave are: doctor or dentist appointments, time off for medical reasons. 2. Sick leave cannot be "carried over" from one year to the next. 3. Sick leave in excess of 12 days requires special review by the Department Chairman/ Program Director. 4. Sick leave requested for medical appointments MUST be requested in advance using the Leave Request Form. Unless sick leave is requested for urgent or emergency purposes ADVANCE NOTICE is required, if approval is not obtained in advance, vacation will be charged. 5. If sick leave is requested for medical reasons that do not allow advance notice the Resident must: a. Contact the Chief Resident by phone or pager– Chief Resident will assign coverage, if necessary, b. Contact the assigned PM&R attending faculty member by phone or pager (i.e., ACH, BHRI, UAMS, VA), c. Notify the Residency Program Director (via phone or email), and; d. Notify the Residency Coordinator (via phone or email). e. Complete the Leave Request Form upon return to work. Educational Leave – addressed in Educational & Administrative Leave, Number: P4

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION VACATION REQUEST FOR UPCOMING ACADEMIC YEAR (Please print) Name_________________________________________ I am requesting consideration for 3 weeks of vacation from the following 5 weeks listed in order of preference: 1. Week starting Monday___________ and ending Friday_______________ Approved___ 2. Week starting Monday___________ and ending Friday_______________ Approved___ 3. Week starting Monday___________ and ending Friday_______________ Approved___ 4. Week starting Monday___________ and ending Friday_______________ Approved___ 5. Week starting Monday___________ and ending Friday_______________ Approved___ Signature____________________________ Date_________________________ I understand that the Program Director will give consideration based on seniority and residency program coverage obligations.

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION RESIDENT REQUEST FOR LEAVE WITH PAY* (Vacation, Sick Leave, Educational Leave, Administrative Leave and Military Leave) This form MUST be approved 30 days BEFORE taking vacation, educational, administrative, military, or sick leave for medical appointments. If sick leave is taken for medical reasons (other than appointments) submit the form upon returning to work. (Please print) Name____________________________________________ Date______________________ I hereby request ____ day(s) of leave with pay during absence from duty beginning _________, 20__ and ending ____________, 20__. This is to be charged to: _____Vacation _____Sick Leave (if unable to provide advance notice, please turn in form the day you return – fax to 225-0627) _____Educational Leave to attend ________________________________________________ _____Administrative Leave to attend ____________________________________________ _____Military Leave ________________________________________________ FOR OFFICE USE ONLY Revised 6/16/2009 Approved by: (in the following order) Coverage Resident________________________________ Date: ________________ Chief Resident___________________________________ Date: ________________ Attending Faculty________________________________ Date: ________________ Other Resident at same Institution: ___________________ Date: ________________ Program Director_________________________________ Date: ________________ Department Chair_________________________________ Date: ________________ This has been coordinated on the BHRI Call & Coverage schedules. Residency Coordinator____________________________ Date: ________________

Department of Physical Medicine and Rehabilitation Residency Program Policy - Educational & Administrative Leave Number: P.4 Date Developed: 6/28/00 Last Review/Revision: 6/1/07 Educational Leave: 1. Educational Course- Each PM&R resident is allowed one 4-day period of leave to attend an educational course at department expense. This must be taken during the PGY-3 year or PGY-4 year of training. Courses chosen must be approved IN ADVANCE by the Program Director and Department Chairman. The Department will provide up to $1,100.00 of funding to meet tuition costs, hotel/travel expenses, etc, per trip. Appropriate travel authorization forms must be completed and approved prior to the travel. This will be charged as Educational Leave and will not affect vacation. The resident will be expected to provide verification of their attendance and costs upon returning. Any costs in excess of the $1,100.00 will be the responsibility of the resident. All requirements pertaining to leave requests-i.e., scheduling 30 days in advance, arranging coverage, etc., will apply to the educational leave. 2. Chief Resident - Each chief resident will be permitted to attend one additional professional meeting of choice (usually AAPM&R/AAP Annual Meeting), including an additional $1,100 for travel expenses, etc. The above rules and benefits for an Educational Course apply. 3. Paper Presentation - Requests for educational leave for residents to present papers at professional meetings will be reviewed on an individual merit basis. The resident will be required to submit a paper for publication in order to receive additional educational leave and up to $1,100.00 of funding. Department funding for such leave would be based on both merit and the availability of funding. If approved, the above rules and benefits for an Educational Course apply. NO Educational Leave will be permitted for: Professional Meetings which a resident chooses to attend other than the above. These are to be charged to vacation and will be at the resident's own expense. Administrative Leave: Board Review Course Attendance – Each year, the Department Chairman, with faculty input may elect to allow administrative leave for PGY-4 residents to attend a board review course. Funding for this travel will not be provided. Requests for administrative leave for residents to attend a board review course will be reviewed on an individual merit basis. If approved, this period of leave will be charged to Administrative Leave and will not affect vacation time. In an effort to facilitate good performance on the ABPM&R Oral Boards, the Department Chairman, with faculty input may elect to provide funding, based on availability, of up to $1,000 for residents who have graduated from the PM&R Residency Program to attend a board review course prior to taking the Oral Boards for the first time.

Professional Meetings/Courses sponsored outside the Department of PM&R – Each year, the Department Chairman, with faculty input may elect to allow administrative leave for PGY-2, PGY-3 or PGY-4 residents to attend professional meetings and/or conferences that are sponsored by funding from outside the Department of PM&R. Requests for administrative leave for residents to attend these professional meetings and/or conferences will be reviewed on an individual merit basis. Funding for this travel will not be provided. Traveling for Interviews – Each year, the Department Chairman, with faculty input may elect to allow up to 3 days of administrative leave for PGY-4 residents who are traveling for interviews for post-residency positions. Requests for administrative leave for senior residents attending an interview will be reviewed on an individual merit basis. Funding for this travel will not be provided.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Procedure for Leave Request Number: P.6 Date Developed: 6/20/00 Last Review/Revision: 6/16/09 Vacation: 1. At or near the beginning of the academic year, residents will be required to submit a leave request form to the Residency Program Coordinator. Use the Vacation Request for Upcoming Academic Year form (found in Policy #P.3). 2. During the academic year leave must be requested 30 days in advance using the Resident Request for Leave with Pay form (found in Policy #P.3). 3. The resident will then obtain approval from the Resident providing the coverage, Chief Resident(s), Attending Faculty, other resident assigned to the same service and Department Chair/Program Director. 4. Upon receiving approvals – the resident will turn in the form to the Coordinator, who will post the leave on the public PM&R Vacation Calendars in Outlook. All of the above steps including return of the form to the residency office must be completed 30 days prior to beginning your leave. Sick Leave 1. Sick leave requested for medical appointments MUST be requested in advance using the Leave Request Form. Unless sick leave is requested for urgent or emergency purposes ADVANCE NOTICE is required, if approval is not obtained in advance, vacation will be charged. 2. If sick leave is requested for medical reasons that do not allow advance notice the Resident must: a. Contact the Chief Resident by phone or pager– Chief Resident will assign coverage, if necessary, b. Contact the assigned PM&R attending faculty member by phone or pager (i.e., ACH, BHRI, UAMS, VA), c. Notify the Residency Program Director (via phone or email), and; d. Notify the Residency Coordinator (via phone or email). e. Complete the Leave Request Form upon return to work. Important! If for any reason the days are not taken, please notify the Residency Program Coordinator immediately, otherwise you will be charged for these days.

Department of Physical Medicine and Rehabilitation Residency Program Policy – Moonlighting Number P.10 Date Developed: 6/28/02 Last Review/Revision: 5/21/09 ***Moonlighting is defined as any professional activity arranged by an individual resident, which is outside the course and scope of the approved residency (includes fellowships) program, whether or not the resident receives additional compensation. For purposes of accreditation, ‘moonlighting’ covered by this policy is ‘external moonlighting’, which is outside the University of Arkansas for Medical Sciences (UAMS) system. (UAMS system includes the participating teaching hospitals.) In order to be eligible for moonlighting activities, the resident must follow the procedure as outlined in the UAMS College of Medicine GME Committee policy, Moonlighting and Malpractice Insurance Coverage while Moonlighting. The resident must submit a written request to the training Program Director and obtain his/her written approval. This information is contained in the resident’s file. Professional liability coverage (malpractice insurance) provided through UAMS does not cover moonlighting activities. Malpractice insurance for such activities is the sole responsibility of the resident. It is the responsibility of the clinical faculty hiring the resident to determine whether the appropriate credentials, adequate liability coverage and appropriate skill levels are in place. The Department of Physical Medicine and Rehabilitation permits Moonlighting only if it does not interfere with training activities in any way. A resident’s total clinical time commitment may not exceed 80 hours a week-this includes residency activities, night-call requirements and moonlighting. As an example; if a resident is spending 50 hours carrying out his/her routine residency duties during a given week and is also scheduled for one night call at BHRI (15 hours of duty) only 15 hours of moonlighting is permissible that week. If a weekend call day (24 hours of duty) were scheduled, rather than an evening call, only 6 hours of moonlighting would be allowed. In all cases, official residency duties must take priority. Residents are required to submit an annual request indicating any plans for Moonlighting. If there are significant changes in frequency or intensity of Moonlighting during the year, a revised form is to be submitted at the beginning of each clinical rotation. Resident must discuss any planned moonlighting with their attending physician to be sure that they will not interfere with any residency rotation activities. *Note - Residents are not required to moonlight. Moonlighting privileges will be withdrawn if the resident is no longer performing satisfactorily in the program. In the event permission to moonlight is withdrawn by the program director, the obligation to notify an outside employer is the responsibility of the resident who established that employment and not the responsibility of the program director or UAMS. Residents will be subject to dismissal from the program for the following: 1. moonlighting without approval of the program director. 2. continuing to moonlight after permission to do so is withdrawn. 3. Using the University Hospital’s or Arkansas Children’s Hospital DEA number while moonlighting.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Duty Hours and Work Environment Number P.11 Date Developed: 3/28/00 Last Review/Revision: 2/5/05 In compliance with the UAMS COM GME Committee policies on duty hours/work environment and moonlighting and considering that the care of the patient and educational clinical duties are of the highest priority, the following guidelines apply: Duty Hours 1. Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. 2. Residents are provided one day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24- hour period free from all clinical, educational, and administrative activities. 3. In order to ensure adequate time for rest and personal activities, a 10-hour time period is provided between daily duty periods and after in-house call. On-Call Activities The goal of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. 1. In-house call: a. Occurs no more frequently than every third night, averaged over a four-week period. b. Does not exceed 24 consecutive hours of continuous on-site duty. However, residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity care. c. No new patients, (defined as any patient that the resident has not seen previously), may be accepted after 24 hours of continuous duty. The resident is expected to be on duty during normal working hours, 7:30 A.M.-5:00 P.M., Monday through Friday. Additional duty hours include on-call duties. Night, weekend and holiday call schedules are formulated by the faculty or chief resident and depend on the specific educational rotation. Residents must be available by telephone or pager while on duty, including while on-call. Specific call schedules and responsibilities are delineated in the written goals/objectives of each rotation, which are reviewed with the resident at the beginning of the rotation. Work Environment 1. Meals: food is available for those residents/fellows who provide 12 consecutive hours of in- house call. 2. Call rooms: call rooms are provided for all residents who take in-house call. 3. Ancillary support: adequate ancillary support for patient care is provided. Except in unusual circumstances, providing ancillary support is not the resident responsibility except for specific educational objectives or as necessary for patient care. This is defined as, but not limited to, the following: drawing blood, obtaining EKGs, transporting patients, securing medical records, securing test results, completing forms to order tests and studies, monitoring patients after procedures.

4. Other work environment benefits (department funded benefits include): • book allowance • educational allowance • elective rotation • meal tickets • travel to professional meetings

Department of Physical Medicine and Rehabilitation Residency Program Policy - Night Call Number: P.12 Date Developed: 6/28/00 Last Review/Revision: 2/5/05 PM&R residents are responsible for providing IN-HOUSE emergency coverage for all inpatients at BHRI on nights, weekends, and holidays. (Not just UAMS patients). 1. Scheduling - Coordinating the call schedule will be the responsibility of the chief resident (s). 2. Frequency - Call will be rotated between the residents who are on the Call Roster. The number of residents taking call may vary from year to year. Historically, PGY4 residents have been exempt from taking call. During periods of resident shortages (i.e., when there are or will be fewer than ten residents at the PGY2 to PGY4 levels for greater than a continuous 30-day period, all residents will participate in the call rotation, so that compliance with the ACGME Work Hours Policy will be assured. However, when PGY4 residents are required to take call, the frequency of their call may be less than the frequency for more junior level residents. The exact frequency and schedule will be determined by the chief resident(s) and approved by the program director. 3. Substitution - the resident whose name is on the official schedule is responsible for seeing that arrangements are made for substitute coverage anytime he/she is not able to report for duty due to illness, vacation, or any other reason! All pertinent individuals are to be notified of any changes in the posted schedule! This is the responsibility of the person whose name is on the schedule! Residents who provide substitute call coverage for others, must be familiar with the ACGME Work Hours Policy and must not make any coverage substitution that would violate any requirement of the ACGME Work Hours Policy. Any change that would result in a violation is prohibited. A signed attestation form acknowledging that the coverage substitution will not violate the Work Hours Policy is required prior to making any call substitution. If a resident who is assigned to call coverage cannot find a qualified substitute (an eligible PM&R resident, who, by providing substitute call coverage will not be violating the ACGME Work Hours Policy) the responsibility for the call remains with the resident who was originally scheduled for that date. 4. The resident on call must remain within the confines of Baptist Health Medical Center or BHRI when on call. A call room is provided. 5. Other rotations: a. Transitional Year - All night call will be dependent on the specific rotation and the requirements of that service. b. VA Ward Service - These residents will be on the call roster for one hour (7-8 a.m.) for the entire North Little Rock VA Hospital. This occurs about once every two weeks.

BHRI PHYSICIAN HOUSESTAFF POLICY PURPOSE: To delineate responsibilities and expectations of the Physician Housestaff. The Physician Housestaff of BHRI are present during evenings, nights, weekends and holidays to provide for immediate medical care needs. The Physician Housestaff are not utilized for routine medical needs (e.g. medication renewal, patient passes, routine patient/family response, review of routine lab work, orders for laxatives and/or stool softeners); these types of concerns are addressed to the attending physician or his/her designee. GENERAL STATEMENT: As stipulated in the BHRI, UAMS College of Medicine and UAMS Department of Physical Medicine and Rehabilitation Interinstitutional Agreements, PM&R Physician Housestaff are to provide care to patients and receive concurrent training from UAMS/PM&R faculty attending physician at BHRI. Physician Housestaff are under supervision of the BHRI Nursing House Supervisor as well as the attending BHRI/UAMS faculty physician member as evidenced by the BHRI Housestaff application(s) on file at BHRI. The Housestaff are to provide immediate attention to BHRI patients for life threatening situations, acute subacute medical concerns and Occurrence Reporting of medical needs. DELINEATIONS: 1. PM&R physician Housestaff are present in BHRI Monday through Thursday, 5 P.M. to 7:30 A.M.; Friday, 5 P.M. to Monday, 7:30 A.M. and holidays to respond to immediate medical needs. 2. Physician Housestaff responsibilities include life threatening situations (cardiac arrest, respiratory distress, seizures, acute psychotic events, drug reactions); acute subacute medical concerns (fevers, hypertensive episodes, chest/abdominal pain, bleeding, mental status changes, swollen extremities) and Occurrence Reporting response (patient injuries/ trauma, inappropriate/skipped medications). 3. Physician Housestaff are not responsible for: a. Report of routine lab ordered by attending physician. b. Refill of routine medication. c. Evening or weekend passes. d. Rash of more than eight hours duration. e. Change in attending physician’s management of patient. f. Routine discussions with family regarding patient care. These concerns are to be communicated directly to the attending physician and his/her designated coverage. g. Ordering laxatives and/or stool softeners. 4. The nursing supervisor is utilized for requests for BHRI Physician Housestaff response. Exceptions are life threatening situations and Occurrence Reporting responses. 5. BHRI Physician Housestaff will respond to all cases requested by the nursing house supervisor. Should a Housestaff member disagree with a nursing house supervisor request they will respond and then refer the question of appropriateness to the BHRI Medical Director for resolution. 6. The Director of Nursing will report any adverse event involving the Housestaff, including failure to show for a call assignment, to the Administrator and/or the Medical Director who will, in turn, assess each situation for appropriateness. When warranted, the Administrator or Medical Director will report the situation and any Administrative recommendations to the UAMS PM&R assigned faculty physician, Residency Program Director and Chief Resident.

7. BHRI Physician Housestaff may have visitors in the Call Room while on duty with discretion (e.g. no loud noise to disturb unit) and must at all times be able to respond immediately to a call. BHRI Physician Housestaff who are parents may have their children present in the Call Room, but must have another adult responsible for the children while they are on call.

BHRI Patient Care Policy/Procedure #D-1 Awaiting copy of updated version from Pam Yount, BHRI Administration (4/28/06)

Department of Physical Medicine and Rehabilitation Residency Program Policy - Meals for BHRI On-Call Residents Number: P.13 Date Developed: 6/15/99 Last Review/Revision: 2/5/05 The resident on call at BHRI will be issued a packet of meal tickets on a monthly basis (that will cover the dates resident is scheduled for call-meal ticket value $6.50) to be used towards the purchase of their evening meal at the BMC cafeteria. In addition, the resident taking call on Saturday, Sunday, or any designated holiday requiring 24 hour coverage will receive an additional $6.50 meal ticket to be used for lunch at the BMC cafeteria. The procedure for using the meal tickets is as follows: 1. Wear UAMS Housestaff ID badge. 2. Select your food items and take to the cashier. 3. Notify the cashier that you are the resident on call at BHRI and present the meal ticket. You are responsible for any amount over the $6.50, and if you are wearing your UAMS Housestaff ID badge you will receive a 20% discount on the difference. 4. The cashier will keep an itemized list of charges and send to BHRI Administration on a monthly basis for payment processing. The same procedure will follow for obtaining lunch on the weekend and designated holidays requiring 24 hour coverage. If you choose to eat breakfast, you are responsible for the cost, and be sure to wear your ID badge to get a 20% discount. Cafeteria Hours Breakfast 7:00 a.m. - 10:30 a.m. Lunch 11:00 a.m. - 2:00 p.m. Dinner 4:45 p.m. - 8:00 p.m. Midnight breakfast 10:30 p.m. - 12:00 midnight In addition, cold cuts and sandwiches are available from: 2:00 p.m. - 4:00 p.m. 8:00 p.m. - 10:30 p.m.

Department of Physical Medicine and Rehabilitation Residency Program Policy - CAVH AM/PM Call Coverage Number: P.14 Date Developed: 6/15/99 Last Review/Revision: 2/5/05 The Chief Resident will be responsible for assigning all NLR residents on a rotation basis to call responsibilities as issued by the Medicine Office (257-2674). Procedure as follows: 1. The call schedule would be given to the senior ward resident by the NLRVA RMS Office Secretary during the week prior to the month requiring coverage. This should allow time to coordinate coverage around other call responsibilities (i.e., residents on call at BHRI should not be given VA call the following morning). 2. The senior ward resident then replaces the staff name with the responsible resident’s name for each call assignment. Copies are then made and distributed to RMS staff and residents as usual. 3. Changes may be made but the assigned resident will be held responsible for assuring that coverage is provided. 4. Missing call will be considered “medical negligence” and will result in a memo to that effect being placed in your file, as well as being considered in your evaluation.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Resident Beepers Number P.15 Date Developed: 6/28/00 Last Review/Revision: 6/16/2009 Beepers are issued to each Resident by the Residency Program Coordinator. For any problems or questions regarding beepers, contact the Residency Program Coordinator at 526-7732.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Photocopying for Residents and Medical Students Number: P.16 Date Developed: 6/15/99 Last Review/Revision: 6/16/09 The Department would like to be as generous as possible in assisting residents with the cost of photocopying, but everyone must realize that this is very expensive to provide and must be used sparingly or the privileges might be revoked. Please remember - the photocopying privilege is for residency training activities only and is not to be used for personal copying. The policy will vary depending on the specific institution as follows: ACH Check with the Pediatric Rehabilitation Medicine Secretary (320-4374). Department copier can be used. BHRI Use the copy machine in the BMC Medical Library. Wear your UAMS Housestaff ID badge and identify yourself as a PM&R Resident to the librarian when checking out the key. There will be no charge to the resident, but a monthly fee for this service is paid by BHRI. This service is restricted to work related copying. Personal copying should be paid for. Medical students at BHRI should have the resident on their service check out the key to the copier. LRVA See PM&R secretary and follow department procedure. NLRVA The PM&R Residents are permitted to use the copy machine in the PM&R office for duplicating small quantities (3 or less copies) or any document less than 10 pages. UAMS The copier in the PM&R Office can be used for educational purposes. Appropriate Copying: Handouts for seminars, grand rounds, journal club, etc. Inappropriate Copying: Personal items and Books

Department of Physical Medicine and Rehabilitation Residency Program Policy - Book Funding Number: P.17 Date Developed: 6/15/00 Last Review/Revision: 2/5/05 For clarification purposes, the following is the policy for book funding for residents in the UAMS Department of PM&R: All residents will be given a stipend of $500.00 for the purchase of books exclusively from the UAMS bookstore. A credit of $500.00 will be issued to each PGY-2 resident by the Residency Program Coordinator during the first month of their PGY-2 year (usually July). No stipends will be issued to PGY-3 and PGY-4 year residents. The UAMS bookstore will keep a record of residents that have purchased books and the remaining balance. The bookstore will set up an account (not exceeding $500.00) for each resident and will keep a record of books purchased and remaining balances for residents. All funds must be spent prior to completing the residency. A resident may spend $500 and request reimbursement one time only or may request that specific books be ordered via purchase order for a total of $500, one time only.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Regarding Travel Number: P.18 Date Developed: 6/9/98 Last Review/Revision: 2/5/05 Residents are allowed one education trip. This trip must be taken in the PGY-3 or PGY-4 year. If the trip is not taken in the PGY-3 or PGY-4 year, the educational allowance will be forfeited. Chief Residents are allowed an additional educational trip (American Academy of PM&R) during their PGY-4 year only. 1. Residents must first obtain a Request for Authorization of Travel Expenses (TA) form from the Residency Program Coordinator. 2. Residents should begin the travel request process at least two months prior to the travel to ensure approval and to complete the required procedures. 3. Residents must complete the TA form and return it to the Residency Program Coordinator. 4. There must be three signatures on the TA form. The Residency Program Coordinator must sign first and then forward the TA form to the Chairman. After the Chairman approves and signs, the TA form will be given to the Business Administrator for signature and processing. 5. Residents should not incur travel expenses until they receive the completed TA form with all three signatures and an assigned travel number. This process may take several weeks. 6. Residents are limited to $1,100.00 per trip. (This also includes the Chief Resident.) 7. The Business Administrator will forward the completed TA form to the resident. 8. The Residency Program Coordinator will provide a copy of the completed TA form to the resident. 9. After traveling, residents should complete a Travel Expense Reimbursement Request from the Residency Program Coordinator. (To guarantee reimbursement, this form should be submitted to the Residency Program Coordinator within 30 days of completing the trip to guarantee results.). 10. Upon completion of the Travel Expense Reimbursement Request with receipts attached, resident should give to the Residency Program Coordinator for processing. Residents must provide explanations for any changes which may have occurred between the Travel Advance Request and Travel Expense Reimbursement form, i.e., sharing hotel rooms, etc. Note: Please refer to the UAMS Administrative Guide to obtain detailed travel policy and procedures. Specifically refer to sections 8.4.01 Employee Travel Regulations; 8.4.03 Travel Advance Requests; 8.4.04 Authority to Travel; 8.4.05 Travel Expense Reimbursement.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Chief Residents Number: P.19 Date Developed: 6/28/1999 Last Review/Revision: 3/11/2010 (DRAFT) Appointment and Term of Service: At the discretion of the PM&R faculty, one resident will be selected to serve as Chief Resident for a period of six months. A resident may serve for more than one term. However, it is desirable to appoint two residents per year, as appropriate. Terms of service will be from April through September and October through March each year. The Department Chair and Residency Program Director will request recommendations of candidates for Chief Resident from the PM&R faculty, the Residency Coordinator, the immediate past Chief Resident(s), and the current residents. The Department Chair will make the official appointment(s) after discussions with the leading candidate(s) and the Program Director. Qualifications: The ideal individual selected for Chief Resident should have demonstrated exceptional maturity and responsibility; must possess excellent leadership and communication skills, at least above average academic performance, and a history of exemplary professionalism. Not all residents will have an opportunity to serve as Chief Resident. It is considered a special honor to be selected and is based on performance and leadership skills demonstrated during the first three years of residency training. Professional recognition of selection and service as Chief Resident is appropriate to be included in one’s curriculum vitae. Performance Expectations: The Chief Resident serves as a liaison between the PM&R residents and faculty. Additionally, the Chief Resident is expected to serve as an effective representative and leader of the PM&R residents. The Chief Resident duties will be performed in addition to regular resident clinical assignments. As an added performance incentive, a small salary bonus will be given as extra compensation. An evaluation of the Chief Resident will be conducted by the Program Director during the term of service, based on these expectations. This evaluation will become part of the resident’s training file. Unsatisfactory performance could result in termination of this appointment prior to its scheduled completion. Delegation of Authority: The Residency Program Director is the immediate supervisor of the Chief resident and delegates certain responsibilities and authority to the Chief Resident, such as making resident call and coverage assignments, and conducting resident meetings.

Responsibilities of Chief Resident: Responsibility Frequency Required Tasks Expectation 1. Arrange Invitational Monthly Plan, contact speakers, arrange & 100% (6 lectures per Lecture Series host lectures term) 2. Coordinate resident Twice Distribute, collect, & turn in 100% (1 evaluation per evaluations of faculty yearly evaluations from all residents term; December & June) 3. Coordinate Board Monthly Distribute questions, remind 100% (6 meetings per Review sessions residents term) 4. BHRI Chart Review Monthly Attend/participate (as requested) 100% attendance Meetings (6 meetings per term) 5. Curriculum Quarterly Attend/participate 100% attendance Committee meetings (2 meetings per term) 6. Faculty Meeting Monthly Attend/participate 100% (6 meetings per term) 7. Department Exec. Quarterly Attend/participate 100% attendance Committee Meeting (2 meetings per term) 8. Research Committee Quarterly Attend/participate 100% attendance Meeting (2 meetings per term) 9. Resident Meetings Quarterly Survey residents in advance to 100% (2 meetings per with Program Director assess problems; make an agenda; term) & Chair distribute follow-up information 10. Coordinate the Quarterly Make & distribute schedules; 100% on-time Resident Call & Post- contact resident or serve as back- completion Call Schedule for BHRI up if a call is missed & VA 11. Serve as an effective As needed Maintain communication lines At least 4 on 1-5 scale of liaison between effectiveness residents and faculty 12. Coordinate the 2 to 4 times Survey resident needs; suggest 100% (1-2 lectures per Visiting Professor a year topics; contact speakers; serve on term) Lectures planning committee; make arrangements as assigned 13. Coordinate the Annually Assist the Program Coordinator 100% completion Annual Resident Picnic with planning 14. Resident Annually Present information at PGY-1 and 100% (conduct 2 Orientation PGY-2 orientations orientations in July 15. Selection Quarterly Attend and participate 100% attendance Committee Meeting (2 meetings per term) 16. Coordinate Resident Annually Assist the Program Director and 100% completion Retreat Coordinator in planning 17. Coordinate the Annually Make all arrangements in 100% completion Winter Holiday Party coordination with Program (and other social events) Coordinator 18. Lecture and Weekly Distribute, collect & turn in 100% (at least 8 event Conference Evaluation evaluations from attendees at all evaluations per month; at Lectures, Grand Rounds, Journal least 46 events per term) Club and Seminars 19. Other Variable As assigned 100% Responsibilities

Department of Physical Medicine and Rehabilitation Residency Program Policy - Guidelines for Resident to Resident Supervision in PM&R Number: P.20 Date Developed: 6/25/00 Last Review/Revision: 2/5/05 An intentional feature of the PM&R training program is a provision of opportunities for residents to gain experience in supervisory roles. Generally, senior residents are more advanced in clinical experience and in physiatric knowledge. Accordingly, more junior residents should take advantage of this knowledge resource by seeking the advice of senior residents, as a supplement to the advice of attending faculty. This is especially true for routine operational matters on most clinical rotations. The following describes the supervisory opportunities within the program: • Chief Residents to Other Residents Chief Residents are usually senior level residents selected for their advanced clinical skills and leadership potential. Chief residents provide general supervision (as a supplement to the Program Director and other faculty) to other residents in many administrative and clinical activities (scheduling, managing communications, general direction, leadership by example, etc). • Senior Resident to Junior Resident Two clinical rotations are designed as supervisory opportunities for senior residents. 1) The VA Inpatient Ward Rotation may have assignments for a senior resident and junior resident. When this occurs, the senior resident is assigned fewer patients and admissions. This smaller patient load is to ensure that the senior resident will have time available to function as a clinical supervisor for the junior resident. This supervisory role includes assisting the faculty attending with clinical teaching of the junior resident, managing the census and patient flow on the ward, and assisting the junior resident with the management of clinical problems on a daily basis. 2) The VA outpatient rotation may also have both a junior and senior resident assigned. The senior resident similarly takes on a supervisory role, assisting the attending faculty with clinical teaching and assisting the junior resident in managing clinical problems. • Other Rotations At times on other rotations may have more than one resident assigned to the same clinical institution (BHRI Inpatient Ward, ACH). When this occurs, a senior resident may end up paired with more junior residents. The senior resident is encouraged by faculty attendings to adopt a supervisory role providing supplementary teaching and clinical back-up assistance.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Criteria and Processes for Academic Actions of Reappointment, Evaluation, Promotion, and Other Disciplinary Actions Number P.21 Date Developed: 7/1/99 Last Review/Revision: 5/27/09 In compliance with the UAMS COM GME Committee policy on Evaluation and Promotion, the following guidelines apply: Reappointment Educational appointments to the PM&R residency program are for a term not exceeding one year. The resident agreement of appointment, which outlines the general responsibilities for the College of Medicine and for the resident, is signed at the beginning of each term of appointment. Renewal of the resident agreement of appointment for an additional term of education is the decision of the Program Director and the Department Chair. Promotion to the next level of training is dependent upon the resident performing at an acceptable level and meeting the requirements for clinical competence for that PGY year. It is the intent of the PM&R program to develop physicians clinically competent in the field of PM&R. Physicians completing the program will be eligible for certification by the American Board of PM&R with an ultimate goal of a 100% pass rate on both the oral and written parts of this examination. Clinical competence requires: 1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. 3. Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care. 4. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals. 5. Professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. 6. Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Evaluation and Promotion During the residency/fellowship period, the above elements of clinical competence will be assessed in writing (at least quarterly), by direct faculty supervisors with subsequent review by the Program Director. Evaluations by peer resident physicians, patients, nursing staff and other paramedical personnel may be included at less frequent intervals. A resident will meet with the Program Director (and other designee such as the assigned faculty mentor), at least twice a year to review results of evaluations, SAE examinations, clinical exercises, scholarly

project, procedure logs, EMG logs, 360 evaluations and OSCE examination. A summary of the evaluations will be reviewed and signed by the resident. The evaluations will be maintained in confidential files and only available to authorized personnel. Upon request, the resident may review his/her evaluation file at any time during the year. Reappointment and promotion to a subsequent year of training require satisfactory ratings on these evaluations and: • satisfactory performance or observation of electrodiagnostic studies at training level- specific targets established by the faculty • passing USMLE Step 3 by the end of the PGY-2 year beginning 7/1/04 • a favorable recommendation by the Resident Evaluation Committee, if the resident has had academic problems and is being monitored by that Committee. A resident receiving one or more unsatisfactory ratings on a quarterly evaluation during the year or scores less than the 30th percentile on the SAE Exam during any year will be reviewed by the Program Director and Resident Evaluation Committee and written recommendations made to him/her may include: 1. specific corrective actions and/or remediation 2. repeating a rotation 3. psychological counseling 4. academic warning status or probation 5. suspension or dismissal, if prior corrective action has been unsuccessful or academic performance and behavior remains unsatisfactory after academic warning and/or probation has been unsuccessful. The Resident Evaluation Committee consists of the Program Director (Chair), at least two faculty representatives, two resident representatives (non-voting), and the Program Coordinator (non-voting). The resident may appeal an unsatisfactory evaluation by submitting a written request to appear before the department’s Resident Evaluation Committee in a meeting called by the Program Director. The Committee reviews a summary of the deficiencies of the resident, and the resident has the opportunity to explain or refute the unsatisfactory evaluation. After review, the decision of this Committee is final. At the completion of the residency program the Program Director prepares a final evaluation of the clinical competence of the resident. This evaluation stipulates the degree to which the resident has mastered each component of clinical competence – patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. In this evaluation the Program Director verifies that the resident “has demonstrated sufficient professional ability in PM&R to practice competently and independently”. This evaluation remains in the program’s files to substantiate future judgments in hospital credentialing, board certification, agency licensing, and in the actions of other bodies. Academic and Other Disciplinary Actions (in accordance with UAMS COM GME Policy on Disciplinary Actions)

Academic Warning Criteria: • First non-compliance with policies and procedures of the Department. • Unsatisfactory attendance, performance of participation in conferences, rounds, clinic or ward rotations. • First occurrence of failure to report to work without appropriate notifications. • Suspicion of substance abuse. • First documented failure to complete medical records in a timely and appropriate manner. Probation/Suspension/Dismissal Criteria: Actions of Probation/Suspension/Dismissal will follow the guidelines in the GME Committee Policy on Academic and Other Disciplinary Actions policy. In addition, specific PM&R program criteria follow: 1. Recurrent failure to attend, participate or perform satisfactorily at conferences, rounds, clinic and ward rotations 2. Receiving more than one unsatisfactory performance or overall unsatisfactory on the resident end-of rotation evaluation. 3. Failure to comply with the policies and procedures of the department, the program, the GME Committee, UAMS Medical Center or the participating institutions 4. Recurrent misconduct that infringes on the principles and guidelines set forth by this training program 5. Documented recurrent failure to complete medical records in a timely and appropriate manner defined as signed verbal orders within 24 hours, discharge summaries dictated within 24 hours of discharge. 6. When reasonably documented professional misconduct or ethical charges are brought against the resident, which bear on his/her fitness to participate in the program. A resident involved in the disciplinary actions of probation, suspension and dismissal has the right to appeal according to the GME Committee policy Adjudication of Resident Grievances.

Department of Physical Medicine and Rehabilitation Residency Program Policy - UAMS/PM&R Library Rules Number: P.22 Date Developed: 7/1/99 Last Review/Revision: 06/16/2009 PM&R Library Housed at Stephens Spine Institute, 7th Floor: 1. Nothing is to be removed from the library unless proper check-out procedures are followed (Make a copy of the front of the book, list your name & date and give to Veronika to record.) If you check something out, you are responsible for returning it. 2. An item may be checked out for two weeks. At the end of this time, it may be renewed for another two weeks and only if no one else has requested the item. NO item may be kept for longer than four weeks without authorization from the Department Chairman via the Medial Staff Liaison. 3. A list will be maintained of all overdue or missing items, and notification will be made to those responsible for their return. 4. Anyone who keeps an item more than one week overdue will not be permitted to check out any additional items until the overdue item is returned. 5. No materials may be transferred to another resident or faculty member. Exceptions to this must be authorized by the Department Chairman through the Medical Staff Liaison. 6. Anyone with a total of four overdue notifications or with repeated unauthorized transfers of materials will be restricted to interoffice viewing only of any library materials. 7. Lost materials must be replaced within one month of notification to replace, or a monetary reimbursement must be made according to the cost of the item.

Department of Physical Medicine and Rehabilitation Residency Program Policy - PM&R Housestaff-Fringe Benefits Number: P.23 Date Developed: 6/15/99 Last Review/Revision: 2/5/05 Vacation – Three weeks per year. This cannot be carried over from one year to the next. The PM&R Department will set specific limitations on when the leave can be taken and how far ahead it must be taken. Sick Leave – Twelve days per year. This cannot be carried over from one year to the next. Holidays – (Official UAMS Holidays are): (Official VA Holidays are): New Years’s Day New Year’s Day Memorial Day Martin Luther King Day Independence Day President’s Day Labor Day Memorial Day President’s Day Independence Day Veteran’s Day Labor Day Thanksgiving Day Columbus Day Christmas Eve Veteran’s Day Christmas Day Thanksgiving Day Martin Luther King Christmas Day Depending on the rotation the resident is assigned to, holidays will not automatically be a day off. The attending physician at each rotation site will make the decision as to whether the resident will or will not work on the holiday. Resident physicians are not given compensatory time off for holidays worked. Contractual Agreement – House Staff appointments are for a period not exceeding one year. A House Staff agreement outlining the general mutual responsibility of the College of Medicine and House Staff member is signed at the beginning of the term of service and is in effect for the full term of service. Renewal of an agreement for an additional term of service is at the discretion of the Chief of Service. Pay Schedules – Residents whose paychecks come from UAMS (all non-VA salaries) are required to have the checks deposited to their bank. Checks are deposited monthly on the last working day of the month. House Staff who are paid by the VA are paid bi-weekly. The checks are sent by mail or direct deposit to the bank. Parking – Dependent on institution. BHRI: Resident may park in the BHRI Visitors Parking Deck. (A BHRI card key may be required). Card keys may be obtained from the UAMS Medical Towers Office at BHRI.

UAMS: All members of the House Staff are granted parking privileges in Level A of the Parking Deck. A UAMS decal and a card key to operate the parking gate can be obtained from the Public Safety Office. A fee of $5.00 will be charged and refunded to you at the end of your residency training. LRVA: Residents are issued an ID badge and this badge allows resident access to the VA staff Parking area. NLRVA: No special arrangements. Park in General Parking area. ACH: Residents park in the Doctors’ Parking Lot. The PM&R secretary will obtain parking Stickers and parking cards for you to use. Name Tag – One name tag and ID Badge will be provided by the House Staff Office at orientation. Uniforms – Five lab coats are provided for each resident. No replacements are provided during training. Laundry – None provided. Insurance A. Hospitalization – Health services and hospitalization is provided to all members of the staff. Coverage for spouses and children may be purchased by the individual Housestaff member. No salary deductions are made for time lost due to illness. However, an excessive amount of time lost in this manner must be made up before the College of Medicine can issue a certificate indicating satisfactory completion of internship or residency requirement. When a Housestaff member cannot assume his responsibilities because of personal illness, he shall inform the Attending Physician on the service to which he is assigned. B. Life Insurance – Is provided to the Housestaff physician and is equal to resident’s salary up to $50,000.00. C. Dental Coverage – Provided to the resident for a monthly fee. D. Professional Liability – Each Housestaff physician is provided professional liability insurance when on official duty. Forms for the insurance are available in the Housestaff

Office. Additional coverage may be obtained from the insurance carrier. It is the responsibility of the Housestaff member to pay the difference in the amount of premium if the additional insurance coverage is purchased. E. Moonlighting by House Officers It is the position of the College of Medicine that excessive or inappropriate moonlighting by residents not be allowed. Accordingly, the following policy is in effect: 1. Housestaff physicians will not be permitted to moonlight in any official clinical programs operated by UAMS without written consent from the Office of the Dean, College of Medicine; Executive Director of Clinical Programs and the Department Chairman. 2. Although moonlighting by Housestaff physicians in clinical programs outside UAMS is discouraged, it is not appropriate for the institution to curtail such activities. Moonlighting by PGY-1 level trainees, in particular, is discouraged. 3. All moonlighting activities must be approved in advance by the responsible Chief of Service to ensure they will not interfere with the individual’s training program and activities at UAMS and that the anticipated moonlighting responsibilities are consistent with the resident’s competence and level of training. 4. Professional Liability Insurance is provided for House Staff only when on official duty. It is the resident’s responsibility to obtain additional insurance coverage for professional liability if he/she engages in moonlighting activities. F. National Guard Duty – UAMS does not have an official policy. The Department of Physical Medicine and Rehabilitation will permit two weeks off as “Leave with Pay”. It will not be charged to vacation time and will not be deducted from required training time. (However, total absence from training for all reasons may not exceed 6 weeks/year). G. Educational Materials – Residents will be provided the following by the Department of Physical Medicine and Rehabilitation: 1. AAPM&R Self Assessment Exam (SAE) - (PGY-1 – PGY-4) 2. Study Guide – (PGY-2 resident) 3. AAPM&R Membership Dues –(PGY-2 – PGY-4). Includes subscription to Archives of PM&R. 4. AAP Membership Dues –(PGY-2 – PGY-4). Includes subscription to the American Journal of Physical Medicine. 5. Educational Course – (PGY-3 only). Includes 4 day period of leave of resident’s choice of PMR related educational course at Department’s expense ($1,100.00 maximum funding). 6. AAEM Self Assessment Exam (PGY-2 – PGY-4) 7. Fringe benefits (PGY- 4

H. Licenses and Certificates – Arkansas does not require residents to have a state license while in training, but it is strongly encouraged for PGY-2 level and above. I. ACLS – A current ACLS certification is required for night call at BHRI. J. Function of Housestaff Office – The House Staff Office provides administrative assistance to the clinical departments, interns, residents and fellows for issues or problems pertaining to Housestaff affairs. Examples of situations in which the Housestaff Office may be involved include the following: 1. Professional liability insurance 2. Health insurance 3. Medical licensure 4. Payroll 5. Ordering of uniforms 6. Letters of recommendation 7. Narcotic exemption forms The Housestaff Office is located in Room M1/1021B on the first floor of University Hospital.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Self-Assessment Examination (SAE) Number P.24 Date Developed 6/9/98 Last Review/Revision: 2/5/05 Each year in January the AAPM&R provides a Self Assessment Examination for residents. All residents in PM&R throughout the U.S. take the exam on the same day. All scoring is done using a code number and no record is kept by the Academy of how any individual performed. The examination is divided into the same 10 categories as the Study Guide, and scores are calculated separately for each individual section. All participants in the examination are compared according to the year in training (i.e., 1st year residents are compared to other 1st year residents) as well as to all participants. The question booklet can be retained by the resident after completion, and can be used as a study tool because the source for the correct answer is given with each question. ALL UAMS PM&R RESIDENTS WILL BE REQUIRED TO TAKE THIS ANNUAL EXAMINATION, AND WILL BE REQUIRED TO GIVE PERMISSION FOR THE RESULTS TO BE SENT TO THE PROGRAM DIRECTOR. OBJECTIVES: 1.To familiarize residents with the type of questions which will be used on Part I of the Board examination. 2.For each resident to see how well he/she compares to residents in the same year of training in other programs. 3.For the Program Director to evaluate strengths and weaknesses of the training program so appropriate modifications can be made. 4.So residents can evaluate their study methods and modify as needed. 5.For residents to see how well they are improving from one year to the next. 6.For the Program Director to recognize early the residents who are not doing well so that appropriate assistance can be given. 7.The results of the examination will be made available to all Faculty as part of the training program evaluation.

Department of Physical Medicine and Rehabilitation Residency Program Policy - Addressing Resident Concerns Number P.25 Date Developed: 2/01/03 Last Review/Revision: 2/5/05 Background In order to establish a forum and procedure by which an individual resident or group of residents can address concerns in a confidential and protected manner. Definitions Chief Resident: the resident or residents appointed by the Program Director to serve as a liaison between all UAMS PM&R residents and the UAMS PM&R faculty. Resident Council: the oversight body of the University of Arkansas for Medical Sciences College of Medicine (COM) Resident Organization. The Resident Council is a standing subcommittee of the Graduate Medical Education Committee and has equal authority with the other subcommittees. The Resident Council is composed of peer-elected residents, appointed chief residents and other residents who represent special groups (e.g. AAMC Organization of Resident Representatives, AMA Resident Section). Policy When a concern exists, residents are encouraged to take advantage of intra-departmental mechanisms to resolve the concern prior to going outside the Department, unless an intra- departmental resolution will compromise confidentiality of the individual(s) raising the concern. Procedure 1. Primary Intra-departmental Contacts: Concerns may be raised with the PM&R Chief Resident(s), the Program Director or Associate Program Director, the resident’s assigned faculty mentor, or the Department Chairperson. A. The primary intra-departmental contact will assist the resident in resolving the concern or for seeking resolution in the appropriate forum. If further discussion is necessary, the concern will be raised by the primary intra-departmental contact without disclosing the confidential source of the concern. B. The procedure for resolution will vary depending on the type of issue. • For issues related to work environment, interaction with other residents, faculty, or staff, the primary intra-departmental contact may discuss this with the Program Director or Department Chairperson while protecting the resident’s anonymity. The Program Director or Department Chairperson may resolve this issue his/herself or discuss the issue further with the entire faculty or an appropriate Department committee. • For issues related to evaluation, the matter will be addressed according to the UAMS PM&R Policy on Resident Evaluation. • For issues related to disciplinary action, the matter will be addressed according to the PM&R Policy on Disciplinary Action including Probation, Suspension and Dismissal. 2. Secondary Extra-departmental Contacts: If the issue is of such a nature that it cannot be discussed at the program/departmental level or the resident desires additional discussion, the resident should notify one of the following:

A. The resident contacts either the Associate Dean for GME or a member of the Resident Council. B. The procedure for resolution will vary depending on the type of issue. • For issues related to general work environment, the Associate Dean for GME or Resident Council may discuss the issue and make recommendations for resolution through the GME. • For issues related to disciplinary action, the matter will be addressed according to the procedure outlined in the GMEC policy on Disciplinary Action including Probation, Suspension and Dismissal. • Should a resident believe that a rule, procedure, or policy has been applied to him or her in an unfair or inequitable manner or that he or she has been the subject of unfair or improper treatment, the resident should refer to the GMEC policy on Adjudication of Resident Complaints and Grievances. Discussions and recommendations by the Resident Council and/or the GMEC will be confidential to the extent authorized by law and handled in a manner to protect the resident.

Department of Physical Medicine and Rehabilitation Residency Program Policy – Supervision Number P.26 Date Developed: 6/16/03 Last Review/Revision: 2/5/05 In compliance with the UAMS COM GME Committee policy on Resident Supervision, the following guidelines are followed for supervision of the care of patients and backup support: 1. Qualified faculty physicians supervise all patient care and their schedules are structured so that adequate supervision is available at all times. 2. Attending faculty physician supervision is provided appropriate to the skill level of the residents on the service/rotations. 3. Specific responsibilities for patient care are included in the written description of each service/rotation; this information is reviewed with the resident at the beginning of the service/rotation. In general, on certain rotations, the more senior level resident oversees the lower level resident and intern. The faculty physician oversees the entire team and is available at all times in person, by telephone or beeper. 4. Rapid, reliable systems for communication with supervisory physicians are available. 1. On-call responsibilities and supervision is documented by the call schedules and is reviewed with the resident at the beginning of each service/rotation or if/when there is a change in the schedule. 6. The following procedure is followed to address fatigue of the resident/fellow: a. The attending faculty is notified of or observes signs of resident fatigue. b. The chief resident is contacted and arranges for the backup person to relieve the resident/fellow. c. The attending faculty determines when the resident should return to the education program. d. The attending faculty notifies the Program Director about these arrangements.

American Board of Physical Medicine & Rehabilitation – Registration of New Residents Registration for Residents is completed annually with the American Board of Physical Medicine & Rehabilitation using the form located at the following link: https://online.abpmr.org/users/director/phyRegister_step1.html

APPENDIX

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Department of Physical Medicine and Rehabilitation Semi-Annual Resident Evaluation of Faculty Faculty name _____________________________________________ Date ________________ Position_______________________________________________________________________ Please rate the following items on the corresponding 10 point scale. The results will be summarized and provided in anonymous form to the staff member for their review. Rate each staff member with whom you had any educational interaction. Choose N/A for any item you feel you cannot adequately assess. 1. Didactic teaching 0 1 2 3 4 5 6 7 8 9 10 N/A Inadequate Adequate Excellent 2. Clinical teaching 0 1 2 3 4 5 6 7 8 9 10 N/A Inadequate Adequate Excellent 3. Intensity of Supervision 0 1 2 3 4 5 6 7 8 9 10 N/A Inappropriately high/low Appropriate Graded 4. Handouts and References 0 1 2 3 4 5 6 7 8 9 10 N/A Not helpful Helpful Very Helpful 5. Research support (omit for clinical positions) 0 1 2 3 4 5 6 7 8 9 10 N/A Inadequate Adequate Excellent 6. Concern for patient care 0 1 2 3 4 5 6 7 8 9 10 N/A Low Priority Adequate High Priority 7. Flexibility with residency demands 0 1 2 3 4 5 6 7 8 9 10 N/A Uncooperative Cooperative Supportive 8. Overall educational experience 0 1 2 3 4 5 6 7 8 9 10 N/A Inadequate Adequate Excellent Please use the back of this form for responsible comments regarding the strengths and weaknesses of your educational experience with this staff member and/or to elaborate on any of the below items. If you wish to assure anonymity, please use a typewriter.

PM&R RESIDENT CHECKOUT FORM Memo to: (Type Name Here) From: Kevin Means, M.D., UAMS PM&R Department Chairman and Residency Program Director Prior to leaving the Program, in addition to the UAMS Housestaff Checkout form, it is necessary for you to obtain signatures from each of the following individuals to indicate that you have completed all of your work, turned in institution property, paid outstanding debts, returned all library books, etc. I. Attending Physician: _____________________________________________________ Printed Name Here All outstanding paperwork and clinical obligations have been completed. ___________________________________________________ _________________ Signature Date II. VA – Gail Stinson _____________________________________________________ III. BHRI – Pam Yount__________________________________________________ (On-Call room key, ID Badge, Parking Card, Medical Records Clearance) IV. PM&R – Jennifer Crow _____________________________________________ (PM&R library books, Resident Office key, Beeper) V. Residency Program Director ______________________________________________ Please return this completed form to the Residency Program Coordinator prior to your departure.

Department of Physical Medicine and Rehabilitation Request to Participate in Moonlighting Activities (Revised 6/16/09) Moonlighting is defined as any professional activity arranged by an individual resident/fellow, which is outside the course and scope of the approved residency/fellowship program, whether or not the resident/ fellow receives additional compensation. For purposes of this request, ‘moonlighting’ is ‘external moonlighting’, which is outside the University of Arkansas for Medical Sciences (UAMS) system. UAMS system includes the participating teaching hospitals. In order to be eligible for moonlighting activities, the resident must follow the procedure as outlined in the UAMS COM GME Committee Policy, Moonlighting and Malpractice Insurance Coverage while Moonlighting. Residents are not required to moonlight. Moonlighting is allowed only with the written permission of the program director upon the resident’s written request to moonlight. This information is contained in the resident’s file. Professional liability coverage (malpractice insurance) provided through UAMS is provided only when on official duty (activities within the residency program) and does not cover moonlighting activities. Malpractice insurance for such activities is the sole responsibility of the resident. It is the responsibility of the clinical facility hiring the resident to determine whether the appropriate credentials, adequate liability coverage and appropriate skill levels are in place. Moonlighting privileges will be withdrawn if the resident is no longer performing satisfactorily in the program. In the event permission to moonlight is withdrawn by the program director, the obligation to notify an outside employer is the responsibility of the resident who established that employment and not the responsibility of the program director or UAMS. Resident will be subject to dismissal from the program for the following:  Moonlighting without written approval of the program director,  Continuing to moonlight after permission to do so is withdrawn,  Using the UAMS or ACH DEA number while moonlighting. As a resident in the Physical Medicine and Rehabilitation training program, I understand and will abide by the above requirements for moonlighting activities. I understand that the performance of these activities will not interfere with my ability to achieve the goals and objectives of my residency program. I request permission to engage in moonlighting activities. List Moonlighting Activities: ____________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Signature of Resident Date ____________________________________________________________________________ Signature Program Director Date

Sample Letter for Resident Elective Rotation Date Name Street City, State, Zip Code Re: Resident Name – Elective Rotation Dear Dr. _________: It is my understanding that you have agreed to supervise the above resident for part of his/her elective time. Since this is an official part of Residency training, the resident will be covered by the UAMS liability insurance for any medical activities performed under your supervision (i.e., it does not cover Moonlighting activities). Our insurance carrier, American Physicians Insurance, has been informed that the resident will be participating in this activity. At the conclusion of the rotation, we will send you a brief evaluation form to be completed. If I do not hear from you to the contrary, I will assume that this plan meets with your approval. We very much appreciate your willingness to participate in the training of our residents. If you have any questions, or if any problems should occur during the rotation, please don't hesitate to call me at (501) 257-6402. Sincerely, Kevin M. Means, M.D. Residency Program Director cc: Resident Residency Program Coordinator KMM:tag

Department of Physical Medicine and Rehabilitation Night Call Substitution and Attestation Form (Revised 6/1/2009) To be completed, signed, and turned in to Mrs. Jennifer Crow, Residency Program Coordinator preferably 10 days in advance of the requested schedule change. Changes made with fewer than 72 hours advance notice must be approved by the Program Director. No changes are approved without this signed form. A separate form is required for EACH call date change. Attestation of residents substituting for call: By signing this form, I agree to provide the above substitute coverage. I attest that I am familiar with the above ACGME Work Hours Policy and my providing the substitute coverage as indicated above will not violate this policy. For Switching a Call Date: Date of proposed substitute coverage: ____________________________________ Resident originally scheduled for call: ______________________ ______________________ Print name Signature Resident who will be on call as a substitute: ____________________ ___________________ Print name Signature Chief Resident Approval: __________________________ _____________________________ Print name Signature Faculty supervising resident taking call as a substitute: _________________________________ Signature Date Faculty of service affected by post-call coverage: ______________________________________ Signature Date PD Signature if switch is made fewer than 72 hours ahead: ____________________________________ Signature Date ACGME Work Hours Policy Essentials: • Residents may not work more than 80 hours per week averaged over four weeks • Residents will have one 24-hour day in 7 free from duty, averaged over four weeks • Residents will have at least 10 hours off for rest and personal activities between duty periods and after call • Residents will not have in-house call more than one night in three • After call, residents will spend no more than 6 additional hours at work to participate in educational activities and to transition the care of their known patients to colleagues • Residents will not take on the care of new patients after 24 hours of continuous duty • Resident time spent in the hospital during at-home call is counted toward the 80 hours Date received by BHRI Medical Director’s office: ____________________________________ Pamela S. Yount, Telephone: 202-7538

UAMS Department of PM&R Residency Program Resident Counseling Form (Revised 9/12/03) This form is initiated when an Academic Warning is issued by the Program Director, or when a resident is placed on Probation status. The faculty member may complete section B of this form or provide the Program Director with the relevant details IN WRITING. A personal meeting with the resident and Program Director is required. Date: ____________________ Faculty Name: ____________________________ Resident Name: _____________________________ PGY level: ____________ A. Behavioral Standards (Performance Expectation) cite policy or manual page if possible: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _______ B. Infraction(s) (include dates) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ________ C. Remediation Plan (Steps to Take to Improve Behavior/Performance) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ________ D. Timeframe

Beginning of Remediation: __________ Ending of Remediation: _________

E. How and by whom will the Resident be Re-Evaluated: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ____ F. Expected Outcomes: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ____ G. Consequences of the Resident’s Failure to Meet Expectations: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ____ Signatures Resident (Print) __________________________________________________ (Sign) __________________________________________________ (The resident signature confirms being informed – not necessarily agreement) Faculty (Print) __________________________________________________ (Sign) __________________________________________________ Resident Evaluation Committee Review Date: ______________________ Outcome Date ___________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ____ Signatures Resident ______________________________________ Date ___________________

Faculty ______________________________________ Date ___________________

PM

by zardari77

Accessibility

Upload Details

Usage Rights

Statistics

PM Document Transcript