UTMB Internal Medicine Residency
Physical and Rehabilitation Medicine
Goals, Competencies, Objectives, Methods, and Evaluation
Assessments
Overall Goal
To make physicians into specialists in Internal Medicine by equipping them with
requisite knowledge, skills, character qualities, and habits essential for them to
demonstrate competence in inpatient care, knowledge, practice-based learning and
improvement, systems-based practice, professionalism, and interpersonal and
communication skills relevant to the specialty field of Physical and Rehabilitation
Medicine.
Patient Care
Competence Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems relevant to the specialty field of Physical
and Rehabilitation Medicine.
Learning Objectives - Residents are taught the following patient management skills.
Each resident is given multiple opportunities to demonstrate competence in:
 The ability to use history and physical examination pertinent to Physical and
Rehabilitation Medicine for the assessment of the following: acute and chronic
musculoskeletal syndromes, including sports and occupational injuries; acute and
chronic pain management; congenital or acquired myopathies, peripheral
neuropathies, motor neuron and motor system diseases and other neuromuscular
diseases; hereditary, developmental and acquired central nervous system
disorders, including stroke and multiple sclerosis; traumatic brain injury;
deconditioning related to other diseases. PTRMDPC, LSC/GA
 Familiarity with the interventions in the following management and therapeutic
problems: rehabilitative care of amputations for both congenital and acquired
conditions; sexual dysfunction common to the physically impaired; postfracture
care and rehabilitation of postoperative joint arthroplasty; experience in
evaluation and application of cardiac and pulmonary rehabilitation as related to
physiatric responsibilities; pulmonary, cardiac, oncologic, infectious,
immunosuppressive and other common medical conditions seen in patients with
physical disabilities; diseases, impairments and functional limitations seen in the
geriatric population; rheumatologic disorders treated by the physiatrist; medical
conditioning, reconditioning and fitness; tissue disorders such as burns, ulcers and
wound care. PTRMDPC, LSC/GA
 Familiarity with the ability to diagnose and treat using the following specialty
techniques and devices: diagnostic and therapeutic injection procedures;
electrodiagnostic medicine; prescriptions for orthotics, prosthetics, wheelchairs
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and ambulatory devices; special beds and other assistive devices; exercise
equipment; special devices for the disabled driver; urodynamic laboratory
instruments; simple splinting apparatuses. PTRMDPC, LSC/GA
Familiarity with referral to health workers skilled in using specialized testing and
therapies: physical therapists, occupational therapists, speech/language
pathologists; orthotics and prosthetics; rehabilitation nursing, social service,
speech-language; therapeutic recreation; vocational counseling.
The ability to effectively present the results of a consultation orally and in writing
relevant to a patient referred for a problem related to the specialty field of
Rehabilitation Medicine. PTRMDPC, LSC/GA
The ability to treat patients with a problem that is related to the specialty field of
Rehabilitation Medicine with practices that are safe, scientifically based,
effective, efficient, timely, and cost effective. PTRMDPC, LSC/GA, ITE
Medical Knowledge
Competence Goal
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological and social-behavioral sciences, as well as the application of this
knowledge to inpatient care.
Learning Objectives– Residents are taught to be competent in the knowledge of these
areas. Each resident is given multiple opportunities to demonstrate competence in:
 The knowledge to evaluate patients with an undiagnosed and undifferentiated
presentation related to the specialty of Physical Medicine and Rehabilitation.
PTRMDPC, LSC/ITE
 Familiarity with the knowledge of the diseases and processes referred to above
including the follow: the neuromusculoskeletal, neurobehavioral, cardiovascular,
pulmonary, and other system disorders common to this specialty. PTRMDPC,
LSC/ITE
 Familiarity with the supportive knowledge of Rehabilitation Medicine including
the following: neuromusculoskeletal function; cardiovascular and pulmonary
physiology; kinesiology and biomechanics; orthotics and prosthetics; drugs
utilized in physical medicine and rehabilitation. PTRMDPC, LSC/ITE
Practice-Based Learning and Improvement
Competence Goal
Residents must demonstrate the skills and habits to investigate and evaluate their care of
patients, to appraise and assimilate scientific evidence, and to continuously improve
patient care based on constant self-evaluation and life-long learning.
Learning Objectives – Residents are taught the following skills and habits. Each
resident is given multiple opportunities to demonstrate:
 The skill and habit of locating, appraising, and assimilating evidence from
scientific studies related to their patients’ health problems. PTRMDPC, LSC/GA
 The skill and habit of participating in the education of patients, families, students,
residents and other health professionals. PTRMDPC, LSC/GA
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Systems-Based Practice
Competence Goal
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care, as well as the ability to call effectively on other resources in the
system to provide optimal health care.
Learning Objectives - Residents are taught the following skills. Each resident is given
multiple opportunities to demonstrate competence in:
 The understanding of multidisciplinary teams concerned with maximal restoration
or development of physical, psychological, social, occupational and vocational
functions in persons whose abilities have been limited by disease, trauma,
congenital disorders or pain.GA
 The ability to incorporate considerations of cost awareness and risk-benefit
analysis for inpatient care. GA
 The ability to recognize the types of patients served, referral patterns and services
available in the continuum of rehabilitation care in community rehabilitation
facilities including the following: subacute units and skilled nursing facilities;
sheltered workshops and other vocational facilities; schools for persons with
multiple handicaps, including deafness and blindness; independent living facilities
for individuals with severe physical impairments; day hospitals; and home health
care services; and community based rehabilitation. GA
Professionalism
Competency Goal
Residents must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles.
Learning Objectives – Residents are taught to seek and possess the following character
traits. Each resident is given multiple opportunities to demonstrate:
 Sensitivity and responsiveness to a diverse patient population, including but not
limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation. PTRMDPC, LSC/GA
Interpersonal and Communication Skills
Competency Goal
Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and collaboration with patients, their families, and
health professionals.
Learning Objectives - Residents are taught the following skills. Each resident is given
multiple opportunities to demonstrate competence in:
 Communicating effectively with physicians, other health professionals, and health
related agencies.
Teaching Methods
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PTRMDPC - Practical Teaching and Role Modeling During Direct Patient Care
Methods and Tools for Assessing Interns and Residents
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DO - Direct observation by qualified faculty guided by explicitly stated
performance criteria and standard for proficiency
GA - Global assessment by qualified faculty
ITE - In-Training Exam
LB - Log books for procedures
Duty Hours for Interns and Residents
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The residency program follows the ACGME Duty Hour Requirements.
Duty hours are limited to 80 hours per week, averaged over a four-week period,
inclusive of all in-house call activities.
Residents are provided with 1 day in 7 free from all educational and clinical
responsibilities, averaged over a four-week period, inclusive of call. One day is
defined as one continuous 24-hour period free from all clinical, educational, and
administrative activities.
A 10-hour time period for rest and personal activities should be provided between
all daily duty periods, and after in-house call.
The maximum of 24-hour continuous call, followed by up to 6 hours for transfer
of care and educational activities is strictly implemented.
Responsibilities, Supervision and Lines of Authority for Clinical
Rotations
The UTMB Internal Medicine residents work from 8-5 weekdays on the 5th floor of
Mainland hospital. They are released to attend their weekly half-day continuity clinic at
UTMB. While at Mainland Hospital they function under the full control and authority of
Dr. Wheeler (409 9385106). They individually see his 5-8 inpatients before rounds each
day. Then they round with him from about 10-12. In the afternoon they attend to followup issues arising from rounds and see new inpatient consults, 1-3 per day. He will
specifically discuss evening and weekend call with each new resident on the service.
Most of the rehabilitation problems seen are those related to stroke, hip fracture, trauma,
deconditioning, and chronic neuromuscular disorders. The patients also have chronic
disease management issues such as hypertension, diabetes, and heart failure.
The Accreditation Council for Graduate Medical Education requires that every IM
rotation have written competency-based goals and objectives (like these) and that they are
reviewed before each new rotation. All residents rotating with Dr. Wheeler should
begin promoting the Mainland Hospital Rehabilitation Unit to our IM faculty,
geriatricians, UTMB case managers and discharge planners. Let them know that referrals
can be made through Buddy Fagle (409 7712690), the admissions coordinator, who
routinely visits potential transfers at UTMB when contacted for that purpose.
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2. Responsibilities of Members:
a. Attending:
 Oversees team function and overall patient care
 Teaches house staff and medical students
 Monitors discharge planning and expeditious care of patient
 Accepts ultimate legal responsibility for patient's welfare
 Learns from other team members
 Assures attendance of team members at all required
conferences.
b. Resident:
 Is directly accountable to the attending for the entire service
 Writes a Resident Admit Note (RAN) on each admission.
 Communicates diagnosis and plan of care to the patient's
primary care physician.
 Leads work rounds by evaluating the intern treatment plan
 Plans discharges and coordinates patient follow-up
 Teaches interns and students, and sometimes faculty
 Assures attendance of self and team members to all required
conferences.
Faculty Notification: It is the responsibility of the resident to contact faculty
immediately for the following issues:
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Potentially unstable patients
Transfers to intensive care
Deaths (expected and unexpected)
Changes in patient status
Procedures
Unpleasant social issues
Risk management issues
Patients leaving or declining urgent treatment against
medical advice
Restricted drug/treatment approval
Potential admissions better served on another service or
with short-term outpatient follow-up
Educational Resources
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UTMB Library Homepage
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