Novel timely rehabilitation education for medical students

Abstract

The global population of people impacted by conditions such as stroke who can benefit from rehabilitation care is rapidly increasing.¹ Clinicians who understand the principles and practice of rehabilitation will be well-positioned to educate and advocate for patients across the full health care trajectory. Despite this, medical schools do not uniformly require students to learn about the rehabilitation phase of care. In our large urban medical school, students were being taught acute inpatient and outpatient clinical care but were not being taught about rehabilitation or exposed to care in post-acute rehabilitation settings.

In 2023, we developed and embedded a three-part rehabilitation curriculum into our medical school's mandatory month-long neurology clerkship. All enrolled students from January to June 2023 (n = 29) were required to participate. As students learned to provide care for neurology patients, they received just-in-time education about rehabilitation as part of continuous patient care. Each clerkship month, students received an interactive lecture-based introduction to rehabilitation and post-acute rehabilitation care, a full day of on-site clinical learning in a local inpatient rehabilitation facility (IRF) and a faculty-mentored group de-brief.

A neurologist and physiatrist co-taught the introduction to describe principles of rehabilitation and recovery, patient eligibility for post-acute rehabilitation care and opportunities for students to support patients across the acute-to-post-acute transition. On the IRF day, students rounded with a physiatry-led neurorehabilitation team and engaged in interprofessional rehabilitation interventions with the team's patients. A physiatrist facilitated the group de-brief, guiding reflection and answering questions students' experiences had prompted them to consider.

All participating medical students (n = 29; 100% of enrolled clerkship students) engaged in the lecture, IRF day and de-brief. Field data collected from the debrief sessions were analysed using a hybrid deductive-inductive qualitative approach with targeted content analysis to identify themes in student learning and inquiry arising from the curriculum. Six themes were distilled. All students articulated the value of firsthand exposure to a rehabilitation setting (n = 29), with comments including “before this, the word ‘rehab’ was a ‘black box’ to me; I didn't know what it meant or what happened there” and “now I can tell my patients what actually happens during rehabilitation, so they know what to expect.” The additional five themes were new knowledge about the field of physiatry (n = 14); new self-awareness of learning needs related to rehabilitation and patient advocacy (n = 13), new understanding of the patient experience of post-acute rehabilitation (n = 12); recognition of interprofessional collaboration in the rehabilitation setting (n = 10); and new understanding of what rehabilitation therapists do (n = 10).

Our curriculum expands students' purview of health care provision beyond acute care and provides students new knowledge directly applicable to engaging more fully with their patients. We will continue to provide the curriculum within the neurology clerkship. The finding that 45% of participants (13/29) found the curriculum stimulated recognition of previously unrecognised learning needs has prompted us to add questions to our de-brief to characterise these self-identified learning needs. We will use this information to build resources and mentorship into the curriculum to empower students' ongoing learning about rehabilitation.

Dorothy W. Tolchin: Conceptualization; investigation; writing—original draft; methodology; formal analysis; project administration; data curation; supervision; resources; validation; software. Alexandra Hovaguimian: Conceptualization; investigation; writing—original draft; methodology; validation; formal analysis; project administration; data curation; resources; supervision; software.

None.