PMRU-4004 - Acute Inpatient Rehabilitation at TIRR Memorial Hermann at Memorial Hermann Greater Heights Hospital

PMRU-4004 - Acute Inpatient Rehabilitation at TIRR Memorial Hermann at Memorial Hermann Greater Heights Hospital

Elective Title: Acute Inpatient Rehabilitation at TIRR Memorial Hermann at Memorial Hermann Greater Heights Hospital
Course Number: PMRU-4004
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Register no later than 60 days prior to the start of the course. C-form required, contact Brian Sullivan ( Completion of Neuro and IM Clerkships. Must become credentialed at MHGH one week prior to rotation.
Responsible Faculty Director: Dr. Richard Huang Periods Offered: 1, 3, 8 including holiday period 8 
Coordinator: Brian Sullivan Other Faculty:
Location to Report on First Day:
TIRR Memorial Hermann at MHGH, 1635 North Loop West Freeway, Houston, TX 77008. Office is located on the 4th floor of the North Tower of MHGH., office # 713-867-3394, email Dr. Huang ( or Kathy Brown (

This elective will help students understand the importance of interdisciplinary inpatient care for patients with a variety of diagnoses such as cerebrovascular accidents (CVA) and other acquired brain injuries, spinal cord injuries (SCI), amputations, hip fractures, and debility. Students will learn the importance of recovery and rehabilitation with an interdisciplinary approach from the medical director of this rehabilitation unit.

1) Understand the various levels of post-acute rehabilitative care and identify factors that make patients appropriate for a particular level of care.
2) Explain the pathophysiology of cerebrovascular accidents (CVA), including risk factors.
3) Explain complications that can arise long term from CVA, SCI, and amputations, and how to prevent these complications.
4) Understand the etiologies/diagnosis as well as treatment of neurogenic bowel, neurogenic bladder, spasticity, pain, agitation in patients with brain injuries, and altered levels of consciousness.
5) Describe the goals of post-acute rehabilitation and the role of interdisciplinary care to achieve the most autonomous functioning in a broad range of debilitating conditions, including CVA and other acquired brain injuries, amputations, spinal cord injuries, hip fractures, and debility.
6) Understand complex rehabilitative care delivery, including barriers to care.

Description of course activities
Students must be able to go to the medical staff office at MHGH at least a week in advance of the start of the rotation in order to ensure they are credentialed at the hospital.
Students will spend their time working at Memorial Hermann Greater Heights Hospital with Richard Huang, MD, the medical director of the acute inpatient rehabilitation unit at TIRR Memorial Hermann Greater Heights. Dr. Huang is also an Assistant Professor in the Department of Physical Medicine and Rehabilitation at UTHealth Houston McGovern Medical School. Students will learn from patients in the program, as well as their family and support people, about the impact of disability and the process of recovery. They will work with treatment providers from various disciplines to learn about goal setting and the therapy in that discipline, as well as with social workers and/or case managers to learn about barriers to community re-entry and resources to help overcome them.

Type of students who would benefit from the course
Particularly students interested in pursuing PM&R, Neurology, Neurosurgery, Orthopedic Surgery, and Geriatric Medicine, as well as any student who wants to learn more about inter-professional care.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 10:00 6:00
Tuesday 10:00 6:00
Wednesday 10:00 6:00
Thursday 10:00 6:00
Friday 10:00 6:00

 Average number of patients seen per week: 20-30 with about 15 patient encounters per day
 Call Schedule: No

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Dr. Huang and/or inter-professional clinicians
  B. Frequency / Duration of Presentation(s)?
    One presentation towards the end of the rotation of 20-30 minute duration.
  C. Format - What guidelines are set for the student's presentation?
    Students will discuss orally with Dr. Huang and/or inter-professional clinicians about disability and various forms of therapy.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Students will write notes in the electronic medical record, if access to this is available to the student.
  B. Format - What guidelines are set for the student's written work?
    Dr. Huang will provide feedback on patient notes, if student has access to the electronic medical record.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Students may benefit from career mentorship in exploring options for training in PM&R, including through the American Academy of Physical Medicine and Rehabilitation (AAPM&R) or the Association of Academic Physiatrists (AAP).

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.