Subacute brain injury rehabilitation: an opportunity for medical education and training

Changes in the delivery of health care have resulted in new sites for rehabilitation of patients with severe brain injury (BI). Adjustments in the training of resident physicians in physical medicine and rehabilitation are likely to ensue. We utilized Likert scales and open-ended questions to survey residents who were assigned over a 2(1/2)-year period to a subacute BI rehabilitation unit (SRU). Residents were surveyed about their desire to participate in a SRU training site, and the usefulness of such a rotation, and compared the rotation to traditional settings in which patients with similar diagnoses were treated. The results indicated that significant positive changes in residents' attitudes towards this type of training site occurred (p = 0.01). The rotation was felt to be useful (p = 0.008) despite initial misgivings. Positive educational aspects were exposure to the unique problems of patients with severe BI (e.g. spasticity and agitation) and a sense of independence and competence in leadership roles. Problematic aspects included the management of medically unstable patients without supportive resources, and a lack of nurses trained in rehabilitation principles. Training of residents in the rehabilitation management of patients with severe BI can be perceived as a valuable educational experience by trainees.