Poster 408 Use of Virtual Patient Simulation in Pressure Ulcer and Patient Safety Education in Physical Medicine and Rehabilitation: An Evidence and Problem‐Based Learning Experience for Medical Students

Abstract

reflexes throughout. Past medical history was significant for an episode of diplopia and visual loss in her 30s, which was diagnosed as optic neuritis and treated with steroids. An MRI at that time was inconclusive. Considering multiple sclerosis versus lumbar stenosis, an MRI of her low back and brain was ordered. Setting: Tertiary care outpatient clinic. Results or Clinical Course: Lumbar spine imaging revealed mild lumbar spondylosis at L5-S1 and no evidence of stenosis. Neuroimaging revealed classic distribution of demyelinating lesions and high T1 black holes with enhancing lesions characteristic of multiple sclerosis. Full workup including B12, TSH, RPR, HIV, ACE and RF were all negative. Neurology indicated the history may be compatible with relapsing MS dating back for 15 years, which was undiagnosed. Patient was started on steroid therapy and subsequently improved. Conclusions: This is the second case of MS presenting with back pain seen in the literature; most recently there was a similar case last year in Spain. In this case, it is possible that MS may have triggered some kind of pain cascade within the spine or that her findings on MRI (spondylosis) though mild, could have caused low back pain superimposed on MS. We offer this case report as an example of careful history taking and physical examination as they can help explain atypical presentations for well-known diagnoses. Further studies can explore how many patients with MS report low back pain as a presenting symptom.

Simulation‐Based Education for Urgent Medical Complications Common to the Rehabilitation Setting: An Educational Program for Physical Medicine and Rehabilitation Residents

“…This study is consistent with prior research that demonstrates utility of simulation training in PM&R education. Simulation techniques have been applied broadly within PM&R education, with studies showing successful use in the instruction of musculoskeletal ultrasound, needle driving for interventional procedures, pressure ulcer and patient safety education, botulinum toxin injections and peripheral motor blocks, among others . Pilot studies have reported the feasibility of using simulation‐based education for teaching autonomic dysreflexia, a common urgent medical complication that occurs in patients with complete spinal cord injuries at T6 or above, to PGY‐2 PM&R residents .…”

“…Simulation training aims to mimic real‐life experience and is consistently associated with positive effects on knowledge, skills, and patient‐related outcomes . There is good evidence to support the use of simulation‐based methods in PM&R education . However, little evidence exists on the use of simulation technology for the instruction of urgent medical complications to PM&R residents .…”