Reaching underserved domestic and international populations through Physical Medicine & Rehabilitation Residency training: A survey of residents and program directors

Introduction In 2015, the World Health Organization (WHO) reported that over 400 million individuals worldwide lack access to medical care. In addition, clinicians are more likely to treat underserved patients during their careers if they have exposure to these populations during their training. Objectives To analyze what forms of didactic experiences are available and which opportunities are the most valuable with domestic/international underserved populations in Physical Medicine & Rehabilitation (PM&R) residency programs in the United States. Design Cross-sectional survey using REDCap software. Setting PM&R residency programs in the United States. Participants A total of 137 participants in Accreditation Council of Graduate Medical Education (ACGME)-accredited PM&R residencies in the United States (24 program directors and 113 residents). Interventions Not applicable. Main Outcome Measures Surveys collected information regarding demographic data, prior global health training experiences, current residency training experiences involving domestic/international underserved populations being offered, participants' perceived importance of training experiences with domestic/international underserved population, barriers that impede these experiences, and if availability of these opportunities affected resident recruitment. Results Participants reported that their PM&R programs did not offer global health simulations (91.2%), educational tracks (75.2%), international electives (71.5%), or rotations with domestic underserved populations (48.9%). Residents viewed exposure to simulation labs (3.25/5), educational tracks (3.42/5), and electives (4.02/5) more importantly than attending physicians. Conversely, attending physicians viewed lectures (3.92/5), journal clubs (3.58), and rotations treating domestic underserved populations (4.42/5) more favorably. Both residents and attending physicians endorse lack of financial support and mentorship as barriers to these opportunities. Participants from all regions outside the Midwest reported that these educational opportunities would affect residency recruitment (56% vs. 31%). Conclusions This is the first study assessing the current state of global health training opportunities for PM&R residents as well as the perceived value of such experiences. Many PM&R medical trainees desire exposure to global health medicine curriculum, and many would alter their residency selection based on its availability.