September 19, 2017

Spine and Spinal Cord Injury Medicine: A newborn hybrid fellowship program in the field of PRM in Iran

By Reza Salman Roghani1 and Seyed Mansoor Rayegani2

1Associate professor of physical medicine & rehabilitation, Shahid Beheshti university of medical sciences, physical medicine & rehabilitation research center, Tehran, Iran.
2Professor of physical medicine & rehabilitation, Shahid Beheshti university of medical sciences,  physical medicine & rehabilitation research center, Tehran, Iran.

Spinal Cord Injury (SCI) is categorized to non-traumatic and traumatic, with road traffic injuries as its leading cause worldwide.[1] The average global SCI incidence rate is 40 to 80 per one million populations.[1] Considering Iran’s population of 80 million and the global rate, we should be facing 3,200 to 6,400 new SCI per year. However, the road accident rate in Iran is 20 times the world average [2], with more than 300,000 injured or disabled per year.[3] Iran had eight years of war and natural disasters such as earthquakes, leading to a significant rate of veterans and disabled SCI patients, who are now are becoming older and frail with increasing complications.

Now, what is the real picture in this era?

Iran’s SCI rate should be much more than the average global rate, but let assume the average rate of about 5,000 new SCI per year. According to the mission of our specialty and the recent attitude of health policy makers in our country, presenting as the Iranian Rehabilitation Strategic Planning Council (IRSC) within ministry of health (MOH); and the return from one of our faculties from the US and visiting other rehab services in Europe, extension and deepening of rehabilitation facilities was more and more in consideration. From educational point of view, we decided to run the first fellowship training program in our field to be “rehabilitation medicine in spine and spinal cord injury”.

Accordingly, we addressed and established two separate structures. The first was the SCI fellowship curriculum editorial committee, and the other was with IRSC to address rehabilitation centers rules, regulations and guidelines and also to negotiate with insurance policy makers to put all rehab center services under primary insurance coverage in a few model centers for the first phase.

After several meetings and panels, the SCI curriculum editorial committee concluded that some topics of pain and spine intervention could be nested within the SCI medicine curriculum, so that fellowship graduates can practice in both fields to address our most critical issues i.e. SCI and also spinal pain disorders management and to have a comparable income to apply for this fellowship match.

After reviewing relevant SCI, pain and spine fellowship programs and related text books,[4-9] the final draft was presented to MOH education deputy and with minimum revisions it was approved in 2012. (Ref)

By establishing our SCI and also spine center, having official rules and regulation, the SCI fellowship curriculum and recruiting enough faculties, we obtained permission for the first program one year ago. With MOH approval and through official announcement, among eleven participants from related fields in written exam and interviews, the first fellow is now matched with our program. We hope that with the international collaboration, we are on the right track and can train enough SCI experts in one the most demanding areas in the world.

References:

  1. Bickenbach, J. International perspectives on spinal cord injury 2013; Available from: http://apps.who.int/iris/bitstream/10665/94190/1/9789241564663_eng.pdf?ua=1 .
  2. Unicef. Road Traffic Injuries in Iran and their Prevention, A Worrying Picture. Available from: https://www.unicef.org/iran/media_4783.html.
  3. Bahadorimonfared, A., et al., Trends of Fatal Road Traffic Injuries in Iran (2004–2011). PLoS One8(5): e65198., 2013. 8(5).
  4. ABPMR. Spinal Cord Injury Medicine Examination Outline. Available from: https://www.abpmr.org/Subspecialties/SCIM
  5. DeLisa, J.A. and M.C. Hammond, Acceptance of spinal cord medicine as a subspecialty by the Accreditation Council of Graduate Medical Education (ACGME). J Spinal Cord Med, 1996. 19(3): p. 175.
  6. DeLisa, J.A., Subspecialty certification in spinal cord injury medicine: past, present, and future. J Spinal Cord Med, 1999. 22(3): p. 218-25.
  7. Slipman, C.W., et al., Interventional Spine: An Algorithmic Approach (Hardcover – Oct 1 2007)  2007: SUNDERS.
  8. NIDRR, The Spinal Cord Injury Model Systems, 2010, The Model Systems Knowledge Translation Center.
  9. Kirshblum, S., D. Campagnolo, and J.A. DeLisa, Spinal Cord Medicine 2011: Lippincott Williams and Wilkins.