Okay, I have 801, so we'll go ahead and get started so that, again, we can have plenty of time for questions at the end, but first and foremost, thank you guys all so much for coming to our, I believe, fourth in our Road to Residency webinar series. So this is kind of the bonus one that we added on at the end, but we thought it was really important to answer some of these questions related to the Triple Board Pediatric Rehab Program, and we often get a lot of these questions, and so hopefully this is a way for everybody to kind of get a little bit more information and pick the brains of the current program directors. So I am going to be sort of leading the discussion, and then I'll let my colleagues introduce themselves as well, but I'm Ashley Bolger, I am the PD in Cincinnati for the Triple Board Pediatric Rehab Program there, and then I'll pass it along, Eileen, you are next on my screen, so I'm just going to go to the right. Sure. Hi, my name is Shay, I'm the Program Director of the Jefferson's Triple Board Program. Hi, everyone, I'm Dr. Amy Kinalikin, and I am the Program Director here at University of Colorado Children's Hospital, Colorado, for the Combined Pediatric PM&R Program, so this kind of Triple Board Program, and I guess I'm also the Program Director for the Peds Rehab Fellowship. So as we talk today, we're going to be focusing on what is Peds Rehab and how do you get there sort of through this combined pathway, but yeah, we look forward to talking with you a little bit more. Yeah, perfect. Okay, so I am going to jump right in, and please feel free to use the chat, I'm going to be monitoring that as well, and I will do my best to kind of multitask and either respond or incorporate those questions into kind of a discussion, but, and then I also guess I should say, Amy, welcome to Amy, I think if you've been at our other webinars, you know her from the AAP, she's recording this, we will also do what we've done for the other webinars and make sure that this gets posted on the website, as well as transcribed and kind of summarized in a more written out that we've done for the other ones as well. So the first thing I was going to pose to our panelists was, because I think what's really important is to start off with what in the world are these Triple Board combined, they go by a million different names, like how do you guys describe what these programs are when you get that question? Amy, do you want to take it? Sure. What, you know, this is I think a unique pathway to become a pediatric physiatrist and what's that? You know, first off, it's a field where we're taking care of children, usually with special needs, brain injury, spinal cord injury, developmental disability, acquired brain injuries, all kinds of reasons why a kid seeds a pediatric physiatrist. And so I think for one thing is like learning more about like, what is peds physiatry, and then the avenues to get there. So what is unique about the Triple Board program is it's a five year program. And currently, these are the institutions represented, and this is as of 2023 to 2024, Colorado, you know, DuPont Jefferson, and then Cincinnati. And then you start with a pediatric internship, and then over the course of five years, complete a certain number of months of PM&R rotation, so a mix of adult PM&R and then some pediatric rehab in there up to 12 months. And so then you also complete essentially like two and a half years of pediatric training too in there. So this at the end of five years, you're ready to sit for pediatrics boards, PM&R boards and pediatric rehab boards. So that's kind of that pathway. And then I'll sort of like contrast it as we talk about peds rehab too, the other pathway is sort of you do an internship in something like surgery, internal medicine, and then you do a PM&R residency for usually three years, followed by two years of a peds rehab fellowship. So I think that those are sort of like the differences as far as those two. And Eileen, I'll let you expand on more. Yeah, yeah, so like Amy said, it really is, the combined program really is a combination of a general pediatrics residency and PM&R residency with that bonus pediatric rehab time. I think one of the things that sets the combined program apart is the amount of time that you get to spend in the intensive care unit setting as a pediatric resident. So you get a lot more of that hands-on pediatric management and that way when you are in attending, if you so choose to make inpatient part of your practice, a lot of us will end up managing events on our own, you know, trick events, managing some of those medical complexities on our own because we have that familiarity from the combined training. That leads into a really good next kind of set of questions is, what's the difference? I mean, we know Amy did a great job of summarizing what the fellowship route is and what the triple board route is, but what's the difference between the two? What are the differences? And I'm not going to say pros and cons, because I don't think there's pros and cons. I'm going to say, what are the differences? Yeah, I think from our standpoint at Jefferson, we only have a combined program. We don't have the fellowship route, unfortunately. So I think from our comparison, the combined residents tend to see a little bit more of that pediatric rehab exposure and training throughout their five years versus, you know, during a fellowship, you're very much focused intern year on honing those medicine skills. And then during the three years of PM&R residency, solidifying your fund of knowledge in physiatry and then being able to really focus and sub-specialize in pediatric rehab. Whereas the combined route, it kind of is kind of intertwined throughout residency. Yeah, and I think other big differences is like five years to be done, one match potentially. And then also I think the other hard part is that like currently and correct me if I'm wrong, but like there's also fewer spots to match into this. So I think the piece that we recognize is that there's multiple tracks to get to pediatric rehab career. And this is one Avenue, but we also know that like this isn't always a match for someone who like, do you want to work in the NICU? Do you want to be in a PEDS ED? Do you want that like pediatrician training, you know, as part of it? So I think some of the journey of talking to med students is trying to find out like if you want to do PEDS rehab, like are you sure you want to be also a pediatrics trained and what that looks like, you know, some more nights and longer hours and sort of like a little bit more of that, like intensive PEDS pediatrics training too. So and then the other sort of differences I think are a little less adult PM&R and then the PEDS rehab learning really being like a longitudinal thread through not just your PEDS rehab rotations 12 months, but I like to emphasize that like the learners in our five-year program are also learning it when they're doing continuity clinic and the complex care clinic when they're learning spasticity at Craig Hospital here at, you know, at Colorado or you know, what I try to do with with learners who are kind of like, you know, going from the VA to the NICU is like, what should you focus on learning wise? So I think it is helpful if someone is like really eager to do this type of track that they kind of know what they're getting into. Yeah, that's why we're here today. Exactly. And I think I'll just echo a few points that you guys made and things that I tend to answer this question with because I get it a lot. You know, in the end, there are probably very few jobs that are different that either one of those pathways can take. With the exception of if you want as a combined person to do some sort of complex care general pediatrics, you would be that would be an option for you. And I know that I've met a few people in recent years that they want that to be a part of their career. That would not be available to you necessarily or really at all. I don't think as a more fellowship trained individual because you're not a pediatrician. So that would probably be the only difference. But at this point, I would say they're pretty equivocal. You can both sit for the boards. Like, I think the differences are kind of what the other two said. And that, you know, you do have a little bit more call a joke. But I'm really serious because I want to make sure people find the right matches. Like, we're not the easiest way to get, I would say. So we are looking for easy. That may not be this may not be the pathway for you. But because I want to be open and honest, you know, when you're in the PICU in your fourth year and all your friends are on completely outpatient years, that can sometimes be a little rough. And so you have to kind of know what you're getting into. So we had a question. And I think this is I answered it a little bit. But in the chat, how do career paths and job opportunities differ between a combined graduate fellowship? Anybody want to add? I mean, I sort of inadvertently. Yeah, and I think it's the same, you know, so graduating being the program director for both and really a champion for both tracks of training. And we even actually in Colorado have a pediatrics resident who's now in our PM and our residency program, too. So that's like a whole nother conversation. But like the whole goal is to prepare all of our learners, like at least in Colorado, for the same jobs. You know, people may have different job interests, you know, but I think some of the the other aspects are maybe if someone was interested in working in a small community and they wanted to be like a general pediatrician and then combine that that like subspecialty care. But I think overall, at least the trend is like jobs and academic pediatric resiatory. And there's such a need that like like no matter your track, like you're prepared, especially to our programs for like any job out there. And I think your strength is also in some of that like really early comfort with inpatient pediatric rehab care, because you've been an intern on the general service. You've been in the NIC, you've been in the PICU, you've been on subspecialty rotation. So I think that compared to like my fellows in training, combined residents come into their peds rehab rotations just like, oh, this is I'm comfortable with this on inpatient. Whether or not they want to do that in the future for their career is up to them. But I think what they're trying to do is probably really expand upon their procedural skills and then even outpatient. So I think I think the strength of a combined resident is a comfort with like inpatient consults. I agree, I think the other thing that the combined program adds is the ability to use those general pediatric skills outside of the scope of peds rehab. We've had a few graduates who've been interested in continuing serving in global medicine, so they've been able to take those general pediatric skills and apply it to that facet of their career as well. Absolutely, absolutely. So I'm going to move on to kind of a next kind of section, and I promise, Sophia, I will get to yours because this goes right into this kind of section of questions that I had prepared. So, you know, I am going under the assumption that many of you are either interested in peds rehab or interested in combined program or some some combination of those two things. But so when you get the question, how competitive is it? Because we just talked about like there's very few spots. So how competitive is it? How do you answer that question? Who's going to pick this one up first? You know, I think I think it's competitive from the standpoint of the applicant trying to find if this is the pathway that the applicant wants to train. I think we get a number of applicants that we don't know how they're applying. Like, are they also applying to pediatrics? Are they applying to child neuro? Are they applying to PM&R? And so even the pool of applications that we'll be going through starting next week, like, is we're trying to find the people who are like really know that this they want to be a pediatric physiatrist. And why do they want to do pediatrics, PM&R, peds rehab, like in this sort of unique track? And so I think there's there's sort of that piece within the applicant pool. And then it's finding the applicants, finding the programs of programs, finding the applicants. And then also it is competitive just depending on the year and how many spots Colorado is recruiting for one this year for combined. Maybe you each can share kind of what your situation is. We're one, we're one this year. Yeah, so we recently increased to two. But yeah, so that's that's four spots in the nation. So it is by nature competitive. But again, as Amy said, really, when you kind of narrow that pool of applicants down to people who understand peds rehab, who truly understand the field and know how they want to take it in their career, I feel like that narrows, narrows down the applicants to a smaller pool. So don't be intimidated. No. And I think it's competitive because like we are as program directors, one piece of like other aspects of our program, too. So this is where University of Colorado Pediatrics is a very challenging pediatrics program to matriculate into as well. And so an applicant needs to be ready to be an intern in June of the year that internship starts at University of Colorado. And then also even PM&R, as you all have known, being here at the AAP, like PM&R as a residency match has gotten more and more competitive. So I think I think I've seen that elevate over the last decade here in Colorado. But I also know that there's a unique applicant who can be successful in all of these areas. And and so that's where I think as board scores become less important, I think it's more about that global picture of what someone's experiences, what their passions are, what their alignment is, knowing that like they want to do this kind of challenging both time and intensity track of training and making sure that like, I love having these conversations on this side of things and even ahead of interview day, you know, just because this is the time where we can talk to applicants, answer questions and connect people with our trainees, too. So what kind of things are you looking for in an applicant? Are there certain experiences? Do you have board score cutoffs? I know that's becoming less of a question, but we still have step two. So I think it still is a question. What kind of stuff, you know, when you're advising students, what kind of stuff do you tell them? Yeah, well, first and foremost, I tell them that we look for some degree of experience within PEDS rehab during their prior time before applying, whether that means doing a rotation or reaching out to some folks to learn more about the field, shadowing a day or two to really kind of grasp what the field entails. And then from there, you know, our program doesn't look at board scores. We look at the whole application altogether. You know, Comlex versus USMLE also doesn't matter for our program. We're looking more for experiences that kind of point you in the direction of PEDS rehab and why you're interested in that, that area and the ability to explain the field and what draws you to it. Ashley, do you want to add Cincinnati perspective? I can add, yeah. So I'm going to go back to what Amy had referenced earlier in terms of there's multiple players in the bucket of figuring this whole thing out. And so I have to try like all of our folks today to get those all those pieces to come to an agreement. And I kind of I have to make sure everybody's happy to at least a certain extent. So so we also have an extremely competitive pediatrics program. And that is often I don't want to say my limiting factor in terms of what we're looking for, but I have to be able to convince them that they're going to survive at Cincinnati Children's. We are a absolutely huge hospital at this point. And you just need you need to have a lot of higher marks, I guess. There's not a lot of things. I feel like everything's going away. So I don't know how they're going to turn that into. But we previously had some cutoffs for step one that PEDS sort of implemented. Not even going to go there because it's not existent for you guys. Not even had a discussion with them about step two, since this will be the first year that we only have step two. So we'll see how they kind of view that. But I do think for ours, there's definitely a level of competitiveness. And I think PEDS tends to be the folks that that look at that a little bit more. I would also say, unfortunately, while our PM&R and PEDS PM&R programs tend to be doesn't matter complex. Step one, I would say PEDS definitely looks for you to have a step one and tends to be a little bit more MD friendly. I hate to say that out loud, but it is it is what it is. So I think you really, really have to stand out if you're coming from an osteopathic school and have really good strategy. Not that we won't interview you and not that we're not going to turn everybody away. But I think it's just a little bit harder. Amy, anything to add to that? You're nodding. Yeah, I think you covered that. And I think this is tricky because like I review applications and then it's the same type of thing. Getting sort of the thumbs up from Dr. Adam Rosenberg often is involved in our. He's the PEDS program director who's been kind of our APD on the PEDS side and then also PM&R and my colleagues there. I've interviewed with our PM&R program even before I was the program director for the combined program. So I have a pretty good idea of the conversations on that side, too. I think each of these aspects of the program just wants the resident to be successful in all those areas. So I think that's where like good preparation can kind of look at, like, do you want to do a pediatrics residency? Can you take care of adult rehab? You know, in our personal statements, we're like, we know we want to do PEDS rehab. But, you know, what was that experience on adult PM&R that, you know, can make sure that someone is, you know, at least in our program, like 18 months of adult rehab, making sure that they're good with taking care of the older people, too. And then, you know, why PEDS rehab? So not to pivot, but I was seeing, Sophie Andrews, your question about our curriculum at each of our programs. So first off, we are referring to each other by first names because we know each other through, like, talking about our programs. Like, what is, since like when I started the program directorship here, I graduated from our combined program. But when taking over leadership, you know, one thing that we try to do as program directors is talk about, like, what are you doing in your program? What's your schedule look like? What's worked for you? So I think the interesting thing is that, like, how the program is created, like required by the American ABP and ABPM&R is kind of like a Tetris game. That's a pretty tight, tightly run. And so I think the differences between our programs just might be sort of where you're doing these rotations. I think some of the things is, yeah, and I've also been happy to be like, wow. Yeah, it's all pretty similar because in five years, the requirements are kind of laid out a little bit. Eileen, is there some aspect of just your combined program that you found to be unique and different? I think probably the biggest thing would be our continuity clinic experience tends to be different from from your programs. So our interns do an X plus Y schedule. So they are treated like our categorical pediatrics residents now, so they no longer have continuity clinic their intern year, but starting their PQI 2 year, they alternate between a regular general pediatrics continuity clinic and a special babies clinic, which includes NICU grads, but you are the primary pediatrician managing those NICU grads up until they transition into the regular Gen P population. And then you don't start a pediatric rehab continuity clinic until PQI 4 year, where then you are no longer in that general pediatrics continuity clinic, and you alternate between that special babies clinic and pediatric rehab continuity clinic. Yeah, I think the nuances between the three programs are similar to that. It's just like some little snippets of, you know, things that work in our hospital system because of X, Y, or Z in the way things are set up. So, I think the other thing I've seen over the years, and I don't currently remember what your guys' schedules are, but our rules say that we have to rotate between the two areas every three to six months. So, some people have done every three months you switch rotations, you know, you go from peds to rehab, back and forth, and some have been every six months, and honestly, that's probably traditionally been dependent on what your pediatrics and rehab parent programs need you to do or how complicated it is. I know the X plus Y schedule, I've had some friends that are trying to start programs elsewhere, and their peds do that. They're like, how do I even do this? So, I'm going to send them your way now, Eileen, now that I know that you guys did that, because I was like, this blows my mind. Add some complexity to the Tetris. But we, I think those are, it's a lot of nuances. Like Amy said, like, it's, in the end, there's very little wiggle room to make things, like, real different from each other, because it's so prescriptive when you're trying to do essentially two residencies and a fellowship embedded within five years. Like, there's just not a lot of room for doing your own thing. And I think, like, our, some of our differences could be, like, the size of the programs, the, maybe, like, the flavor of the PM&R rotations. You know, I think pediatrics residency has so many requirements with your number of inpatient months, number of supervisor months, elective months, and then, you know, elective months can be flexible, but then there's some that are helpful, like, rheumatology, peed sports, you know, so I think, and then as we look at, like, how the schedule is built, I have a template, but then sometimes, depending on exactly that, like, how the other programs need to be balanced, sometimes a residence, you know, four months might be six, and, like, I look at their whole learning picture, and it's amazing how well it's worked out for each learner, so. And stay tuned, because I think the pediatrics requirements are shifting for Gen P, and so things will change again. So we'll be a few years behind that, because I feel like we always are, but yes, we, eventually, it'll trickle down to us. Cool, okay, so we talked about what you're looking for in an applicant. Do you guys look for any specific types of letters of recommendation? That's another question I feel, like, commonly gets asked. I think, just good balance among the programs you are applying to. So, like, if you have an opportunity to have a PEDS rehab letter, or sort of a field adjacent to it, like developmental PEDS, or child neuro, depending on the school, you know, in your experience that you've been able to do, that's great. I think that if PM&R, also, sometimes it's a physiatrist, who's PM&R, who takes care of children, so a letter that's kind of like PM&R, I think, can be helpful. And then, you're also applying to a pediatrics residency, so just having representation from, you may, if you're doing internship applications, you probably have an adult IM, or, you know, letter, but if you can have a pediatrics letter, or I even say, like, I'm triple boarded in pediatrics, PM&R, and PEDS rehab, and encourage my colleagues writing letters, if you have multiple board certifications, make sure they're on there, because sometimes letter writers don't know a name of someone who's, maybe they're less familiar with, but they may know, like, oh, she's boards, or he's board certified in pediatrics. So, I think letters that reflect who you are, and the rotations you've done, the best of your ability, but, you know, if you can dip into those, it can be great. Yeah, that's kind of what I say, too. The trifecta is, if you can get a PEDS rehab letter, an adult PM&R letter, and then a Gen PEDS letter, but it's always better to have letters of people who really, really know you well, and can speak to specifics, than just hitting all of those different columns. And I would look at it from the perspective of, I can't remember who said this earlier, but, you know, when we're digging through applications, we're trying to figure out, do you really want to do pediatric rehab? Do you know that you really want to do this? Because depending on the year, sometimes we get a lot of people that really know they want to do PEDS rehab, and I assume that each of you can only interview so many people, and your programs don't let you just, you know, interview everybody, but I think, you know, when it comes to those really big application years, you're still trying to stand out, and so, you know, if you can have those three types of letters, I think, especially in those more competitive years, that is super, super helpful, and it can often be a little bit of a tiebreaker, so to speak, but I agree with everybody else. They still need to be good letters and strong, and they know you and all that good stuff, but. I also encourage, like, applicants that you submit in September, but there's other clinical experiences that you may acquire between now and, you know, when rank is in February, and so if there's additional information that a program should know about, or if you do, if you have to do an away rotation in November, and you feel like a letter from that institution would be helpful, like, feel free to share that, so that can be updating your ERAS and emailing programs, emailing us directly, you know, I mean, just like these are the ways, I think, where not every, you know, some MS4s or fourth-year medical students, like, have to have a fairly structured third year, and so just if you have clinical opportunities that sort of shape who you are and your preparation, like, keep doing those and saying yes to those, and then if you feel like it's important to share that with our programs, please do. Yeah, let me see if we got anything else in here for the moment, and then I'm going to work in some of these other ones. I'm also trying to type answers as well. Should people apply to the triple board programs if they're not sure if they want a triple board way of training? We haven't directly answered that, so. Yes, but ask lots of questions ahead of time, like, reach out to us, like, be a part of this. If people want names and numbers of both fellows, combined residents, like, we want to connect learners with the people who can help answer those questions, and also, like, your ranked list isn't due until February. Yes, we want people to interview who are sold out. We want to find everyone, but we also know the journey of students, that there's options, and there's different reasons that someone might want to apply different ways. So, I think that you have to start with applying, you know, but I also encourage you still apply to, if you're interested in the PM&R track, apply broadly to PM&R. Some people are interested in PEDS as a secondary, so apply broadly there, too. Don't just apply to combined training programs. Yeah, agreed. I think you also find out a lot about what you truly want in a program along the interview trail, as people are asking you questions, and you're doing that soul searching. So, you know, if it is an additional three applications to the combined programs, I say, why not? Exactly, cool. So, that leads to another kind of secondary question. Can I also, can or should, we'll answer both. I also apply to your respective pediatrics and or PM&R parent programs. How do your programs deal with that? Yeah, absolutely. We know that you need to have a backup program, because there are only so many spots in the nation. So, I think I speak for all of our programs when we say we expect you to have a backup application route. So, yes, whether that be general pediatrics or, you know, adult PM&R, some people have applied to MedPEDS as a backup if they're interested in transition of care. Yeah, I would encourage you to do that. I agree. And then I also recognize that some people may, like, for instance, one of my current fellows, I interviewed for our combined program, and I, you know, follow up now years later. I'm like, why didn't you do the combined program? And he just said, I wanted to do PM&R. So, I also know that, like, the applicants are trying to figure out the right pathway to training in this whole time period, gathering information, finding out about training tracks. And so, sometimes it's not it's not a backup to do PM&R. It's a first choice. So, you know, I think that is the reality, and I think comes into focus for applicants as they go along. We do also get people to withdraw. So, some people are like, no, I found out what I want to do and change. And so, you know, this is where you're on a journey to find your career path. And, you know, we understand that the information comes in at different times, too. So. Yeah, I agree with everything you guys said. I would say the only thing that's just maybe slightly different for our program that I have not been successful in changing is that we many, many, many, many years ago, apparently the combined programs, because there's lots of them within our pediatric hospital, used to be a way to get in the door in a less competitive program. And so, they long, long ago made the rule that you can't apply to more than one pediatrics program. So, it's just a weird rule that we have at our institution. So, unfortunately, if you're a pediatrics backup, they will only allow you to be on one rank list. You can still say you're interested in both, but they'll sort of force you to choose. But for PM&R, absolutely. Like, we have plenty of people that we've matched that decided they wanted to go PM&R, and they interviewed both programs, and they ended up at our adult PM&R program. So, it's a weird rule that I don't exactly understand the history, but I've been unsuccessful at changing it. So, maybe someday. And then you do have to apply to each of these programs separately. So, the program number, applying to combined program in Colorado, if you want to apply to PM&R, you have to apply to the PM&R program and just pay the extra. I know that the numbers add up, but I do think, like, if you're interested in PEDS rehab or PM&R, like, apply to both, you know, and then some people are interested in PEDS too. I think you get a great overview of all the programs as we do our combined interviews, but then if you apply to the PM&R program too, you essentially do a whole half day with PM&R rolling through all of those residents and faculty too. So, just remember that they're all separate, and I think that's just an important piece because, you know, everyone applying each year is new to this, like, application process. And then also remember just if you're applying to PM&R programs, still select, like, internship programs to apply for. So, it could be in your home institution, it could be nearby a PM&R program that you're doing. And so, just, I think, on my journey to combined training, I had 26 interview days, and it was back when I had to take out a loan to travel everywhere, but it was the reality of, like, finding that pathway. And we understand that people are also interviewing at other places or different ways, but people, like, this is where it is. You don't have to tell everyone, sort of, what your, like, it's your privacy to, like, what types of training programs you're applying to. I think we like to have conversations and mentorship and help people guide, you know, and talk about these types of options because we know they exist, and we know that it's up to you to kind of find out the right path. Cool. So, how important, a question from the chat, how important is research, volunteering, and other extracurricular activities? I can speak for our program that it's nice if you have some research experience. We're not looking for a ton of research experience. Our division tends to be more clinically focused, and so it's not a huge deal breaker if you don't have many publications in your name out there. We do really value folks who are excited about educating and teaching, so if there are teaching opportunities that you've been able to experience, we really appreciate when those are highlighted in applications. And then, just from the advocacy side, you know, having extracurriculars and volunteer experience is so, so helpful to see because as a pediatric societist, you're going to be advocating for our population, and so if you already have that experience, then we know that that's something that's comfortable and also of interest to you. And then, I think, too, like, as you think about things to be involved with in school, whether it's leadership or volunteering, like, what are ways that you could take something and turn it into something better, you know, transformative experiences, so ways that a lasting impact. I think I think it's, as residency program directors, like, seeing someone who's really dedicated something or grown in leadership through an organization that has left a lasting impact is probably more life-changing and shaping than, like, just a few one-off experiences. However, those little dabbling experiences are also important because that's what, where you're seeing maybe, you know, a volunteer event at Special Olympics or serving an underserved population or advocacy, so just sort of, like, you know, this is where, when, if you find something that fits your passion, like, lean into that, you know, and then I think the thing I look for is what is an applicant's, like, perspective on those experiences, not just what have they done, but what have they learned through it. And then I'll just add a little bit, and we've talked about this a decent amount in other webinars if you were able to join us, but this will be the first year that the application is drastic, we'll say drastically different, because it is pretty different, and so you're limited to 10 things. So my advice to everybody, whether they're combined, whether they're adult human, are whether the pieces tell your story and tell what's important to you, and if, you know, because I think part of this journey, I often use the analogy of speed dating, you're trying to find a good fit, and they're trying to find a good fit, and if you just really want to go to a program because there's a certain name associated with them, but you absolutely hate it there, and you didn't have a good time, and that's not going to be a good fit for you, and you're going to be miserable for five years, or four years, or however long you're with them, and so I think that's what I'm going to try to do with these 10 experiences, so I think it's going to be different for all of us, and how that's going to change over the next few years, but tell us who you are and what you're passionate about. So tag-teaming off of this, what does research look like in your programs? Just sort of rolling through what some of our combined program residents have done recently. Christina Sarmiento graduated a few years ago, and she did a systematic review with a number of other fellow, a few other combined residents looking at abusive head trauma, and then actually even presented at some of the academic conferences, and so it was a big in-depth systematic review supported by the kind of research staff, meaning like statisticians within our department, but executed in such an amazing way and disseminated. Now she's like in a actually a clinical research track. Some of our other residents, usually what we're trying to do is like have them have an academic research project that really can be presented not just at our local regional, but then even disseminated, so I think each of our, they also could do like educational academic projects, but most recently at least one of our residents is working on some concussion data and outcomes associated with that. Yeah, I would say our program, not a ton of people are or have a passion for research, so we at least try to encourage our residents to dabble in it a little bit with case reports, case series, and then also look into other avenues of clinical research. Nobody has really kind of taken the plunge yet, but all of our residents have at least presented posters or at a platform presentation. I would say we're probably all over the place at our program, so I, you know, from an ACGME requirement, all three of our programs, the residents have to do something scholarly before they leave some sort of presentation, some sort of research. It's a requirement, you can't graduate without it, but we've had in the last 10 years anywhere from an MD, PhD that was in the RMSTP program, which is like the highly coveted research track through AAP, that would be kind of one extreme, and he's on faculty now, so he clearly has a passion for research and is like mostly protected time for that, all the way down to, I would say, much wider portion of our residents are kind of dabbling their feet into things. They might join a group that already has some data or, you know, a much, I want to say simpler, but a much more clinically applicable project, because we do have a good chunk of ours that don't plan on doing any research once they leave us, or at least not as a large part of their, so it's all over the place in our program. I mean, I have a graduate from last year that was an author on a new book chapter, but then like my current graduate is at much more minor projects, so like it just kind of depends on what craft it is. Okay, let's talk a little bit, because we're about 15 minutes away, so I'm trying to keep us going through like the whole process. Let's talk a little bit about interviews. You guys can't comment on like what your typical interview structure is. I mean, you don't have to give super big details, but just kind of how that works for your program when you're thinking about all these different moving pieces. So, we have a two-day interview process, and we try to keep the general pediatrics interview format and the adult PM&R interview format exactly the same as what it would be if you were just applying for those individual programs, knowing that people will be applying to those programs as either backup or their primary pathway. So, the first day is usually in the morning. There is the general pediatrics interview day. You interview with all of the general pediatrics folks, and then in the afternoon, you interview with the pediatric rehab division, and then day two is the adult PM&R interview day. In Colorado, with our evolution of virtual interviews, sort of the information part of like an interview day has really been put a lot to like an outstanding virtual recruitment site for pediatrics, PM&R, and peds rehab. So, first off, like the ability that like an applicant would need some time to really sift through, I think, the meat of each of those areas. And then our interview day is what I try to do is have sort of two pairings of interviews. If someone is just applying to the combined program, it may be one day where we talk about pediatrics, peds rehab, and the setting of PM&R with interviews sort of in each of those areas. If someone is also applying to PM&R, then they'll actually have a PM&R day, but then forego their PM&R interviews on sort of the peds rehab day. So what we often try to do is pair those up and then even let all applicants know right away when these pairings are before I even have gone through the application just so if someone is really interested in our interview date pairings that as you're accepting other interviews, then maybe you're kind of holding that. And then even Eileen, Ashley, and I have kind of shared our temporary dates just to try to make sure we're not making it harder on applicants who are trying to kind of thread the needle with these interview dates. I think we may have a couple, like one overlap, but I think otherwise we were pretty good and spaced out this year. So I would also say we have gone through an evolution in virtual world. I think the last three years I've done something slightly different every year as we try to find like what works best because I do think virtual is not in person and that is a very different beast to tackle when you have a two-day interview. So we're kind of in a day and a half-ish. I wouldn't say we have two full days, but this year we're doing two set dates and they're peds rehab focus dates. So on one day you'll interview with peds rehab and adult rehab and those are kind of all melded into one with the PDs from both programs kind of present in orientation and then interview with both sets kind of all intermixed in that one day. And then the other day is your traditional pediatrics program where you're basically with other people that are either by applying to pediatrics or to combined programs. So in the general applicant pool we do them back to back so they're next to each other. But that's our version this year. I don't know, it wasn't our version last year, but we're tweaking and we're seeing what's going to work. So that's kind of where we landed this year. I should clarify it's like it's usually half days over two days because I think no one can interview for eight hours and since so much more of these experiences are moving towards the interview part as opposed to like, hey I'm going to tell you about my program, that's why we've you know tried to condense it more to like half days and make sure we're not you know burning someone out after eight hours. So no one wants to be on Zoom that long. Ditto. I should have clarified that. Yeah, our first interview year was not like that. We totally burnt people out because we just transposed our regular in-person days. The other day it was not good. We've all learned. Yeah, yeah. Oh goodness. Okay, so any advice for people in terms of you know once they if they choose to interview the triple board programs and obviously they're going to be interviewing at backup programs, like how do they even think about constructing their rank list, putting this all together, like what advice do you have for folks? I think it's first how do you want to train, where do you want to train, and then well who else is involved in your life too is important. So I think this is where it doesn't just boil down to I want to do combined. You know for instance when I was on my journey and I'm still married to the guy but my husband was from out west and so you know this is where we had to look at his jobs, where we wanted to live, those opportunities. And so like even though I was like I really wanted to do combined, I had kind of a mixed rank list based off of okay no, I could do you know PM&R at Colorado for instance. And so it was a mix of finding out my passion for how I wanted to train or really wanted pediatrics, but then I think it was dependent on other factors too. So I think I'll bump it over to Aileen. Yeah, I think that's very much part of it. You're not making this decision in isolation of the rest of your life. I think the other thing too to think about are some of those intangibles. As you're interviewing, you're going to meet groups of residents and attendings. Look at their way of communicating and their dynamic. Does that fit your learning style? Is a program more you know self-directed or is it more structured? You know that's going to shape your training over five years and five years is a big commitment. So you want to make sure that you feel comfortable in whatever style of training you're really committing to. Yeah, I had a very, I didn't realize Amy, we had very similar stories. I don't know that I realized that until you were telling yours. You know I encourage people to do what your heart says and that you know we don't know what your rank lists look like. We don't know where you put us on there. We don't know if you, we were the only combined program you put on there. I think you know everybody's a little bit different. I had a similar thing. You know I was, I had been dating somebody for I think seven months when the rank list was due. So that was even you know, you know do I make any decisions based on him? I'm still married with him. You know we have two wonderful kids. It's great but at the time you know like that's still kind of new and like but we did have those conversations and we did think about like logistically in the country like where he was willing to move if this continued to go in the direction we thought it was going. And so so mine was completely and utterly mixed. Like it was all, it was all over the place. So so I think do what your heart says and that may look different for each and every one of you. Yeah I agree. And and I think there's there's kind of no wrong answer. Plus like you have until February of fourth year to be wrestling with this. So I know everyone loves clarity but this is where it might take some time. And so I think this is where moving through like an interview season and and and asking questions and doing follow-up or saying you know often sometimes after the interview applicants. I'm getting in touch with my fellows, the combined residents, other people. If if it's important for someone to be in a certain part of the country. Like if someone was like I have to be out in the southwest. It's like I'm connecting with Ashley or with other people. So like I think we're we're champions for finding the like for you know finding applicants who are interested in Pieds-R-Rabbit. And then also it's okay. Sorry guys it's okay to train in PM&R. It's okay to sorry guys it's okay to train in PM&R. And then what we want to do is keep you interested in pediatric rehab. And and like mentorship across the nation. You know we do one-on-one chats with med students. And I think as we've been doing a lot of this we said we need to talk about this program. That's why we're here today. But we also know that there's different ways to train. Like we even have a pediatrics resident as I said who applied to combine was a super strong applicant. And for whatever you know reason in the match that year went into Pieds. And then still maintained an interest in PM&R. And so now is training in PM&R here at Colorado. There are interesting you know there's talk in the boards about is there an avenue through pediatrics training to then go into PM&R. And right now we don't have an answer for that. Right now the avenue to be board certified is to then do a PM&R residency. But who knows in the next five years that that could change too. Because we need pediatric physiatrists. Meaning the children with disabilities. Someone who's an expert in their rehab needs is everyone has a job. Yeah. Yeah. No I would say the same thing. I think you know it's kind of a running joke at my institution. Because I do medical students as well. So I'm the primary contact for medical student rotators. And clearly I really like education. But I keep in touch with a lot of them that are coming through to rotate. And maybe decide. And I don't really know if they just don't match with us. They don't like us. Or they just chose to do a PM&R residency. I have no idea. But I'll keep in touch with them. And I'll tell you right now we have we take two fellows a year. And two of them were my students that applied to the combined program. And that rotated with us the fourth year. And came back to do fellowship. It's so cool. Like I love when that happens. We just graduated another one that was a similar situation. That left for residency. Kind of decided I really want to do the adult with the fellowship. And that's that's kind of where my heart lies. And then came back for fellowship. So it's it's really cool to see it come full circle. But but yeah we need more people. So don't don't lose your passion. If you love Pete's Rehab regardless of what way you decide to go. We will not be offended either way. So. I think some other great ways to get involved are to like even through whether it's AAP or even AAPM&R. I hope I can say that on this thread here. But like there there are monthly like journal clubs being hosted by fellows nationally. Sort of grand rounds or lectures being led by faculty. And then also the opportunity as a student to even attend some of the conferences. Like whether it's AAPM&R AAP or even AACPDM with CP and developmental medicine. That's another really high yield learning opportunity. And so look at you know are there scholarship opportunities to attend. Usually the med student cost is a lot lower. So as you're just trying to figure out like do I do I. Is this the academic discussion of disability medicine that I love. Those are some just really great organizations. Also the AAP or the pediatrics organization has like a council on disabilities. And so I think this is this is the the the rainbow of opportunities is really broad. And so those I think are just some ways that even if your institution doesn't have like a pediatric physiatrist. First off we'll connect students with mentorship even if you don't. And then also we'll you know happy to talk about sort of what are some other ways to get plugged in. So I'm I am mostly done with my questions. So I want to we have about five minutes left. So I wanted to just open it up if any of you students on here have any additional questions that you have not put in the chat or that you wanted to pose. We have a few extra minutes. You're happy to answer anything. I think Pepper you asked like reflecting the population we serve since it's a lot of disability medicine. Do we have openly disabled faculty or trainees. The answer is yes. I think in both PM&R and even in Peds Rehab as we go to conferences there's people representative whether it's hearing loss mobility impairments different complex health needs. I know for one Dr. Pam Wilson who is my fellowship program director before me is a Paralympian. So she's a wheelchair user from a spinal cord injury earlier on in life. And she is she is the wheelchair athlete of the year right now. So gold medal silver medal in Paralympic curl in world curling. So it's pretty awesome to have mentorship like that. If you weren't going to say that the word I was going to do it. I was like if she doesn't say it again. Yeah we we have the same thing. So one of one of my colleagues in the program director for the fellowship program is has cerebral palsy and is a primary wheelchair user. So and we've had various people come through training that are primary wheelchair users or some version of that. So just part of a big field. Yep. Likewise we have a resident who is a also a Paralympian who had a spinal cord injury and then another resident who has skeletal dysplasia. I mean there was some question about any just about away rotations. So I think this comes up a lot just because not every residency or sorry I should say medical school has rotations in whether it's PM&R or Peds rehab. So I think for a lot of people it's a little bit of a has rotations in whether it's PM&R or Peds rehab. So I think a finding out who are the pediatric physiatrists in my program getting put on your networking chops and reaching out directly to them can be helpful. And then also looking at like the PM&R rotations at different institutions. And even there's like if you apply for a PM&R rotation away like a Colorado. We have different sites Denver Health University and children's. And so we just slot people interested in Peds rehab at the children's site. And so like think about away rotations if that's something important to you. Some people can do a bunch and some can't. You know I think it can be all of our sites offer away rotations. And so think about you know even if it's not in Cincinnati or at DuPont or at Colorado you know opportunities to do do say if you're really interested Peds rehab Peds physiatry at any institution. So this is a small field of pediatric rehab that we know a lot of our colleagues nationally. And so I think we're excited to you know try to give students good clinical experiences. And we know that not everyone can sort of do a formal away and travel and all that. Yep and it looks like there's another question about how long are aways. We only do four week away electives. We have a pediatric one and an adult one. Those are actually two separate. So you don't apply one and then you have to apply to them differently. They're different codes and be slow. Amy are yours all four weeks or do you have a different length you know. Yeah they are some of the interested students come and do a PM and R away. Some do the pediatrics disability in medicine and when my colleague Dr. Maud finds out someone wants is on that but interested in Peds rehab then what we do is just collaborate to give them some more like pediatric rehab. So we kind of sometimes make a custom schedule. So yeah at Colorado it's four weeks and there unfortunately that is tricky because every school sort of lines up differently. But I encourage aways all the way from when they start even into the winter. So we understand I understand if people have to do interviews and that but I know it's kind of nice when you do get them in sort of pre-interview season but clinical experiences are clinical experiences so. And then I'll ask this one last question. I think I think it's the last we had not answered. Do you have any interview tips aside from being ourselves and knowing our application? What do you note from applicants you rank? I think like I've done your homework on what the field is and also on this track. So all of you being here right now is like a great way to find out more about combined training. Also it's okay to to ask these questions ahead of time and to ask for ongoing conversations about combined training. We get it. This is like a unique track and so I think this is where I love having conversations you know ahead of the interview day. Sometimes interviewees sort of have more questions just about the nuances of the program and so that's okay. But I think that that's important. And then to make sure you have a stable internet connection the best you can. It always makes things less difficult. So I think that that's a really good tip. Eileen your light is amazing. So whatever Eileen is doing right now for lighting. Not that not that it matters but it just I think presents an applicant really well. And then too if something happens like someone gets COVID and you're sick like ask the program to reschedule stuff happens. We are all doing virtual interviews and so those are my tips. I think the other piece that I think was mentioned was second look. So every institution is a little bit different is if they allow a second look. What's been the guideline for all of our programs is like no visit should affect the ranking of an individual. And so I'm not monitoring if people are taking like flights to Denver to check out the city. Like if like that was something for me like with my spouse I was like I should have brought them to sorry Ashley Cincinnati in order to see it because I was super excited you know. And so it's just like I think some of it is like a second look can be also just exploring a town you know in the community. Yeah yeah and I think that APPD which is the pediatric side had just put out recommendations that no programs should be hosting any residency specific second looks. So hopefully that'll kind of even out things as you're going along the interview trail. But if you're interested in you know coming to the city and seeing what things are like it's always helpful to to email one of the residents or the chief resident because they can help you with tips of you know where to go and what to look at without being a formal experience. And when you do contact the residents they're at least at Jefferson there's a policy that we don't know about your your visit and they just kind of coordinate with you. That's been our policy too they have to it has to come after after like all the interviews are done like you can't come in the middle of the interview season and only residents can know about it. So the PDs the faculty unfortunately well fortunately or unfortunately we just don't want it to influence us and we're it's it's really hard. I mean there's some programs I've heard of that are able to coordinate it to where you know they are able to get their rank lists in super early and then have some more kind of formalized not going to impact. But we've just with so many moving pieces and so many people involved that's not been a possibility for us. So our chief resident usually coordinates all of it and runs with it and I just one year one year I accidentally saw him walking someone through the hallway totally it was in like our ICU tower and I just like made a beeline because I knew what was happening but I didn't want to know who it was. Awesome well I it is a little bit after nine o'clock or whatever time it is in your individual time zones but I just want to say thank you so much for attending please please please don't hesitate to reach out for any of us. We're happy to answer questions we do that a lot and you might you know you reach out to one of us you might get pushed to one of the other one of us because we do that a lot too. So definitely definitely reach out we're happy to help in any way so. Ashley we just put our emails in the chat if you want to add just to. Yeah I am doing the same thing I'm just not cool enough to multitask while talking. Well and we know that a presentation like this probably leads to more questions and so please like reach out it would be us or we connect you with our trainees and they've been on the same pathway as you as well. So we are we're we we love it when people express interest in peds rehab and and can help kind of guide the light on on how to get involved in the field and then you know talk about training tracks. Yeah and then my last thank you is just to Amy from AAP who's helped with all of these webinars so we'll do the same thing we'll get this posted on the website and then Amy you have a way to do the chat and I can kind of like summarize everything like we've done for the past you can send those my way I'll take care of that and all of that will go up on the website with everything else. So thank you guys so much enjoy the rest of your evening. Thanks everyone. Yep thank you Amy, thank you Ashley, thank you Eileen. Bye guys.

Triple Board Pediatric Rehab Program

Applicant tips

Research in the field

Interview preparation

Virtual interviews

Away rotations

Second look visit

Residents advice

Rank list construction

Training program insights