2024 Q&A Summer Series: Brain Injury Medicine-2024 Summer Series Brain Injury Medicine

2024 Summer Series Brain Injury Medicine

Video Transcription

It's Benjamin Nguyen, I'm the brain injury director at the UT Southwest Medical Center. We are delighted that AAP is putting together a series to highlight different subspecialty  and we enjoy the chance to talk with you guys today about what the Brain Injury Fellowship has a chance to offer. The format is pretty straightforward.  With each of us, there's five of us, each of us will give a very brief overview of our Brain Injury Fellowship and why we think brain injury medicine  is the only fellowship type of opportunity to pursue. Everything else is tied for a second, but so I'm gonna quickly run through what we have to offer  and if we can ask you guys to hold your question and ask us as a group at the end, that will be greatly appreciated. All right, so can everyone see my slide?  Okay, perfect, thank you. All right, here we go, let me turn it. Okay, so again, I have no disclosure to disclose, no conflict of interest. All right, so a little bit about me.  I attend Baylor College of Medicine in Houston. I graduated in 1996. I also did a PM North residency there and then I went to Mississippi Methodist Rehabilitation  Center for my Brain Injury Fellowship. And of course, back then, all Brain Injury Fellowship was non-ACME accredited. So this is a relatively new phenomenon  within the past five years. After that, I would serve as a professor at the University of Cincinnati in Ohio, where it was too cold for my wife.  So we relocated back to Texas in 2005 and we have been in there ever since.  At UT Southwestern, I am currently the Brain Injury Fellowship Director since 2010. I've been fortunate enough to train 13 fellows today. I also teach residents at the rehab unit,  on the consult unit, as well as in the clinic. And I'm also active at other university medical group activities such as the Medical School Admission Committee  and also the JAMP, which is a special state funded program in Texas that allow economically disadvantaged students to pursue medicine.  So this is a brief picture of the hospital system where we cover. Our main hospital is the Clements University Hospital, the one on the left.  Now this is an old photo. The newer photo has a third wing, the orange tower. And the orange tower is focused specifically on neurosurgical, neurological,  as well as psychiatric patient. So most of my activities now is on the orange tower. We also have an opportunity to go to Parkland Hospital, which is our county hospital.  It has a total of 983 beds. So it's a very big hospital and you will have a lot of ability to learn about brain injury both on the consult side, on the inpatient side,  as well as in the clinics. And these are the people associated with our Brain Injury Fellowship Program. I am the fellowship director.  Amy Matthew is my associate fellowship director and Godly Johnson is our Brain Injury Fellowship Program. And of course, Tara Isbell, she's the person behind our medical education.  She's the Jimmy Program Coordinator, as well as the Residence Program. And she helped us put together this presentation today. All right, so these are some of the members  of our Department of PM&R who are Brain Injury Medicine Board Certified. Dr. Varsha Kaur, who is the Director of Outpatient Clinic. Dr. Kohan, who is at the VA  and help a lot with the blast concussion type of injury. Dr. Kowalski, the current chair of the AEP. She does brain injury medicine. And then also, she was one of the original group  that helped come up with the Brain Injury Medicine Certification Board that you guys take to become certified. And of course, Dr. Matthew is the Associate Program Director.  Dr. Shanti Pinto, she is in charge of brain injury research. Dr. Shelby Testa, she is running the inpatient unit at CellDipshy. And of course, Dr. John Thodakar, my first fellow,  who is now the Director of Inpatient Therapy at Parkland Hospital.  And of course, these are other faculties who worked with our program. The Patricia Gordon and Patricia Krohn, Outstanding Nurse Practitioner,  because we probably have one of the biggest injury take-home pump program in the country. Definitely one of the big, two big one in the state of Texas. Of course, Fatima Gold  is the Director of our Specificity Program. Dr. Norman Pan, he doesn't look like this, but we looked on the internet, we couldn't find any pictures,  but hopefully next year when we come back, we'll have a picture of Dr. Pan. And of course, we work very closely with the Woodshire City Mobility Clinic,  and also with our Division of Neuropsychology with Dr. Bo and Dr. Wilmot. Okay, now our Brain Injury Medicine Fellowship, we also use professors from different specialty.  We work a lot with the Department of Neurology, Dr. Kelly to help with Alzheimer's, Cognitive Therapy, Dr. Farben to help with Kepler seizure, and of course, Neurobiology,  where our fellow get to learn about MRI and CT with Dr. Johnson and Dr. Perez. And they will also spend time doing neurocritical care at Parkland Hospital,  and they will also have an opportunity to work with our neuro-optometrists who specialize in vision deficits following brain injury.  And these are our Brain Injury Fellow Medicine today. As you can see, several of our fellows are in academia. My first fellow, Dr. Toda Carter, right now,  he's the Director of Inpatient Care at Parkland Hospital. And as you can see on here, multiple fellows have gone into academia. And our current fellow, Priya Nangwani,  she just started a month ago.  And these are some of the locations that our fellow goes to. William P. Clement Hospital, or our University Hospital, Parkland Hospital, our Comedian Hospital, DDA Medical Center,  where our fellow go to learn about blast injury, and of course, the Lipschitz Pavilion, where they do inpatient rehab. So as you know, part of the ACGME accreditation  required a fellow to do four months of inpatient rehab. So our fellow would have a two months opportunity to work at the county hospital,  and two months opportunity to work at the private hospital. And of course, most of the fellowship program is focused on the outpatient side.  And this is where the fellow have the chance to work with PMR physician, neurology, nurse practitioner, and physician from different specialty.  All right, and then our curriculum. Well, we have a brain tumor medicine lecture, didactic series, which occurs monthly. We also have a fellow work with a neuropsychology fellow,  as well as the specialty fellow, where we have them do further collaboration. And they have a quarterly brain injury medicine journal club. They will have a chance to work  with the quality improvement. This is kind of like a requirement with Dr. Parshakar. And they will have a chance to work on the mock oral board.  They will have an opportunity to work on the book chapter study guide, as well as to research with Dr. Pinto in the Pinto lab. Additional opportunities are the chance  to work with context, the TBI model system,  Tiber, as well as a baccalaureate program.  And then our fellowship is a multidisciplinary fellowship. You will have a chance to participate with neurosurgery, cerebral vascular conference,  as well as the interdisciplinary concussion meeting. The fellow will have lots of opportunities to participate in community committees during their fellowship here.  And then this is the neat thing. We work with the Pinto lab. Dr. Pinto, Shanti Pinto, is a member of our program. She specializes in research. And her research is NIH funded,  is one of the 16 model system. I'm sure you will hear from future speaker about their model system. And right now she has several project ongoing  about cardiovascular disease after TBI.  Of course, our fellow will also have a chance to learn to bleed and to participate with our stroke support group, as well as our acquired brain injury support group.  Because as you know, most of the interaction with the patient occurs outside the hospital setting when they're at home. So that's why I think it's important for us,  for our fellow to be well-versed in the support group. And of course, we will also have the opportunity for the fellow to participate in advocacy.  For example, Dr. Thodakar is currently the chair of the TBI advisory council. I am one of the committee chair for the education and awareness support group.  And they would have plenty of teaching opportunities as listed here.  All right. And then this is some of the activities that our fellow participate in throughout the year. The first picture is the graduation of our most recent fellow, Dr. Mahasin.  And then these are some other activities. This picture here is Dr. Iwanei. She was a fellow and now she's currently in Atlanta. And then this is our picture  from last Christmas meeting party with our recent fellow, Dr. Mahasin was there with our current fellow, Dr. Priya. So thank you very much. That is a very brief overview  of our Braintree Fellowship Program. I'm sure that you will have a fantastic exposure to the four steps in the presentation. All right, I'm gonna go ahead and try to log out.  And I think next up is Dr. Desai from Carolina Rehabilitation. Thank you, Dr. Desai.  Thanks, Dr. Nguyen. Let's see if we can get this started.  All righty. So my name is Dr. Seema Desai. I am the Brain Injury Fellowship Program Director at Carolinas Rehabilitation in Charlotte, North Carolina.  I'm also an assistant professor through the Wake Forest School of Medicine, which is one of our recent partnerships, which is very exciting.  We recently built a new rehab hospital, which is very exciting. It's called the David L. Conlin Rehabilitation Center, but because that's a mouthful to say every day,  we just still call it Carolinas Rehab. We have 72 private rooms, which is really nice. We used to have like a 1940s building with shared rooms everywhere.  So this is a nice little upgrade. And the fourth floor is our brain injury dedicated unit with the 24 beds of which 12 of those beds  are on a locked unit called our neurobehavioral unit where patients can go and wander a little bit or if they just have more behavioral needs.  So just tell you a little bit about our hospital. Again, we are 72 beds. We are a tertiary referral center. And so we get a majority of our patients from our next door hospital,  which is Carolinas Medical Center, which is the level one trauma hospital, one of the few level one trauma hospitals in the state. In addition to a brain injury fellowship program,  we have a residency program, a cancer fellowship program and a spinal cord program. So a lot of times it's really nice for our fellow to make friends with the other fellows  and develop a relationship and friendship. We have a lot of subspecialty clinics. We have stroke, P&O, TBI, spinal cord, oncology, ALS, EMG  and pediatrics as well, which includes traumatic brain injury and concussion. Within the brain injury fellowship itself, we have spasticity clinic, baclofen pump clinic  and adult hydrocephalus clinic that's run by our neurosurgical team. Neuropsych clinic run by a variety of our neuropsychologists.  Movement disorder clinic that's run by our neurologists who specialize in movement. Sports medicine, both from an adult and pediatric side. PTSD and TBI clinic,  which is actually run by a neuropsychiatrist at the VA and headache clinic as well run by our neurology team. These are all outpatient opportunities  to work with all different sorts of specialists, including neuroradiology, I forgot to add that in there.  Just some nice things to know about our program. We do have a DOC program where we take on obviously disorders of consciousness patients. We call it our ERP program,  which is emerging response program. We do have a locked neurobehavioral unit as well as a reduced stimulation program. This is run by one of our psychologists  where we're able to come up with a neurobehavioral plan for the patient and we meet every day to ensure that plan is being executed. We're CARF accredited.  We are a TBI model system follow-up site for three straight cycles at this point, which was 15 years. And as a follow-up site, we still have all our data  from when we were a major TBI model system site. So we have about a thousand patients in our registry where we can still use all that data to look at retrospectively.  And we're also the owner of the Ecuador system. There are several other hospital systems that are also part of this. Another great place to pull data from,  especially if you have a big enjoyment with research.  So what does your typical day look like? So typically if you're on inpatient, you'll round in the morning, you get admissions in the afternoon, and then you have a continuity clinic  that's all year round, which is Wednesday morning and Thursday afternoon, which is with myself and one of my other brain injury colleagues, Dr. Crawford. When you're on outpatient,  you have the variety to kind of choose from lots of different clinics. So a lot of times we will ensure that you kind of get the most exposure that you're interested in  and tailor your outpatient experience so that you're getting a little bit of everything.  During your outpatient clinic, you still maintain your continuity clinic. So that's throughout the entire year so that you are seeing these patients, get to know them,  get to inject them, refill their pumps, and you're seeing them multiple times throughout the year to develop that relationship. You also have just a dedicated consult month  with our Level 1 Trauma Center. And on that, you go to what we call flash rounds, which is with our surgical ICU team. And that's every morning at 8.30  where you quickly flash through all 30 patients that they have up there and determine if any rehab needs they need, or do you just need a consult?  Do you need to help their storming? Do you need to help their agitation? And to ensure that they're not using that favorite Haldol that they sometimes were using  before we were on service. And then scholarly activity as well is intermixed throughout your year, specifically more on your outpatient months when you have some more time.  Just like UT Southwestern, we have a lot of different committees that you can join, whether it's advocacy committees like the Brain Injury Association of North Carolina,  where they meet every week on our unit, or there's also program committee meetings, program management meetings with therapy  and other educational opportunities.  We do have some structured education. We meet every week with the fellow and go through a pretty extensive didactic series along with journal clubs, mock orals,  and then the opportunity to teach residents as well. Not only can you attend your own brain injury fellowship education, but you have the opportunity  to go to some of the resident lectures if you want as well. And then typically a grand rounds of your choosing on a topic that you find interested to you to present to the staff.  And that's it for me. I will turn it over to Dr. Sabini, I think.  Sabini, I think.  Okay. Good evening, everyone. So my name is Rosanna Sabini. I'm the program director at the Zucker School of Medicine, Hofstra slash Northwell. Try saying that a few times.  I'm currently the professor there for the Department of Human R, and as well as the chair at the hospital that I'm located at. And I run the concussion program.  Okay.  Now, where's my screen for the PowerPoint? There it is. Okay. So these are the locations. So we're located on Long Island. So we're surrounded by water.  These are the locations that you will find our hospitals.  South Shore is down here, and they're actually building another tower. We're all about knocking stuff down and building bigger and better in New York.  So we're growing. We are now officially a university hospital. And Glen Cove, which is where our inpatient rehab is located up here, was recently moved up  in the standing for U.S. News Best Rehab Hospitals, up to 24. So we beat a few of you out there.  Okay, so history of our fellowship. We were initially accredited back in 2017, and we've had five fellows graduate since then. Our hospital system is very large  and located throughout the Westchester, Manhattan, Staten Island, Queens, Brooklyn, Long Island area.  So there's a lot of opportunities for the fellow to really decide based on their interests to fine tune and follow some of my colleagues. So I trained at Mount Sinai,  did my brain injury fellowship at Pittsburgh. Here are some of the recent scholarships that I do, notable mentions. So I try to stay academically active along with my fellows  as we try to drive them into that more academic lifestyle  and future. This is our core faculty. Some are fairly new, so they don't have their photos. Dr. Bloom is for our research. Dr. Khan and Dr. Hu are on inpatient at Glen Cove.  Dr. Ramrook is also on inpatient. She is one of my former fellows who has joined our team. And Dr. Waldman is our new neuropsychologist  for the Eastern region.  This is our educational curriculum. So it's a bit different. We do a Monday through Friday schedule where you're looking at just being at a different place  for a couple of times of the weeks where we focus on consults and outpatient when you're with me. And you'll focus on inpatient and outpatient  when you're at Glen Cove for your inpatient rotation. And then we do dedicate time for didactics and research every Friday.  Each location tries to focus on one specific aspect of the brain injury continuum.  The beauty of this is that the traumas that we see at South Shore where I'm located will sometimes go to Glen Cove. So you're seeing them, let's say on a Monday,  and then they could get discharged the following week to Glen Cove. So you're continually following their course of care.  I try to be as flexible with trying to create  a more individualized fellowship program to cater some interests that a fellow may particularly want. So my former fellow, Dr. Varchuk,  she really enjoyed the neuro rehab aspects. So she got to rotate with my neuro colleagues in the ICU, the trauma colleagues for another week and the stroke service for another week.  There's certainly ample time in the schedule to achieve that academic opportunities and certainly complete the fellow lectures to get them ready for the boards.  Like I said, Long Island, you go east, you're in the Hamptons, you go west, you're in the city. You can't be flanked by two better places.  So this is our current fellow, Dr. Hall, who recently came to us from New York Presbyterian. Everyone just took their boards today. So she's looking to really come back  after an exhaustive day today.  So why choose our program? I mean, we have a very large extensive health system. There's flexibility to try to mold the year into a unique experience.  I really treat the fellows as a junior attending to be actively involved and also teach the residents at times take even first call for in-house calls  when you're staying a little bit later, there is no call. Our rehab network is extensive and we have a very robust concussion programs that looks to really keep up to date  with the treatment guidelines. And we also have the fellow present at the annual brain injury conference. So it's really there to develop the academic growth  but also networking community involvement as well. And just some of the things to consider, just know that when you're interviewing to just ask about how the program will help you  with job interviews and contract negotiations about billing and documentation. Try to get to know the program director a little bit more personally.  See if you have special interests and see if they can provide it. Ask about where previous fellows have gone, reach out to former fellows  and read all the instructions for interviews.  Those are some of my perks. So, and I'll take questions at the end. Thank you. And I'll pass it on to Dr. John  from the University of W Washington. Yes. Thank you for that introduction. Can everybody see the slides?  Okay. All right. So thank you. So I'm Cherry John. I'm one of the program directors here representing the West Coast from Seattle.  I think, so I get to still say that it's 5.30. So right outside right now. So just quickly about me, I went to university, sorry, Boston University for my medical school  and then went to MedStar Georgetown in Washington DC for my PM&R residency. And then I moved to the West Coast for my fellowship.  So I got to experience kind of different health system in a different region. And I wanna just highlight what makes us unique in University of Washington here in Seattle.  So a couple of things, I think I do have to say, I'm really happy to be in brain and dream medicine community because it's such a great field and I love being able to correspond  and work with those who are in the field. So I really do wanna just say that all of us, I think take a lot of pride in our fellowship and what we do.  And I think one thing that I think we are trying to make sure for our program, because we are a hospital based rehab program, our rehab unit is in the hospital for both sites  and fellows have to work a lot within the big academic health system. So being able to figure out how you integrate yourself in a kind of a world where you,  it's not just the rehab hospital, you're working with the other folks all over the kind of trauma council and everything is a different experience. I think that people are used to,  at least that's how it felt for me when I came here. So I wanna make sure that we continue to help people grow in that aspect. The other part that I really love about brain injury,  I think is the continuing education and you're always learning from all sources. So that gets highlighted here from all the folks. And I think that's true for other programs too.  And I think, again, we do try to make this individualized as possible based on all the kind of the, all the specialty sites that are available, which is great.  And that does help to figure out if you know which part of brain injury, one, you're not familiar with and wanna grow or two, if you have special interest  and wanna do more of, that's always helpful. So think about that as you're looking to grow your pathway.  And then this is our program leadership and faculty and there's quite a few of us. I do wanna just highlight Dr. Hoffman because she's wonderful addition  and is the TBI model system director for our site. And then we also have a few physicians who work at Seattle Children's and they do a lot of brain injury.  So they also work with our fellows, which is wonderful. And then quickly about our rotation sites, we serve a really big wide region. I think that's a little bit different  if you think about how many level one trauma centers are in New York and Boston, it's not the same out here. Maybe all due to sort of population density and everything.  Harborview is really one of the few level one trauma centers here in this whole region. And we have patients who fly in from all over and how that changes and makes you creative  in terms of trying to treat people, especially when they're discharging to middle of Alaska where they have really minimal outpatient therapy opportunities as well.  So, and then Harborview Medical Center, this is a primary site for the fellowship. It is the only level one trauma center for the whole state.  And then we do see a lot of brain injury because of that. And this is the site where the fellow does the consults and then inpatient as well as half a day  of continuity clinic for the whole year. And then also other specialty clinics. Continuity clinics happen at two different sites, one at Harborview and the next one  at the University of Washington Medical Center that I'll show you. But both sites are a little bit different in terms of who you see. A lot of the time at Harborview,  you are serving those who are coming from all over and the hospital mission is to serve those in King County who may be most vulnerable in population  and brain injury most definitely falls into that category for many.  And then University of Washington Medical Center, Montlake Campus, this is where the other continuity clinic happens, lot of concussion and then both sites  you have spasticity follow-ups. But because of kind of the nature of patients who are seen there, it can be more of CNS cancer related  or related to transplant or cardiac disease issues that have resulted as a consequence.  And then last site is Seattle Children's Hospital. It's such a wonderful hospital and I love going there as a fellow. And the consults and outpatient clinic show you  how to return somebody to sports as well as school after a injury. And I think that for us, I wanna make sure that fellows get a good chance to teach  and it's different ways to teach in the lectures and the different audience. It can be to the PM&R residency, but fellows have also lectured to our rehab,  other learners, so PT, PhD program, OT and speech therapy.  There are a lot of those who go through that and the fellows have given lectures there as well as to rehab psychology and neuropsychologist. We've had that as well as reaching out  to other departments like neurology and surgery have also been involved with our fellows and kind of try to grow each other's education.  And then the other part that we recommend to the fellows is going to how to teach lectures and the climb that gets put on by the University of Washington,  graduate medical education. There's a whole certificate program on how to improve teaching, which has been beneficial.  And then lastly, these are our previous and current fellows since we became ACGME accredited  and they've done a lot of great things. Dr. Plummer is at Vanderbilt. Dr. Abraham is back in Texas actually, starting her own sort of path in terms of growing new SNF work as well.  And Dr. Mehta is doing consults in Ohio. Dr. Gimmark is in Spokane actually and teaching the residency. And Dr. Smith, who just graduated, will be joining our faculty  and Dr. Wallingford will join us.  She starts her fellowship in August. We have a, we ask that the fellows start in August, so she'll be starting tomorrow. And that's it from me.  And I think the next is Dr. Franzese, so.  Everybody hear me okay?  No cicadas still?  Okay, very good. Let me take over here.  Everybody see my screen? Okay. Hi, I'm Kevin Franzese. I'm the Assistant Program Director for the Brain Injury Fellowship at the University of  Pittsburgh and University of Pittsburgh Medical Center. Very happy to be here to rep our program. First, a bit about Pittsburgh.  Pittsburgh is not just the cloudiest city in America. It's also a thriving mini metropolis with varied and interesting things to do.  I say that as a native New Yorker who came here with some concerns about things, about life I'd be having at Pittsburgh. I want to just disabuse you of any concerns you might have,  except for the bagel situation is not good in Pittsburgh, but the rest of it is fine. It's really a wonderful place to live. I've been very happy out here for the past seven years.  It's the city of bridges. There's like a million bridges. That's what happens when you make the steel. It's cheap. There's plenty of things to do indoors and outdoors.  Dr. Galant takes everybody biking all over the place, sometimes causing injuries to faculty and trainees. Something to look forward to. These are our core faculty.  Dr. Amy Wagner is our Program Director who is involved in research and our consult service. Me and myself, I'm the Assistant Program Director. I'm very involved in resident and  trainee education at large in medical school. I have inpatient, outpatient, and consult responsibilities. Then Dr. Galant also had inpatient, outpatient responsibilities and runs  a spasticity clinic and other outpatient activity.  Details about our fellowship, we're ACG accredited with commendation. We have two slots this year. Last year, we had our first two fellows.  We use a rotating format now with the two trainees. There's two major tracks that you would go on. You either have a three-month block on inpatient and have your continuity clinics,  or you'd be on the other rotation, the B rotation, where you'd be on our consult service with your clinics or your electives, and you'd rotate back and forth every  three months with your counterpart. These are resident supported services, so lots of opportunities to practice as an attending, supervising, and teaching,  and also rolling up your sleeves and getting your hands wet. There's no call unless you want to take call in the faculty pool at some of the other sites,  which is an option. The fellow was invited to participate in some of the residency focus track opportunities. The residents have focus tracks in medical education and  administration which are both available in one-year opportunities to the fellow. The fellow gets one-half day per week protected for research activities or other projects,  and there are just multitudinous opportunities for education and research at Pitt. As far as educational activities, like I said,  there are bimonthly reverse lectures based on reading. In that, we would give you a reading list, and you would create a lecture,  then teach me and your counterpart about it every other week. Then also on the corresponding Friday, we have interdisciplinary lunch and learn, where you would lead  educational activities with the entire rehab institute. You'd be teaching a group of physical occupational, speech therapists, nurses, administrators. It's very well attended.  It was born out of my interest in neuroradiology. I would just go to the rehab gym during lunch and pull up scans, and talk about the scans with the staff,  and then people started coming to that. Out of that, we now do basically whatever you're interested in lately, you can come and talk to the team about.  There's opportunities to teach the residents weekly brain injury topics on the unit, grand rounds, the fellows participate in the resident core lecture series.  We also do journal clubs out about in the city, which is really just an excuse for galore to take you out to have dinner somewhere, which are well attended.  We have lots of electives. We can conform these to whatever your interests are, but Pitt has a robust bioengineering department.  The Center for Assistive Technology is popular to see how a lot of the things that we use for patients are made or customized to their needs.  There's a concussion elective, neurophysiology. I would just make a point, you get core concussion experience through me, but if you actually are concussion clinic is  adjacent to the larger UPMT concussion program, and if you want to have immersed experience with that specifically, we can build that for you.  Neurophysiology, headache management, mood disorders, neurocritical care, neuro-ophthalmology and otology, neurosurgery, neuropsychology, neuroradiology,  TNO, sleep and spasticity management. Lots of options for you to burnish your skills. As far as our clinical sites, UPMT Presbyterian and Montefiore Hospital  is like the flagship hospital for the University of Pittsburgh Medical Center. It's a 900-bed level one trauma center. It's going to have even more beds.  They somehow found a way to squeeze another tower onto the footprint of that building, and it's on the way up. They said it was just going to be for solid organ transplants,  but I think we're actually going to have rehab space there too. I'm sure they'll find a way to get us over there for consults. Anyway, that clinical site is where  our acute care brain injury consult service lives. That's a five-day a week dedicated brain injury consult service that brain injury physiatrists staff.  We follow patients with a consult, a first resort for neurostimulation, agitation, dysautonomia, spasticity. We'll carry around a squat box and inject patients on the units.  We round in several of the ICUs at Presbyterian, including the neuro ICU and the neurosurgical ICU, where we help shepherd patients from there to the floors.  There is an embedded LTAC inside of this hospital system where we're credentialed, and so we can actually have patients who aren't quite ready for  IPR transition to the LTAC where we'll follow and co-manage them there until they're ready for IPR. There's also a spasticity clinic, one of our faculty, Dr. Noonan, is out there.  Lots of unique opportunities at Presbyterian. Then there's the Freddie Pooh Sports Medicine Center. This is where the Steelers practice and Pitt practice.  The orthopedics has their concussion clinic with Dr. Collins, where you can get exposure to sports neuropsychology, vestibular musculoskeletal exertion therapy,  and my clinic is there too, where I manage the medical aspects of these patients' needs. Then this is where you're going to be spending most of your time.  UPMC Mercy is a level 1 trauma center with 400 beds. They just built a new outpatient and research building called The Pavilion. They wanted a fancy name for that.  That's where a lot of our research labs are. The beds change with COVID, but at this time, for your purposes, we have a 26-bed neurorehab unit plus  an 18-bed locked service for our behaviorally complicated patients, where we also host our Disorders of Consciousness program, which has been active since 2015.  It's a unique program that patients stay for a bit longer than a lot of places can offer, and we're very proud of our two-thirds community discharge rate  regardless of outcome for those patients. We have our outpatient continuity clinics there and also do specificity management there. As far as community engagement opportunities,  there is a support group that the fellow was involved with. We have Dr. Max Hurwitz, joined us from Washington several years ago, and has launched a street medicine service.  As you know, or you will come to know, traumatic brain injury is a tragic comorbidity associated with being unhoused, and we are eager to integrate  our brain injury service into the street medicine offerings, and that's something the fellow will be able to be involved with. We host our annual regional brain injury conference  that the fellow was encouraged to present at. We are involved with Synapse, which is one of our former trainees. Alyssa Totman has  a undergraduate traumatic brain injury interest and support group that we mentor the participants at Pitt through that, which the fellow can be involved with,  and we also are involved with the Brain Injury Association of Pennsylvania. As you can see, I'm presenting through dusk. It's getting dark out here,  but thank you for letting me talk about my program, and I'm happy to open the floor for questions to everybody, I think.  Fantastic. Well, thank you, everyone, for taking part of this program tonight. As you can see, you have really great outstanding samples of  program director being here to answer questions for you, and I think the common theme or common thread that everyone see is,  all of the brain injury fellowship program are fantastic, that they are really dedicated to provide you with opportunities to be a successful brain injury specialist,  no matter where you happen to be. But at this time, we would love to have a chance to answer any question that you may have for us.  The first question is for me, the pizza in Pittsburgh is hit or miss, but there are several places that are up to my standards,  and also my wife's standards, who's from Coney Island. So you can get your pizza fix if you need it in Pittsburgh.  Don't let me steer you wrong, I'll point you in the right direction.  Any other questions? Besides, I have a question. Kevin, so is the Costco pizza at Pittsburgh any different from Costco pizza at, let's say, Texas or New Jersey?  It's exactly the same. I don't know how it is. The chicken bake is the same. The roast chickens are the same. They probably all come from the same factory in Ohio or something in the middle of the country. They just banded out to the rest of the union.  All right.  There's a question in the chat.  Okay. Yeah, go ahead. Can you read that for us? Sure. Megan asks if our residency program does not have an associated fellowship, is it important to try to arrange an away rotation? And then the follow up to that. Also, is it important to get a letter of recommendation from a brain injury specialist?  Would you like to answer that person? We can go around and add on.  Sure, of course, I think that realistically, if you can get a rotation away rotation in, that would be good for you so that you can kind of figure out what you're interested in and how different places are at.  But I also understand that logistically, not all residencies will give you that time to do so. So it does give you some idea of if you want to go to a different place and actually live there for a year and give you that info. But I don't think it's absolutely necessary. Many people cannot do it as well.  And in terms of getting a letter from a brain injury specialist, again, I think a lot of the times I've seen it with a specialist, which is great, but many also could not just because of the limitations of their kind of how their rotation worked and whatnot. So it really is important, I think, for your letter to showcase your strengths from somebody that you've worked with closely.  Great. Dr. Sabini, any suggestions from you?  So I'm a fan of folks to spread their wings and look at other places. I guess for logistical reasons, I was at Sinai and they hadn't yet at that time had a fellowship there.  But I think if they did, I would have really missed out on the opportunity to train at Pittsburgh, which was great. So and that's not that's not a plug to you, Dr. Francesi.  So because the pizza is better here. So I think it's important because if you can, if your interest is in brain injury, the program should have probably already offered everything that you need. And it's always good to look and see what other people are doing out there, their perspectives.  So I think that it may be relatively important to show your demonstrated interest in brain injury by having a letter from them. I only say that because sometimes programs, at least mine, will get some questionable applicants who are applying to multiple fellowships and may may choose to have that as a backup.  This happened a couple of times when our applications were really high. But I you know, I don't. And, you know, the stakes for maybe sports medicine is getting more difficult and people just want to get into a fellowship. I'm not sure why.  So, yeah. So you can even think about not doing a fellowship. But anyway, that's my answer.  All right, great. Dr. Seussai?  I'd probably just echo what Dr. Jun says. It's great if you can do an away elective. I know we've had some folks from programs that don't have a fellowship. And so they were able to do an away elective and really enjoyed it.  You know, we're in North Carolina, so it definitely is, you know, a trek for some people to come to us. And so we do our best to try to help with housing and things like that. But, you know, it's a lot to just try to come somewhere for a month.  But I think it gives you a really real experience of what it's like to be a fellow because we do make sure that you have like a little mini exposure of everything. You know, you do a week of inpatient, you do a week of outpatient, you do a week of consults, and then, you know, do a hodgepodge of things to really like figure out what would fellowship be like.  And so I think that's really important to figure out, you know, what you're looking for in fellowship, because when you start fellowship, it's usually, you know, July, and you're probably going to start looking for jobs in like mid-September to October. So you kind of have to have an idea of like what your interests are, kind of going even applying to fellowship, you know, do you really enjoy inpatient or do you enjoy outpatient? And then you can figure that part out in fellowship too, but it just gives you a head start.  Great. Dr. Prenzi?  I don't have a lot more to throw on top of that wisdom, but I would just add that I'm sympathetic to the plight of some trainees who are in experience, who experience environments are less rich than others. I get that. But when I'm looking at, to echo what Dr. Savini said, when I'm looking at someone's file, and I see very little exposure to the field, and also, like, do you have the ability to do that?  The elective is kind of evidence of you proactively trying to broaden your experience, because, you know, one of the things, the questions I ask myself when I look at someone's file is, have you experienced our field so you know what you're getting into, so you have a vision for what your goals are for yourself, right?  So, if you haven't had a rotation in brain injury, or you haven't worked with someone who does this, you better acquit yourself very well that you have a vision for what your career is going to be like and what you're trying to get out of fellowship because you probably haven't had that experience yet.  So, there are multiple ways to show that you have had some experience in BI. If you're in one of those places, then I would say get involved in the interest groups in your national organizations, the parent universities if possible, talk to people in other areas, in other departments, and try and find some other ways to have some experiences they could write about for you in a letter.  Great, fantastic. So, again, I'm going to share with you my observation. So, of our 13 fellows, only one of them did the away elective with us, and he matched to our program. Now, my thought is similar to everyone here. We would actually encourage our residents to explore other opportunities to see how things work in another setting.  So, for our, most of our, actually all of our residents who are interested in brain injury medicine match a different program among some of the ones who spoke today. And so I think that's great that you should find other areas, because not two programs, each program does things separately.  And the other thing is you're going to be living somewhere for a year. Make sure that you're comfortable with that environment. I know that now with virtual, we have a lot more people who apply. So, you know, but at least in our program, we won't pay for you to come out to see the program, but we do offer like a stipend to offset some of the costs.  Now, I know it's expensive, so you can't go everywhere, but based on what I've heard today, and based on my interaction with other program director, I don't think there's a program that you can go wrong. You just have to find a place that will make you, will allow you to be the best brain injury physician that you will be, and to make sure that that's a good place for you, and maybe, and also your family, if you happen to be married. Thank you.  Great. Any other questions that you guys may have for our panelists?  I think there's another one here in the chat about procedure minimums for brain injury fellowships, and do your programs keep track of the fellow procedures, example, intrathecal vacillin refills, toxin, and do you offer opportunities for greater proficiency if needed?  Great. Thank you, Dr. Desai. Can you go ahead and start?  Sure. So the ACGME does not have procedure minimums for brain injury fellowships. However, in our fellowship, we do keep track. We actually ask the fellow to keep a tally, an Excel sheet, actually, so we can look at it, and it's on our, like, our shared drive, so everyone, all the faculty can, who are working with the fellow, can look at it. So that's how we keep track.  The second part of your question is, do you offer opportunities for greater proficiency? Yes, we do. I am kind of constantly looking at their procedure log to see, okay, it's been three months since you've been here. Okay, how many toxins have you done? How many pump refills have you done? How many phenols have you done? So I am looking at those things and ensuring that I'm happy with the number so that we're not cramming it all in.  At the end, because you don't want to get to, like, January and be like, oh, my gosh, you're really behind in the amount of toxins that you really need to be proficient. So that's something I keep track of, as well as my colleagues who work with the fellow.  Great. Thank you. Dr. Francine, can you share with the applicant your experience?  Well, now I feel lazy. We don't count our fellows' procedures. But we're fortunate to have a procedure-rich environment in our institution. So the fellows have dedicated clinics for pumps, spasticity, and other related procedures.  And we sort of go by our impression of how the fellow is doing when we review them intermittently and also the fellow's sense of efficacy and familiarity and confidence.  And if coming through the year, there are specific things that you have concerns about, we would find ways to facilitate more exposure to that to get you up to where you want to be.  Like, for example, two years ago, there was a fellow who was very keen to get as much pump management as possible. And so what we did when he wrapped up his research project, we sort of spent some of his half days per week that he would normally have for protected time to go jump over to Dr. Horton's clinic and steal some more pumps from residents just so he could get some more exposure with that.  So we'll facilitate whatever your needs are to make you feel confident when you come out of here that you can practice the kind of brain injury psychiatry you want to practice.  Thank you.  Okay, next, Dr. Han.  Oh, I'm sorry. May I speak to Dr. Sabini?  So we keep track, but I feel like we don't really need to because we're constantly doing  this on a weekly basis.  You know, our role as faculty is to pretty much give you hands on and you're running the show by a few months. So it's all about  garnering expertise, confidence to be able to do it on your own. So once you achieve that, it doesn't matter how many you have.  Thank you. So like Dr. Desai mentioned earlier, it's not a requirement you have an X number of procedures from during your brain injury fellowship.  However, we do require the fellow to keep a log to let us know how many they have done because I know when you apply for attending privileges, some hospital would actually ask the number of procedures you have done just to make sure that you're competent in that procedure.  So we always encourage our fellow to do that. Now, we also have a spasticity fellowship here at UT Southwestern. So our brain injury medicine also attend the spasticity clinic, you know, every week for like three months.  But they will also have opportunities to do more if they so desire. So again, I think our fellowship has a lot of flexibility like most of the fellowship you've heard here today.  There will be plenty of opportunities for the fellow if they want to pursue a certain area of interest. Thank you.  Any other questions you guys have for today?  Oh, great. Thank you, Candice for posting the link site to the virtual campus. I'm going to make sure that I will forward this to our residents, because they may not have a chance to watch this today.  Thank you. Anyone else have any questions?

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This one hour panel-style discussion will include a general introduction about the fellowship and the core components of the fellowship, followed by Q&A.

Presenters: Dr. Amy Wagner, Dr. Cherry Junn, Dr. Kevin Franzese, Dr. Rosanna Sabini, Dr. Sima Desai, and Dr. Benjamin Nguyen