Today, we are going to be talking about research in physiatry. And I have four folks with you to talk about how they conduct research, what got them interested in research, what their career looks like, all that kind of stuff. We have a medical student just about to finish up resident, and then two faculty here to talk with you guys. So I'm going to go ahead and hand it off to them. They'll do a little bit of introduction for you guys, talk to you a little bit about what they do, and then we'll open it up to questions. We have a few that were sent in ahead of time, but then you'll be able to put them in the chat box or unmute and ask your questions yourself if you'd like. So since you are first on my screen, Randy, I'm going to turn it over to you to start. Okay, great. You can hear me? So I'm Randall Swanson. I'm at the University of Pennsylvania and the Philadelphia VA. I've been in attending for eight years. Long and short is, so I was in a combined med PhD program. I did the first year as a med school, and I was doing research during that time. I left. I did three years of purely in the lab, basic science, PhD in cell and molecular biology. I went back to the third year of medical school while I was writing my dissertation. I completed medical school, did residency training at Moss and Temple back when it was a combined program. I'm sub-specialty board certified in brain injury, although I didn't do a fellowship because I trained there at Moss with John White and those guys. I just went into practice. I practiced for three years and then sat and took the brain injury boards. So I, although I had a PhD, I did not do a postdoc or anything. I had about five publications. I was in the rehabilitation medical scientist training program as a medical student. And so John White and Mike Boninger and those guys helped me negotiate for my first job where I went in and what Penn has is called the CE track. So it's a physician scientist track where you get 30% protected time for research for the first three years. And I also got a small, modest startup package of around $50,000. So I started, I wrote my first grant, which was a K award, which was funded to do some preclinical work in traumatic brain injury using a large animal pig model. So I got that, that bought out 75% of my time for about a year and a half, and then make a long story short, the national program lost funding. So nine of us across the country lost funding. So then I went back to doing clinical work, primarily, you know, like 90% of my time for about three years. I was a co-investigator on another grant during that time. And then I successfully wrote and got a VA career development award for another three years to give me a total of five years of career development funding. So I have a VA career development award. I have a department of defense grant. We have three other grants we just submitted. And I have what's called an IPA from the federal government. So the federal government, they've got these centers for brain injury and for injuries after the military. And instead of getting a grant, there's mechanisms where you can get directly paid from the government to do, to work as an expert for them. So 10% of my salary is being bought out for that. So anyways, I go back and forth. I guess I'm mostly a clinician. It's been about 50-50 over the last eight years. And I've gone back and forth as funding has come and gone. So I guess I'll stop there. All right. Maggie, do you want to go ahead? Hi, I'm Maggie Atkinson. I'm a medical student. I'm only a couple months into my third year. So I think I'm on the complete opposite end of the research spectrum there. But I kind of got into research through the REMS program, through the AAP, where last summer I spent the summer at Shirley Ryan doing kind of clinical research on knee osteoarthritis. And then that allowed me to be able to go to the AAP conference in February, where I was able to present my research and had just a ton of fun, like meeting up with other medical students, talking about how their research is looking and what their journey is like, and even what they're doing with their different clubs and stuff like that. And then also just get to see how the research world looks in academia as well, which I thought was a very valuable experience for myself. And then, yeah, now I'm just... Our school in Phoenix doesn't have a lot of physiatrists doing research around us. So just trying to look for different other little options and to stay in the research world there. Okay, you're up next. Hey, hello, everybody. I have a few slides that I will share, hopefully. It kind of helps with the conversation. All right. Everyone see the slides okay? All right. So I'm a vocarier adult. I am currently at the University of Minnesota and transitioning to the University of Washington soon. I thought I would kind of share a little bit about my background. So slightly different course, and I think it's the entire purpose of having a panel a little bit different pathways. I attended medical school at the University of Nigeria. And subsequently came to the University of Mississippi, where I did a PhD in health and kinesiology. So kind of separate processes for medical training and subsequent graduate school training there. My focus is in physical activity epidemiology. Worked for one year as faculty at the University of Mississippi before transitioning to the University of Minnesota for residency. I will be finishing on Friday. So super excited. And then transitioning to the University of Washington for a physician researcher position primarily focused in stroke rehabilitation. During my time in residency, I also served as the resident of fellow councils, research representative. And so hoping that, you know, just kind of show a little bit more about what my scientific domain, physical activity, behavioral epidemiology looks like. This is one model put together by Salis and Owen that tries to talk about the different facets of what physical activity epidemiology could look like. And so on the kind of first two blocks on the left, there are some studies that really are primarily focused on looking at links between physical activity and health. Those are pretty common. So how does physical activity associate with stroke outcomes and stroke prevention or secondary stroke prevention? And then there are studies that are primarily focused on how do you measure, how do you properly quantify physical activity? Because if we can't do that accurately, then that also kind of influences the accuracy of all other facets of our studies that we conduct. And then we look at correlates. And so this is where we look at things like demographic correlates with physical activity. We look at behavioral models and how those may correlate with predicting habitual physical activity behavior. And then applying all of this information, we test interventions. We look at the stroke population, kind of think about patients in the acute rehab setting and long-term settings and looking at interventions that can influence long-term physical activity behavior. And how do we translate this into clinical practice, right? So how do we use evidence-based measures to positively drive physical activity behavior in our rehab patients? So that is my scientific, the background for my scientific interest. And I am specifically interested in more translational-based research. And so kind of putting it briefly, I study evidence-based methods for clinical systems to efficiently provide tailored support for long-term physical activity following neurological injury. I thought this might be a good point to, as we kind of dive into introductions, to just thoughts, also kind of earlier in this process, as you'll find is intentionally done with our panel. And so when you pick a scientific domain, always think about your personal interest. Think about what you're intrinsically motivated to look at. What are you passionate about? I think it's one of the first things that you should critically think about. And then how does this fill a gap in clinical practice or gap in the literature in general? You also want to think about how feasible it is if you're picking a specific research project to work on in medical school or in residency, because we're limited by time and a lot of responsibilities. And to speak more to this feasibility, we have a podcast that's kind of recently been put out that you should check out if you already haven't done so. Dan, who's on the panel, was our faculty, provided faculty supervision with the creation of this podcast. So check it out. It lays out just a couple ideas on things that are feasible in medical school that may help you also think about how a research path might be important for your career. I always say, I think about this in two ways. As a primary clinician, you want to be able to distill the literature and look at things objectively. And so it's very important to have that background of how do I look at articles and make an impression and have conversations with patients as a user of this information. And then you may also be on the other side where you're a creator of information as well. And so I think it's important, either way you fall into it, I think it's important to have a fair idea of the research process. And it's a team science, so being involved in various avenues to do AAP is helpful for this process. So in medical school, there are options as medical students, as you can see on the panel, a lot of us are also involved in RMSTP, which could also provide some mentoring. And so that's something to keep an eye out for through AAP that may help connect medical students who are in institutions, especially where you don't have a strong research support to connect with faculty across the AAP. And this just kind of points out, just highlights from the Research 101 podcast, some things that might be more feasible during your time in medical school to think about as potential research products that you could work on. All right, that's a brief summary. I know Amy is going to send out my email information, but I am transitioning roles, and so my email will change by Friday. I just wanted anyone who needs that to have direct access to it as well. All right, that's all I got. I'll pass it over to Dan. Thanks, Oki, that was awesome. Actually, I particularly appreciated the idea of how to find a research domain. I think all of us will be able to probably expand on that as well. Like you, I also put together a couple of slides just to keep myself honest, and so I'll share those now. But I also wanted to say at the outset that Randy was being incredibly modest here. He's been an incredibly successful clinician and researcher with a couple of JAMA papers, and so he's definitely a great resource to pick his brain while you guys are here. Just a little bit about my path. I started out doing – I did undergrad at MIT where I studied neuroscience, and that took me into an MD-PhD position at Boston University just across the river where I focused on Alzheimer's. That all changed when a 6'8", former professional wrestler walked into my boss's office asking about the long-term impacts or repetitive head impacts and its relationship with Alzheimer's disease. That got me down a path that led me to study chronic traumatic encephalopathy, or CTE, and then now also ALS, so basically the long-term neurodegenerative sequelae. There's been a lot of press related to this disease process, including some of the press related to our work, but there hasn't been as much research related to it. This is when I got started, and the research was around here. Here we have just the number of Google – the log transform number of Google hits related to news stories about the CTE research, but you can see that the actual number of research publications on a linear scale, there really weren't very many. I started here, and then there's been fortunately a lot, and this is something I haven't updated in about 10 years, but there's been an exponential growth in the number of publications. Actually, sorry, this is one I put together about three years ago. This is the actual number of publications that have increased, again, with some of our key findings along the way here, but the idea is that you can – I was lucky enough to get involved very early on in this domain, and so I completed my PhD in this work, dropping that Alzheimer's work completely, and then did a postdoc year before going back to medical school, and that led me to doing residency over at Stanford, where I continued doing some research, and now I'm a faculty at Harvard Spalding, and I just wanted to give – so I continue doing work here. I'm 80 percent research, 20 percent clinical, and just wanted to highlight a particularly exciting study that we had published last week in Nature Communications, where we basically better understand the risk factors associated with repetitive head impacts and how they result in CTE, where basically the cumulative force that people are exposed to increases their likelihood of getting this disease process and increases their risk of the disease, and that was covered in the New York Times. This is the front page of the sports section, actually. They dedicate an entire page to our research, so that was pretty neat, and with that, I will be happy to talk about any questions. So, we did have questions submitted ahead of time, so maybe we'll go ahead and start with those, and then that'll give folks some time to put questions in the chat box. So, let's start with one that I know gets asked a lot and is on a lot of people's minds. How did PM&R research to get into residencies? Go ahead, if you wanted to start. I was going to say, you don't need it, but it doesn't hurt, right? It's one of those things where, unfortunately, even in the last decade when I was an applicant and to now, the quality of the applicants has certainly improved substantially, and the hidden gem of PM&R has become not-so-hidden, and so certainly research helps, especially if you want to get into one of the top-tier programs, but I know in our program and probably true in many programs, there's a diverse set of interests amongst the residents. Not everybody comes in having had a lot of research, and not everybody leaves having done research. Yeah, I would agree. I will say that in the past couple of years since COVID, I think it's made a bigger impact when you have so many more applicants and everything's being done through virtual interviews and stuff, then we need ways to filter out the residents. That being said, I can only speak for myself, so I've been on the admissions committee. I think I've done it like six out of the eight years I've been here, and we also have a fellowship also. I think, though, it sticks out when medical students put on there that they have done research, but then you ask them a question about the research, and it's clear that they were some middle author, and they know nothing about the research, what's going on. I think that's more of a detriment, right? So if you're going to list research, you've got to be prepared to know what that research was, and when someone asks you a question, you have to know about it. So that's what I would say. I would strongly agree with that comment, Randell, based on my experience as well at our institution. I think the general advice I give based on my experience coming here and getting through residency and peripherally being a part of the process is be yourself primarily, because when you're authentic, it kind of shines through. And so if there's something that you're interested in, if you've been involved in some research, it doesn't hurt, because your passion, it's a way to strike up a conversation. It's favorably evaluated, but if you're also passionate about something else, and you think I'm going to be more in the clinical practice role, and you have done something else that makes you stand out, you're a host of a podcast or something like that, that could be different, but it's also a way to show how you share your passion for aspects of rehab that are of interest to you. I think that could also be very well looked at, so don't try to put yourself in the box if you're interested in research. It doesn't hurt. That can be good, but there are also other avenues to make yourself an exceptional applicant. All right. So another question, and I know this is actually something we've been talking about on the research committee. How do you see tech like VR and AR affecting research? I guess I'll just start real quick. So I think there's a lot of caveats, but in our lifetime as practicing physicians, it's gonna drastically transform the practice of medicine. So I, myself, we have a Department of Defense grant right now in collaboration with biomedical engineers where they've developed a novel virtual reality platform where we are using it to quantify eye motion problems. So ocular motor problems or vestibular problems in post-traumatic brain injury versus other peripheral vestibulopathies versus PTSD and psychological components. And the main thing is using this as a direct validation against physical therapy where they use the whole neurocom, you know, the person's hooked up to a whole machine and they're in there. And can we deploy this to the front lines across the country? Can we do it through telehealth? Can we, you know, is it something that can be done remotely and without like super expensive in-office equipment? That's just one thing. I also know from some study sections I was on, you know, there's a lot of research where they're seeing, especially in rural areas, can we do research studies where we send devices to people in rural communities? We are monitoring them through some type of, you know, virtual platform while they've got said device or virtual reality, and then get it mailed back to do research and include people in rural areas and stuff. So anyways, I think that it's gonna greatly transform things, but there's a lot of hurdles and there's a lot of data. And there's a lot of things like, we have a researcher in our department now who's an occupational therapist turned PhD. And she's studying a lot of these wearable devices in post-stroke rehab, once a person leaves rehab. The problem is how do you get that data into the electronical medical record? How do you analyze it, the big data? If you're getting like 24 hours of data for six months, like how do you start to analyze that? So there's a lot of research questions. Okay, I'll stop. That is awesome. I should connect with you offline, Randell, because I am, that's very, very much so in kind of the wheelhouse of my interests. And yeah, I would say that personally, my opinion is that VR is only gonna improve our research capacity. There are challenges that we need to figure out, but I think ultimately I am excited. Okay, another question that we got, where do you see prehab research going in the future? Okay, I guess I'll start this one too. So please feel free to cut me off. So I'm gonna talk about from the VA standpoint for a second, and I encourage any of you guys, if you can, in any way, shape or form, train in the VA, work in the VA in the future. You know, I was a Marine in my past life, so I really have a passion about this, but I think the VA has really led healthcare in a couple of novel ways. Like primarily the first one was electronic medical records, right? Now it's archaic, the VA electronic medical records, but at the time it was like, state-of-the-art, the first thing, you know, to have electronic medical records. And now the VA is leading the charge in whole health. So there's whole health, what's it called? Anyways, the radical redesign of healthcare within the VA. So most institutions, even though they are nonprofits, they're all making money on people being sick, right? The VA as taxpayer dollars has a vested interest in treating people before. And with our nation's longstanding with our nation's longest war, they realize we're facing this crisis, right? So anyways, they have this whole new system on prehab and also whole health. And now we're paying for people to get acupuncture and chiropractor and massage, and they can basically get unlimited physical therapy. And once they're done with physical therapy, they can transition to programs in the community, like the fighting back program and stuff, where they'll pay for them to have a gym membership. All these different things to try to get people preventative care and holistic preventative care so that we don't wait until someone, that the machine is broken and now we're trying to fix it. And so anyways, the VA is really trying to change healthcare. In the civilian sector, Kaiser Permanente is one of the big healthcare systems that's also doing this also, because they're, I guess, out in California-ish area, for those of you who know. And they are such a huge insurer and they have all these programs where how do we do prehab? How do we do everything from what we would consider prehab for sports or for injury, but also nutrition and sleep and all of these pillars of whole health. So I think the wave is changing. And so, you know, primary care doctors and stuff, they have to, when a patient comes in, ask, you know, did you get your colonoscopy or your pap smear, your mammogram, all these things, and there's metrics. In the VA system now, two years ago, we had to do four hours of online training. This year, we had to do eight hours of in-person training about all this whole health preventative stuff. And when we're doing our patient notes, we have to document this stuff. It's getting recorded and it's tied to our bonuses at the end of the year, right? So they're not joking around. They're trying to implement these things. I think it makes sense. You know, when you think about physiatry as a field, each field has its domain, right? It's neurology, the brain, right? Nephrology, the kidney, right? So it's all, what's our domain in physiatry? And, you know, really, I think the way that I've heard it explained the best is our domain is function. And that is part and parcel, it's tied inextricably with the idea that prehab is necessary. Now, as Dr. Swanson alluded to, though, the problem within the general community is getting it funded, getting it paid for. And so that's where us as researchers, and in my particular work, one of my colleagues, Julie Silver, is focused quite a bit on this, in addition to many other people across the country, is demonstrating the value added with this so that we can get insurers to pay for it like they do in the VA and Kaiser. And the concept of prehab spans multiple domains. We're currently working on a systematic review, looking at prehab in brain and spinal cord injury related cancers. And so there's intersection between prehab and multiple domains where rehab is important. And so I think the few, I do agree with the rest of the team that prehab is definitely, we're gonna see more, I predict that we're gonna see more in the future. And I think that's a step in the right direction for healthcare overall. All right, and there was one more question that was submitted ahead of time, and then we'll open up to additional questions. And I'm curious about this. The role of psychedelics in TBI recovery. Any thoughts on this? Have any of you been doing any research on this area? No, I don't think I've done any research. I'll tell you that we have a grad student now in our team that's very interested and he was just on ESPN. They did something about psychedelics and he was trying to get a whole bunch of the faculty to go and I don't think anyone did it. But we just take a step back for one second. Tomorrow I'm giving a talk on biomarkers. So if we look at, in the past 20 to 25 years, if you look at the amount of money that's been poured into biofluid biomarkers for traumatic brain injury, for sports related concussion, from our nation's longest wars, right? So blast injury. There have been well over a billion dollars put into TBI research. There's been tons of publications and all the clinical practice guidelines 25 years later, whether it's the DOD, VA, whether it's the CDC, the emergency physicians, every single one of them recommends there is no role for blood-based biomarkers in TBI. So it's promising research, but nothing is translated into the clinic. Yeah, there's a few things with like whether or not you should get a head CT in a child or this or that. And the problem with these things like psychedelics where you don't know what's going on and there has been, okay, let me gather my thoughts. So there's been all of this research, but nothing's really translated into the clinic because we're looking at a heterogeneous diagnosis, right? So the National Academy of Sciences last year put out this big, huge consensus that basically says no one could ever fathom funding a drug trial for a trial for cancer based on mild, moderate or severe cancer in 2023, right? But that's where we are with brain injury. So before we even think about funding like research, we have to first figure out what exactly are we talking about? We can't take this heterogeneous thing of like, oh, someone had a mild traumatic brain injury and we're gonna give them drug X and look at outcomes. I would say, I'm forgetting the name of the paper. Maybe some of you, other colleagues on here know. Now, John White and some other leaders in our field like maybe two or three years ago, published a paper about how we really need to redo all rehabilitation research and look at the specificity of what are we actually doing, right? What's the target of our intervention? What's the specific thing we're doing in the specific outcomes? And so I think psychedelics and stuff is so far down the road before we would ever think about doing a trial. That's just my opinion. And I believe what you're referring to is the rehab treatment specification system. And then does that work, just to build on that, characterizing or phenotyping the different groups of brain injury based on symptom present data. That's a huge thing that the researchers at Pitt are doing now. So, again, we need to bucket these things because they all likely have different interventions and different treatments that'll work most optimally for them. And without doing that, we're really just using a shotgun approach. So couldn't agree more. Yeah, and I will say psychedelics. So we have a very unique guy, a physician joined in our group here in the next couple of weeks who is a psychiatrist, addiction medicine board certified, and then did brain injury fellowship. And he's really looking at all this stuff with addiction and behavioral changes after head injury. And there is a lot of work going on with ketamine treatments. There's people doing psychedelics and stuff in the military for PTSD. The thing though is with all of these is it's not like you just do the psychedelic and then you're miraculously cured. It's like you do the psychedelic and that allows you to actually start to do psychotherapy and start to do all these other things that you have to do on a daily basis to really make a change. So unfortunately, I think that all this thing with psychedelics, it's just another thing people think, I'm just gonna take this magic pill and everything's gonna be cured. It looks like we have a question in the chat box. Speaking of prehab and lifestyle medicine, do you see a future where things like sleep, diet, and exercise are taken and considered as additional vital signs? Yeah, I think that's a great question. I think the issue with introducing anything as a vital sign boils down to ultimately you need to demonstrate efficacy or value with that additional marker because the clinicians are already overburdened, overstressed. And so if you're adding additional things onto their day, different additional things to track, there needs to be some there there. And so that's where I think, again, research in PM&R to prove the evidence basis behind these different markers is important because I absolutely believe that managing things like sleep, diet, exercise is incredibly important. So specifically in my clinical practice, where I see a lot of people who have a lot of exposure to repetitive head impacts over years due to military or sport or domestic violence. And the people who they're starting to have cognitive problems now decades later, if I treat their sleep, if I manage their diet, if I make sure that they're getting exercise, much like for other neurodegenerative processes where we know it's the case, these people get better. And so we just need to, I think, prove that and to demonstrate it convincingly. And I think that it'll be something that's more widely adopted. And I think in my area of interest, I think part of what we have to figure out is how best to capture this information. So like Dr. Swanson mentioned, there's measures that they can report themselves or in this area where we have wearable devices, the ways we can capture movements in patients on a living environment. And so there's a lot of data we have to figure out what's the best data that represents what we're looking for and what's the best way to capture this in a way that's not overburdening some to clinicians who are already stretched in a million and one directions. And then what do we do with this information when we get it? And so I think there's all of these facets we have to figure out. It's definitely sounds like a great idea. We're all in rehab, we all have a passion for some of these kinds of modalities for treatments and for improving patient's function. But there's still a lot in terms of how we drive this in an evidence-based manner. And that's part of why research is important because when we can prove that this is a good way to do it, then it can become part of standard practice. Yeah, and forgive me, your last name again is Dr. Ado, right? Did I say it right? Correct. Okay, so maybe do you wanna comment? I heard you say in the beginning, your background is also in like movement, epidemiology and stuff, right? And another confounding thing is, it normally is with these lifestyle interventions, which I'm a huge proponent of, it's not a single thing. There's usually multiple confounders. So when someone is exercising, they're more likely to eat healthy, they're more likely to sleep better, they're more likely not to smoke. And so then it's very hard to tease apart from scientifically which one of those things is making a difference. Do you wanna comment more? Yeah, absolutely. Part of, I think one of the thoughts we had during my PhD was how self-efficacy can translate between health-related behaviors. And so my area of focus, physical activity behavior. And so we find that in theory, this is kind of an area that's still being researched. Someone who's better at exercising as they get more confident that they can do this in the presence of barriers. And so it's raining outside, as they've kind of got to a point where this is more habitual activity for them, it's reflexive. That confidence tends to, has the potential to translate to other behaviors. So whether it's eating healthy, sleeping better, there's that potential. And so, yes, there is some amount of confounding that can occur, because then you start to figure out, okay, what is driving what, becomes the question. At the same time, I think there's still a good amount of evidence that shows that physical activity, for example, is when you control for some of these other health-related behaviors, that also have positive benefits with some of the health outcomes that we're all interested in. And so in part of figuring out that efficiency, it's a question of where do you start, right? If a patient has multiple health-related behaviors that they can improve, where do you start so the patient doesn't feel overwhelmed? And how can you tailor programs to fit patient's lifestyle and their physical and built environments, which are not always things that are easy to change, but they are interventions that we can apply even within those constraints of patient's built environments to systematically make things better. And so I think there is a collective thought that the structure of the healthcare system needs to change, and it's how do we drive this change is basically by collating evidence. And that's kind of where we're at right now. Yeah, last thing I'll say on this, if any of you guys on the call are interested, two things. One, there is, I would say, a growing movement to design some clinical trials, which I'm forgetting there's a specific catchphrase name, and my colleague just submitted a grant doing this. Anyways, there's this behavioral change, big, famous nudge unit that they have at Penn, and it's taking people that have a composite of poor modifiable factors and allowing them to do one change, whichever one they want, but follow over the course of the trial, how has their behavior changed and stuff, even though there might be people that do different changes. And also NIH has this whole year, this is, what is it? Something like the decade of nutrition or something like that that they had this whole big, huge initiative from 2020 to 2030 for funding studies involved in nutrition and specific dietary interventions and stuff. And all of these things, NIH has this big initiative. So if you guys are interested, there is multiple ways to get involved and you can spin this from, you know, any different sub-component of PM&R. There's a question, if there aren't PM&R research opportunities locally for medical students, would you recommend trying to find virtual PM&R research or interesting research in other fields that is locally available? I want to show my specific interest in PM&R through research, but don't know the best way to go about it. I can probably start with this one and then you guys can fill in the cracks in the details since I'm also still struggling with this question too. But I would say, so where I'm at, there's not a lot of PM&R research. I haven't found very much at all, but there is a strong like brain center and like stroke center. So I've been trying to go that avenue of being like, okay, well maybe I'm not working with a podiatrist, but I am doing something that interests me and is, can apply to PMNR. So I've kind of gone that route. I've also, from talking with other medical students that have matched into residency programs from my school, they've also said that a lot of times when they do away rotations, they might be able to find like a case study or make connections with other mentors there while they're at an away rotation. And they've had a lot of success with that as well. So I know that doesn't completely answer the question and definitely a work in progress for myself too, but those are just kind of the ideas that I've been hitting around with. I think being the next in line kind of close to this process, I think I can jump in and then let our faculty also contribute. So I think that the first thing you should hear is that you're not alone with that problem. And so if that gives you any measure of reassurance, we should start there. We also recognize that this is a fairly, fairly common problem within the AAP. And I think earlier on I had mentioned that part of our interest within the medical students and the resident fellow council is to find ways to bridge this. And it's part of why we are hoping that in the near future, we have some kind of mentorship database available to AAP where you're able to connect with mentors outside of your institution that are within your area of interest. So that's to come. But I would also agree with Maggie in that you can also be creative in the meantime and find the next best thing. Being involved in some type of research that's close to what you're interested in again provides an opportunity for you to have those conversations throughout the application period and while you're in the interview season. I did something as well clinically while I was at the University of Mississippi, finishing up my PhD and I had an interest in PM&R. And I did not have the opportunity to have PM&R-specific rotations because that's the scarce thing in that region. And the closest thing was sports medicine. And so I was able to work with a sports medicine physician and also had some experience doing cardiac rehabilitation as part of my graduate school experience, which funded part of my PhD training. And so I think there are all of these other facets that can sell your passion for function. And it also creates a unique opportunity because then you have a different story. So while it's a challenge, you're not alone. It also provides an opportunity for you to have a unique perspective that no one else potentially throughout the application period would have. So think about it from that way. And I also definitely appreciated, Maggie, your perspective because I feel like I realized with the panel that you don't need to have a PhD basically to be able to do research in physiatry. And I don't want to give that impression that that's the case. And so that's really important. And to build on something that Dr. Addo said earlier, actually, and alluded to just now as well, especially when you're applying for residency positions, what matters, I think, more than anything else is passion. And it's really transparent when you're feeling passionate about something. And one of the beauties of physiatry is that it's a field that is very interdisciplinary. And so you don't have to be working with a physiatrist on a research project to be doing research that's germane to physiatry. And so you can be working with someone in neurology or an oncologist or a cardiologist, someone who's in a very different domain and still be doing research that will demonstrate that passion you have for the field. Although I do think virtual research opportunities are options, but it just tends to be harder, I think, to do substantive research when you're not able to work more closely with the collaborator. Not that it's impossible, but it's just more difficult. Yeah. And I would just add, I agree with everything my colleague said. I think it's challenging when you're a medical student and you're thinking about going to residency. And then once you're done with there, if you're going to do a fellowship, and then if you're going to get a job, to think about the future and what do you really want. And as a PhD, when you're going through a master's degree or PhD, everyone likes doing research, but they don't realize, well, what does it really entail? When you're a PhD researcher, you're not the one really doing the research. You're sitting and writing grants and writing papers in some office and other people are doing the fun stuff. And I think you have to think about what do I really want? So there's people that are in the rehabilitation medical scientist training program. You can get involved in that. And the goal that Mike and John will say is you want to have a career where you're going to be doing at least 75% research, right? So you're maybe seeing patients a day a week, or you've got some rotation where you're doing the inpatient service a couple of weeks every quarter, but you're primarily a researcher. You're writing your own grant, you're leading a lab, you're leading a team. That's one way to go. That takes a lot of work and it's a lot of things to try to balance. And you give up a lot of clinical skills. I mean, when I graduated residency, I was a master at doing EMGs and all this stuff. And I did all kinds of Botox injections and intrathecal baclofen pump, all of these things. And you fast forward now, and you go into the research for years and you only do clinic on a certain subpopulation, you lose it. Now, when I'm on call, I rely heavily on the residents. I mean, you can't imagine how much drugs have changed in eight years, right? Things like this. So that's one thing. The other thing is as a physician. So there's a lot of people in my practice at Penn, I think there's 26 of us attending that are pure clinicians and they're experts in their field, and they don't have a PhD or whatever, but they are expert clinicians. And then you have all these basic scientists that want to work with them. And so they get their name on grants as a co-investigator, which takes minimal effort on their part, but they get like 5% of their salary bought out, which really translates into a tangible reduction of RVUs, which is what at the end of the day you really want, right? So that it gets some protected time. So like one of my colleagues, there's four of us brain injury docs at Penn. I'm the only one that has a PhD and has any grants as a PI. One is a hundred percent clinical. The other two dabble in research. And my one colleague is a co-investigator on two DOD grants right now with two different investigative teams and they're recruiting out of her clinic. So she's getting 10% of her salary, hard money coming in, bought in, bought out that reduces her RVUs and her target. And for that, she has to go to like a meeting once a month and then just tell patients about like, Hey, there's this study and blah, blah, blah. And if you're interested, talk to the clinical research coordinator. My point of all this is there's tremendous ways to get involved in research and you, one way is to just be an expert clinician, right? And if you don't have access to research, you could write like nice systematic reviews. You could do a nice systematic review and meta-analysis on something you're interested in. It's going to increase your, you know, expertise in your field as an expert clinician. And you can go that route too. You don't have to go the route of being a principal investigator and writing your own grants and stuff. Oh, great. I think we just had another, another question here. How would you best summarize the cumulative risk for CTE in athletes that was mentioned as a former college athlete and football coach? It is something I often get asked by parents and would like to improve my ability to answer them thoroughly. Yeah. Thanks for that question. That's a great one. I think a lot of times parents come into the clinic and they're concerned that their kids have CT or at risk of CTE after they get one concussion or even a couple of concussions. I think what we're conclusively demonstrating most, I think, clear from the paper that was published last week is that concussions don't really matter when it comes to CTE risk. That it's the cumulative force of impact sustained over someone's entire life that matters the most. And that cumulative load can happen from, you know, football, but it can happen from boxing. It can happen from non-sports. It's just your brain doesn't care what hits it. If you're getting hit in the head repetitively and you're getting cumulative force, you're at risk. So if parents are concerned then about their kids' cumulative risk, there are pretty low-hanging fruit, easy ways to mitigate that. So in some ways it's scary because it's not those more visible concussive hits that are causing these injuries, but it's the ones that kind of happen insidiously that end up being most associated with the CTE risk. But, you know, you think about two things. First off, if you could eliminate half the hits in practice, we know over two-thirds of head impacts occur in practices. If you eliminate half of those hits, then you can decrease CTE risk over the course of four years by about 40%. So that, you know, talk to coaches about limiting the unnecessary drills in practice. Similarly, if you're worried about cumulative G-force, if you were to eliminate the top 10% of head impacts from, say, football, you could decrease the risk associated with CTE by about 20%. So again, you know, there are pretty easy ways to do it, but it's not through concussions. It's through managing concussions. It's through minimizing the total amount of hits to the head and the force of those hits that athletes are experiencing. We had another question asking about applying for residencies and with the research asking, do you think program directors will be looking for a wide breadth of research topics, or would it be better to just be passionate about a certain, if you're passionate about a certain topic, can most of your research presentations and publications be in that one subject matter? So is it better to be focused or have a bigger variety of experiences, I guess, when you're applying? I'm really curious to hear what Dr. Swanson says because I'm also on our residency committee for the last few years, and so he might be completely different, and I think that actually is, there's a lot of program to program variation, and it really has to do with the composition of who happens to be on the admissions committee. There's no monolithic answer to this. I can say for us, in general, I like seeing something like a story that makes sense, right? If somebody is just involved in, even if it's, you know, 20 publications, but they're all in very disparate fields, and there's no cohesive unifying narrative, it's hard for me to to wrap my head around why that person's going to continue doing research, or if they're going to continue doing research at a, you know, substantive level. That being said, if they have an answer for that, then that's a good thing, but, you know, I really think that the narrative is the most important thing, and if you have a cohesive unifying project, that that probably ends up being more important than anything else, but again, as Dr. Swanson said earlier, you can have a lot of research in a lot of different domains, but you better know, you don't know which research project I'm going to find the most interesting, and which one I might then start asking you detailed questions on, so you better know all of it. Yeah, I completely agree. I think also, you know, I understand that you guys put together this huge package, and it's a lot of work on your part to put in an application to apply to residency, but you have to also understand, I remember whenever, you know, we were sitting in the RMSTP meetings, and Mike and John used to say, you got to write this big 100-page grant, so that somebody at 11 o'clock at night, when they're tired on a plane, is going to read it and not be pissed off, because, you know, it's, you know, they have to dig for information, it's like in their face, so it's sort of that way, right, when you're interviewing residents, when you're on the other side, you're the attending, and okay, we have to block off half of our schedule, and now we're going to interview five residents, each one of us, we have five residents today, the secretaries take all the information that you guys put in that application, they whittle it down to one half page of bullet points, and then I will read that, and maybe look at a few things that interest me, and then it's a conversation, because by the time you're sitting across the desk from us, you've met the academic requirements to come to our residency program, and now it's the real human interaction, and the human thing of the story, like Dan was saying, what's the story of you, and how you got here, and what makes you you, from a research perspective, how that's integrated into everything you've done, that's what really matters, right, it's really the story, not, you know, it can, and it can be come from a lot of different things, yeah, I always pick out, I usually ask them about their research, and it just turns me off, if it's clear that they have no idea about the research, it's like, I hear John and Mike's, you know, voice in my head about grants, it's just like one of those things, that then I already have a negative feeling towards this person, and it's just human, you know, and I don't know how to get around that, just say that's the way it is. It's like, not a segue, necessarily, but I'll just add to that, in general, a general rule of thumb is, you know, everything that you put on your CV, you should be very versed in, you know, that should be the last thing you read the morning off before your interview, because that is what we're seeing, that's your pre-introduction, if you will, and so you want to make sure you have all that information cold, and able to kind of talk about it, and then, you know, any other contextual information during the interview process is certainly welcome, but yeah, on the topic about breadth, I don't think I have anything additional to add, I do agree with the perspectives, you know, some variation, I think is okay, but there should be some amount of cohesion, and you should be able to kind of talk about it, some experience is better than none, but if you can narrow your experience into what's most interesting, that's preferred. All right, I don't see any other questions, and we are getting close to the top of the hour, so I was hoping that maybe each of you could share one piece of advice with the students, or one thing that you has found that has helped you in your career, so thoughts? I guess I'll start again, I think the most important thing, about to turn 45 in a couple weeks, is to really know yourself, and think long and hard about the life that you want, because when I was 26 years old, and thinking I'm going to do a medical degree, and a PhD, and be a neurosurgeon, and run a lab, and do all of this stuff, you know, life looks very different when you're 45, than when you're 26, and so you have to sort of think like, what do I want the day in a life to be, if I'm going to be a researcher, am I willing to commit to being able to write at least a grant every cycle, be doing all of these different things, and what does that really take, and if not, that's okay, but you just have to like, yeah, know yourself, that's my take-home point. And yeah, just building on that, I think it's hard to, any of us could slog through 90 hours a week, for you know, five to nine years, depending on if you want to do, you know, depending on what kind of residency you want to do, that I think, especially when you're considering fields, which residencies to apply to, look at how the attendings lives are, and imagine yourself in those shoes, because you know, again, you can power through a few years, but if the finish line, you know, when you're 40 or 45, I just turned 40 last two months ago, so, but when you're in the, in your 40s then, the idea is that, is that the life that you want to be living, in terms of work-life balance, in terms of clinical interest, in terms of non-clinical, so research, in my case, interest, but doesn't have to be research, is that something that you want to do, are there attendings that are modeling that, because if there aren't, then it's probably difficult to do it yourself. And I would also build on that, and say, you know, some of the things I talked about earlier, in identifying your area of interest, you got to think about what intrinsically motivates you, because if you can connect to what you're passionate about, that definitely helps, helps you in the long term, even when things may get overwhelming, and so my piece of advice is also be patient, it's a process, as you can see on this panel, we're all on different parts of that process, and so sometimes you might, it might look overwhelming from the start, you're like, how can I get all these things done, but you can, so just take a step back, take a deep breath, and be patient with yourself, surround yourself with the right mentors, and the right peers, who can also stimulate your curiosity, and you'll ultimately get there, but you know, just my piece of advice is be patient with yourself. I feel like I don't have too much advice and knowledge of how to do research, but I do feel like the one thing that has been helpful for me was going to the AAP conference in February, and like they're expensive, some schools do have like different travel grants, so definitely look into that, but I felt like that was just really helpful from my perspective of being able to go to different presentations, and see like what's like interest in like the field, like how physicians are doing research, talking with other medical students too, to be like, hey what are you doing at your school, like just kind of like that aspect of networking, especially if you're from somewhere where there's not like a whole lot of that on a daily basis, I thought that that was really helpful as well. All right, well I would like to thank you all for being here, and thanks for sharing your research stories with us, I appreciate it. I kind of strong-armed my research committee into doing this for me, so thank you all for stepping up and helping out, I appreciate it very much. Thank you all students for attending, tomorrow we're going to be talking about disabilities and physician bias, and then we will wrap things up with our Ask a Resident panel on Thursday, so bring your questions for that one as well, we have a good panel of residents, so I will see you all tomorrow, same time, same place. Thanks everybody. Amy, thanks so much for organizing this, it was a pleasure to be here. Oh it's my pleasure, so glad you guys could join us, thanks. Thanks for having us.

physiatry

research

career paths

technology

prehabilitation research

TBI recovery

medical students

mentor

passion