Welcome, everybody. I'm so excited everybody could join us this evening to talk about brain injury medicine. I'm so happy about the panel that I have here this evening all to discuss Brain Injury Medicine Fellowship, discuss what it's like to be in the field of brain injury medicine, and then most importantly, to answer your questions. We're going to start off tonight. I'm going to give a little broad overview of this last 20 years of Brain Injury Medicine Fellowship kind of, I'm going to use 20 years since I, that's about the time I've been in the field. I'll talk about the, I'll talk a little about ACGME and how that's changed so many things since 2014 and give sort of a broad overview of what fellowship looks like now and certainly what the ACGME demands that the fellowship looks like now. And then each of our panelists are going to talk about individually about their, about their lives, how they got into the field, you know, where they are now, you know, what the type of interesting work that they get to do in the field of brain injury medicine. We're going to have Elisa talk a little bit then today about an interesting program called Synapse and how that's been really also very good for the field of brain injury medicine. I have Katie Eltonji here, also one of my former fellows, talking about her experience about doing a fellowship and kind of where that's brought her to now. And then most importantly, we're going to answer all of your questions. You know, certainly I hope to get all of your questions answered tonight. Myself and then the panelists hope to answer all of your questions. But I know for myself, and I'm sure all my panelists feel the same way also, we're here to answer your questions on the long-term also. My email address is up there. I'm certainly available by email or by phone call or Zoom or wherever you'd like to be in touch to talk more about fellowships just in general. My goal is really just to educate people about brain injury medicine fellowship and the field of brain injury medicine so that people can understand if it's something for them. So I have no disclosures. I'll tell you a little about my own history. So I completed my residency in 1999, and I put this End of the World Time magazine here because everybody was talking about Y2K and your plane's going to be crashing from the sky after it went from the 1990s into the 2000s. But it wasn't the end of the world, actually. And during residency, I really enjoyed everything. I had a strong interest in neuro. I wish I'd had a strong interest in neuro coming into PM&R. And I was really looking for a fellowship and a career where I can do everything. And I had an interest in some inpatient and some outpatient consulting and research and teaching and kind of all the components that I really get to do now, I thought of then, and that I really wanted all those pieces. So at that time, so looking at 1999, there was few brain injury medicine fellowships. I literally interviewed at the three fellowships that were available at that time. Actually, it turned out to be two because one of them lost funding. There was also very few brain injury medicine applicants. People were just not familiar with it as far as doing a fellowship at that time. Most of the people who were doing brain injury medicine at that time had really learned on the job. And some people even questioned my need for fellowships. And so many people had learned on the job and that there was no AC and GME accreditation for it. But for the way I was looking at it, it would be a really concentrated year of learning that would really get my career started in brain injury medicine. Looking back on it, I was very right. I think it really was exactly what I wanted. I was happy I did the fellowship that I did, but certainly people at that time questioned my need really to do a fellowship since I had done a residency where I learned a lot about brain injury medicine a lot already. So like I said, my fellowship pre-ACGME, so there's no requirements as far as what the fellowship actually has to look at. In fact, actually, my fellowship director, the first day I came in there, he said, so what do you want to learn for the year? And I had to think to myself, what do I really want to learn for the year? I guess I'd come for a residency that was so structured. I wasn't used to like, so what do you want to learn? So I did my own fellowship over at VCU and there's certainly much more of a focus on moderate to severe brain injury. But I learned a lot about outpatient. I learned a lot about inpatient. I learned about consulting and procedures and research and administrative work and billing and leadership and teaching. I mean, these are the things that you'd want from any fellowship. And like I said, I felt it put me in a really good place for what I was off to do next with all these different things that I learned at the time. So like I said, coming out of fellowship, I thought it was definitely an advantage, especially at that time where there's so few people coming out who are fellowship trained in brain injury medicine. I thought it was a big advantage coming out with that type of fellowship. I walked right into a directorship. I was the director of the trauma rehabilitation program over at University Hospital in Newark. After being there for a few years at Mount Sinai in New York City, offered me a directorship in their brain injury medicine program. And then after being at Mount Sinai for 10 years, I became the director of the Center for Brain Injuries over at JFK, which is where I am now. So looking at the changes over this last 20 plus years, around 2010, like I said, so my own fellowship training hadn't really been anything in concussion. Around 2010, all of a sudden, all these concussion patients started showing up to my office. And I'm like, who are these people? I don't really know that much about concussion. I knew concussion is injury to the brain, but there's so much media coverage with regards to the military and sports and specifically the NFL. And I mean, now, 10, 15 years later, when I look at physiatrists are so well suited to care for this population, this concussion population, because when you're looking at concussion patients, it's always about the brain injury, but their musculoskeletal injuries. And if you're not looking at both, if you haven't had the training to look at both brain injury and musculoskeletal injuries, there's no way that you're really prepared and take care of these concussion patients. And I see that again and again. Unfortunately, I see too oftentimes patients with concussive injury, not getting good care, mostly because people are ignoring the musculoskeletal components. And if you're ignoring the musculoskeletal components, the concussive issues linger that much longer and sometimes aren't even concussive issues. They're really more musculoskeletal issues that are the ongoing problems. So then the ACGME comes along. And so there'd been a long interest in getting ACGME certification in brain injury medicine. It was really in 2014 that it finally became a subspecialty brain injury medicine became a subspecialty. The American Board of PM&R really led the specialty and continues to lead the specialty, but neurology and psychiatry can also become board certified. Over this last almost 10 years, the ACGME grandfathered people in so that if you met certain criteria and took the examination and passed it, you could become certified in brain injury medicine, a board certified in brain injury medicine. That grandfathering in is over now. And so now it's become board certified in brain injury medicine. You need to do an ACGME accredited fellowship, or you need to do a residency in either PM&R neurology or psychiatry, then do an ACGME accredited fellowship and pass the written examination. So I love this ACGME definition of the specialty. So brain injury medicine addresses the prevention, diagnosis, treatment, and management of persons with brain injury, including the prevention, diagnosis, and treatment of related medical, physical, psychosocial, and vocational disabilities and complications during the lifetime of the patient. And if you're doing brain injury medicine, and if you're doing brain injury medicine, I know for myself at least, I really enjoy the long-term relationships I end up with, with the patients that I take care of. You know, they've been through some oftentimes some of the hardest times they've ever been through, you know, with regards to their brain injury. And we end, I end up with so many close long-term relationships with patients. Like I said, I left Sinai more than 10 years ago, and I'm still treating a number of patients who slept in from Manhattan to see me in New Jersey. Because again, it's, it's, it's sometimes people are left with long-term disabilities related to brain injury, and you know, they, they know that we are the people who really understand those, those long-term needs. So in 2014, PM&R program started to apply for ACGME accreditation. We then were able to put the match into place through the National Residency and Match Program. Then, you know, the ERES came into place also, you know, which is nice. So it makes everything for the, the people applying very similar to what they feel like when they're applying for residency programs. And now, amazingly enough, we have 29 ACGME accredited programs. So wonderful to see so many programs. Like I said, it was two or three when I was applying 20 years ago. So it's wonderful to see the expansion, so many programs actually going ahead and becoming ACGME accredited, which having gone through that process is certainly not an easy process to go through. So some of the requirements that people should be aware of. So now concussion, like I was saying, concussion is now one of the requirements of, for the ACGME for brain injury medicine program. You know, learning about blast and combat injuries and repetitive head injuries, and learning about consulting and pharmacology and prognosis and aging and brain injury are all critical parts. So it's not just learning about like, about the moderate to severe patients with brain injury, but sort of a cross section of patients with brain injury, both across the severities of injury and the types of diagnosis in brain injury. Like I said, everything from concussive to severe brain injury. Research is an also a mandatory part of the fellowship of which I think it's an important and mandatory part of most fellowships. Certainly want people to learn the basics. I think if, if I was an applicant applying, I would look at kind of what my own interests are and understand what the fellowship offers, you know, what they have been offering. You know, the goal certainly over the years, at least to be able to do some research that you could present with the hope that also you'd be able to, to publish your research. And, and every fellowship does that a little bit differently. We've tried to, to help people, myself and some of the other fellowship directors over this past couple of years, tried to help the fellows that are doing their fellowship as to help them with the ideas that they have and how they might enact them during the fellowship year. So procedures. So, you know, PM&R overall has always been a procedure oriented specialty and certainly brain injury medicine is no different that way. Certainly there's so much to be learned and so much to be done in botulinum toxin and intrathecal baclofen pumps and histonia and Botox for migraines. Certainly so much opportunity with regards to procedures there, so much need from patients. And, and again, these are sort of long-term things, right? So patients who start Botox are likely to continue to need Botox, you know, ITB pumps similarly, Botox for migraines similarly. And so if you're interested in our procedures also, certainly expect that that's something that you'll get to learn and master during your fellowship. And then what I, what I love about it and which I've alluded to already is that you get to still use all the skills that you, that you obtain during your residency. You're still a physiatrist, so you get to use all your musculoskeletal skills, your, the diagnostics, the interventional procedures, pain management, EMG, and as much as that as you'd like. Certainly the more that you're interested in, the more you're about to do for your, on your own. I think that's still a big advantage, again, of taking care of these complex patients. You know, our knowledge as physiatrists, it really puts us in a great place to, to take the best care of these complex brain injury cases from concussions straight through to severe brain injury. I'm going to turn it over now to, to my colleagues to talk a little bit about their own experiences, both at what got them into brain injury, what they do in, in brain injury. I'm going to start off, I'm going to start off with Dr. Wagner. I'm going to stop sharing my screen and let her put up her screen to talk about, about her experiences. Great. Thank you, Brian. Let me just bring this up here. All right. Hopefully everybody can see my screen and we'll try to share it here. Okay. All right. So my name is Amy Wagner and I am a professor in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh. And I'm also the Fellowship Director for the Brain Injury Medicine Fellowship Program at UPMC. And so it's interesting that I'm, I'm going first out of the panelists because I think I've had sort of a, maybe a bit of an atypical career compared to others in the panel. But one thing that I do have in common with Brian is I came in at about the same time when there weren't really many, many fellowships out there to choose from. And I think I've had some similar speeches and conversations about whether or not to do a fellowship at the time and took a little different track. So in terms of my pathway to Pittsburgh, I graduated with my MD at Northwestern University back in 96. So I feel pretty old putting that out there on a slide. But you know, it was really neat. I'd never heard about physical medicine and rehabilitation until coming to Northwestern because of its association with what was then called the Rehabilitation Institute of Chicago, now called the Shirley Ryan Ability Lab. And had some really nice exposures very early on in my first and second years of medical school. And so I knew pretty early on that rehab was of interest to me. Made my decision kind of at that typical point in medical school that many do and weighed the pros and cons and worked with my my husband at the time to generate a match list and landed at the Charlotte Institute of Rehabilitation, which is now known as Atrium Health. Everybody's changed their name at least a couple of times in this many years. And so I think one sort of interesting caveat that I would put out there about my journey is that when I came into residency, I was pretty certain just based on my interests and you know some of my own sports injuries that I thought I would do something related to sports or musculoskeletal medicine. But I changed my mind and that may be something that not a lot of people do in residency. They come in with a pretty set focus on what they think they want to do and kind of continue across that track. But late in my second year, I was exposed to my brain injury medicine inpatient service and already had an opportunity to experience a number of other rotations. And when I got there, I just felt like it was the final frontier that there was just so much that was unknown. So many questions to be asked about why people with seemingly similar injuries ended up on very different recovery trajectories, differences in practice patterns across different attendings. And I also was developing a growing interest in research. The Charlotte Institute of Rehabilitation is not necessarily all that well-known for its rehabilitation research, but it was a venue at the time that was very open and had a lot of resources to support residents who were interested. And so kind of blending those two things, I really became interested in studying the brain and brain injury and trying to integrate that in research. During residency, I attended a training program that no longer exists, but it was run through what was called NIDILRR at the time and is now named NIDILRR, called the Research Enrichment Program for Physiatrists. And I was able to do some data-based outcomes work using the existing trauma registry at the Carolinas Medical Center and Charlotte Institute of Rehab. And so when I was looking for a position, I did have some of those similar conversations and wound up going with the idea that I didn't need a fellowship at that point in time. Instead, I looked for a position as an attending that would give me some protected research time to try to build a research portfolio in the area of traumatic brain injury and wanted a place that was strong in conducting clinical and translational research, as well as one that would have supportive mentors and a supportive training environment. So that's kind of how I started my time. I joined a brand new department, which seemed like a little bit of a risk, but was really enamored with all the possibilities there and was the second research-intensive recruit to a department that was just started the year before I arrived. My first year also was provided some protected time through a NIDILRR research fellowship, and I was a clinical instructor for my first year, which gave me about 50% time to write grants and the other 50% to do some clinical work. And so my clinical work was really focused in two different places. I did some acute inpatient rehabilitation coverage over at our inpatient rehab facilities, which are now located at what we call UPMC Mercy. And I have spent the lion's share of my clinical time as an acute care physiatric consultant, primarily focused on brain injury medicine in our Presby and Montefiore facilities. And so we'll talk a little bit more about that as well, but I think another big piece of my role in the department has been to wear different hats as it relates to the academic mission. Again, my focus early on was really research-oriented. I was able to get a graduate faculty appointment and took on a lot of work teaching residents about research, developing a research curriculum, assumed a research directorship for the department for a few years that transitioned into a fairly long stint as a vice chair of research. And then at that point in time, academically or administratively, I took a little bit of a pivot and had a number of years under my belt now with seeing individuals with traumatic brain injury and other forms of brain injury, developed my expertise a little more slowly than the typical person that would be a full-time clinician, but felt comfortable enough in my shoes clinically to step in and fill a need and take a little different direction. And in 2016, I took on the Brain Injury Medicine Fellowship Directorship. I also was able to sort of move in a different direction from a mentorship and faculty development perspective and have spent the last several years really focusing on helping faculty develop academically and go through the the tenure and promotions process within the department. And that's been a nice piece to my work as well. So back in 2017, I was able to finally kind of reach the top rung academically at Peck with a full professorship of tenure. And 2020 had truly the honor of being nominated by some of our peers in the field to become a member of the National Academy of Medicine for the body of work that I've been able to do as a part of our department. And it's a testament to all of the resources and mentorship that I had, as well as anything that I've contributed along the way. But it's, I think, sort of a culmination of the kind of impact and footprint that I'd hoped to have academically within physiatry more broadly. Just so that you understand, too, my footprint and my needs and my expertise also sort of required other resources. So I've had, in order to develop, so I've had multiple secondary appointments within the Department of Neuroscience at the University of Pittsburgh, the Center for Neuroscience. And the major force in my life has been the multidisciplinary Sapper Center for Resuscitation Research, which is where I sort of cut my teeth in translational research and really grew up with an amazing cadre of physician researchers, as well as PhD related researchers all interested in in brain injury medicine from many different points of view. And also have had some nice relationships as well with the Clinical and Translational Science Institute. In terms of my research contributions, you know, as a scientist, we love to talk about our research, and I could probably take the whole hour, which I won't. But I'll just go through very quickly that, again, my first year I spent as a research fellow. So doing some high level learning about what I needed to know in terms of translational research, understanding secondary injury mechanisms, learning about clinical research design, preclinical research design. And during my first year, I was able to obtain a career development award, which protected my time about 75 to 80%. And that was really critical with getting my research trajectory sort of launched. And over the last 23 years or so, I've been able to garner funding from a variety of different federal sources, as well as some foundational sources totaling about 29 million, and pushed not only into TBI, but also cardiac arrest, which has been related anoxic brain injury, which has been a really interesting place to spend some time over the last few years from a research perspective, have been able to disseminate my work, have been able to incorporate trainees at all levels from undergraduate to medical students, on up to residents and fellows of various types. And we've studied things like how to use biomarkers to link biology to function in order to hopefully, with the long term goal, inform precision care for our population. We're working on some novel molecule development that we think will be helpful in promoting recovery after acquired brain injury. And we've spent a lot of time over the years studying dopamine systems and dopamine neurotransmission and trying to understand why some of the drugs that we use in the clinic work, and how they might work differently in different scenarios with different types of patients. And I've also spent a fair amount of time looking at sex differences and brain injury recovery. As I mentioned, from a faculty development perspective, being able to work and support my co-faculty has been a really nice piece of what I do. Clinically, we've been able to innovate over the years and develop an acute care continuity consult service, which has the job of sort of working side by side with our neurosurgical crew, our trauma crew, the neurocritical care crew, in order to help co-manage, if you will, patients, particularly low-level patients with disorders of consciousness in terms of early neurostim trials, management of secondary conditions, and that kind of thing. And with my path to the Brain Injury Fellowship Directorship, I was also grandfathered in to award certification in 2016. And since that time, we've been training one fellow per year, but I have here in bright red because we're super excited, beginning in 2024, we'll be recruiting two fellows per year. And we've worked with the curriculum to really try to promote continuity where we can to give that longitudinal experience to our fellows, as well as add a variety of clinical electives based on that question that Brian mentioned early on in his fellowship, you know, what do you want to learn? What do you want to get out of this fellowship time? So we've really tried to be open with our allowable elective time to provide that. And we've also been able to provide some unique opportunities for administration and education development through our administrative and education tracks that are also available to residents in our program. And of course, being where we are, we're able to provide both some clinical and preclinical brain injury research exposure and provide some fellowship among the fellows with a quarterly fellow research series. So in total, I guess I'd say from my own career perspective, it's been nice to be able to take on roles within brain injury medicine from a consultative perspective clinically, from an educational perspective, as well as from a brain injury research perspective. And, you know, there's still lots of work to do, but I hope to be able to continue to make an impact on the field. And one of the main reasons that we're here tonight is to try to attract people into the field and to think about it. And I would say that I have no regrets with the path that I've taken and was glad that I had the right attendings at the right time, helped me get excited about brain injury research way back in residency. So thank you, Dr. McDovitt. All right. So that's all I have. Thank you so much, Amy. Thank you for sharing what you've done and where you've been and where you are now. Wonderful. Next, Ben, can you present next? Sure. Right. Can you see me to screen now? Yes. Okay, great. Okay. Well, let me adjust my slide. One minute, please. All right. Well, again, you know, I want to thank you, Brian, for organizing this. And as you guys know, Brian has done a lot of leadership on this topic with the AAP. And thank you, Brian, for sharing your slide set with me. I basically modeled some of my presentation based on Brian. Okay. I'm sorry. Here we go. All right. So again, I'm the professor of the Department of PM&R at UT Southwestern Medical Center. My email is right down below. I have no disclosure. So my journey to brain medicine is as follows. I did medical school at Baylor College of Medicine, graduated in 96. I did a PM&R residency in 2000. And I followed that with a brain issue medicine fellowship at MMRC in Jackson, Mississippi, also a non-accredited ECGME program. After that, I went to University of Cincinnati, where I helped with the brain injury unit for five, four years, and it was too cold for my wife. So I moved back to Dallas. And then I've been with the University of Texas Southwestern Medical Center since 2008. And my path into brain injury medicine is that, like I tell a lot of my residents, a lot of time, it's the specialty that pick you, as opposed to you picking the specialty. My interest in, when I first went to medical school, I wanted to be a surgeon, but then I was involved in a car accident. So that's how I was exposed to PM&R. And that's why I went into brain injury medicine. And I can't emphasize the role of mentorship, because my mentor, Stuart Yablon, he's more of a brother than a mentor. So that's what, you know, fueled me to go into brain injury medicine. All right. And then, so again, like Brian mentioned before, at that time was non-ECGME accredited, and the population at Mississippi Methodist is mainly moderate and severe TBI. A lot of them from car crashes and the HV vehicle flip. We did a lot of specificity management, mainly with Botox and Myoblock. Stuart was also involved in some study getting, to get FDA approval Myoblock for specificity. And then we did a lot of intrathecal baclofen trial, including the use of gait lab. And we also did a lot of patient with concussion, and I was also able to work very closely with Mark Sher of neuropsychology. So that was a good experience for me. And then after I finished my fellowship, I went to University of Cincinnati Medical Center, where I serve as a brain injury medicine attending with Tom Watanabe at Drake Center. Here, I also attended trauma round unit, which is where we ran with the trauma surgeon. And then at that time, the trauma surgeon usually only do trauma. So they left all of the medical management of brain injury to the PM&R folks. So we did a lot of acute brain injury medicine management. I also took on some administrative duties. I also did a lot of resident teaching. And so I'm going to run through this slide pretty quick, because I want to have time for you guys to ask questions later on. So I've been a fellowship director since 2010. And Amy Matthew is my associate brain injury fellowship director. I have trained 10 fellows today. And I was attending for Zell Lipschitz Brain Injury Unit from 2008 to 2018. Now I do mainly consult in outpatient clinic concussion, COVID. And then I also have a lot of administrative duties, university duties, such as I'm on the medical student admission committee. I'm also a UT Southwestern CHAMP council member. And this is our facility. To your left is Clements University Hospital. And to the right is Parkland Hospital, our county hospital. These are the leadership team in brain injury medicine at our facility. Myself, Amy Matthew is the associate program director. And Godley and Terry Isbell. This is the faculty who are board certified in brain injury medicine. Myself, Amy, Kathleen Bell, our previous chair, Sarancha Parshakar, Shelby Halsey, who now does the brain injury unit, Karen Kowalski, our previous chair before Kathleen Bell, Shanti Pinto, she is a new addition. And she does a lot of research with NIH grant. And of course, John Dodecar, my first brain injury fellow who would stay on as an attending. Now, these are other members of the brain injury medicine team, including our nurse practitioner. And then in our program, the fellow will take to a lot of different department. They spend time with neurology, neurocritical care, neuroradiology, as well as ophthalmology. And then these are the past fellow, the 10 past fellows that I had the honor of training. Our current fellow is Joseph Tesler. He's on the bottom row, fourth over. He will be going to Anaheim for his job. All right. And then this is some of the things that our fellow goes through. They would spend inpatient at the general PMR rehab at Parkland Hospital. Also see TBI patients, stroke patients. They would spend a lot of time in outpatient clinic, including we're going to have a blast injury clinic to the VA, where they will have a lot of exposure to blast injury, which is one of the ACGME requirement. Of course, they spend a lot of time with the neurology department, as well as the therapy service, as well as neuro-ophthalmology. Our fellow also go to rehabilitation. This is a transitional program or a day neuro program that specialized in treating patients with acquired brain injury, about going back to work, going back to school, and then spasticity management. And this is the Braintree Medicine Fellowship curriculum. We have Lecture Club, Lecture Journal Club, Quality Improvement, Mock Oral, Teaching Services. And also we have, our fellow has opportunity to do a lot of research in the context as well as the TBI model system or TAVR as well as the PUMP program. We also have a lot of multidisciplinary conferences with the different services at UT Southwestern. The fellow also serves on a lot of committees and meetings. And we also have a O'Donnell Brain Injury Institute which focus on brain injury. All right, and then one of the things that our fellow does is they have to learn to attend, to facilitate a stroke support group. I mean, I'm sorry, they have stroke support as well as brain injury support group. And then we also teach our fellow to do a lot of advocacy work. For example, John Todakaris, the current chair of the Texas Brain Injury Advisory Council and one of the committee chair. And then the fellow also have a lot of teaching opportunities to the staff, to our therapists, to our residents. These are features of the fellow faculty and staff camaraderie. So that's pretty much all I have. Thank you, Brian. Thank you so much there, Ben. Sherry, are you prepared to be next? Yes, I'll just quickly, my mind will be free. All right, so I'm Sherry Dunn. I'm at University of Washington. So thank you for choosing this time. I can join and then I think, I know that it's a late on the East Coast side things. So thank you. And then there's my email. So let me just go over a couple of things. So I came into brain injury medicine because initially when I was at Boston University, I thought I wanted to do internal medicine or neurology. And then one of my friend who actually became a neurologist went to kind of a subspecialty luncheon thing that they had. And she was the one who told me about it and got me interested. And during that time, I got interested in spinal cord injury and then ended up going to DC for my residency. And I thought throughout the whole time, I would probably do spinal cord injury and not brain injury. Because I actually at that time, I was in the hospital and I was in the ER and not brain injury. Because I actually at that time really liked the fact that it was more orderly, I guess, at that time. But then I think throughout the my rotations, I became interested in brain injury because of some of the things that you've heard. I've had a really great mentor who got me interested in brain injury medicine. Both of them had a neurology background, which were wonderful from Michael Yockelson and Sue Anderson or Lynn now. And then, so that actually got me interested in brain injury sort of more during late third year and fourth year of residency. And I came to University of Washington for my fellowship. At that time, this program was not ACJME accredited. So I began my fellowship as an acting instructor, which was an interesting experience. Learning about how to fill, because I was working at that time sort of technically. And going to different places was really fun with the trauma center, university hospital and everything. During this time though, as you've heard, fellowship was I think where I do the most professionally. The teaching and how to teach, as well as how to interact with some of the teams. Those were really invaluable experience that I got from my fellowship with Jen Dr. Zumsteg and so forth. So that kind of prompted me to stay and what I do now. And I stayed at UW throughout this whole time. I'm mainly at Harborview Medical Center. My work includes actually sort of a rotation, little bit different. I go from consult to inpatients, few months at a time throughout the year. And I have outpatient throughout the year and the continuity. For me, this works really well because I like seeing people throughout that whole stage and then getting to know them in the outpatient clinic. And so I think that's probably why I really enjoyed this job and really get to see people and their family when they're in that consult side where they're just have that event and they're just so disoriented and trying to be really helpful in terms of, yes, I've seen your low injuries like the one that your loved one sustained. And I can tell you that I've worked with them in the outpatient setting, which I find to be really gratifying. And I became involved with the program for fellowship around like 2017, when our program applied for ACGME accreditation and learned a lot through that, how much bureaucracy there is in the university system because we had to go through that university application and then the ACGME application. So that was a really steep learning curve. And our program was able to get the accreditation in 2018 and have been working with fellows since, which has been a really invaluable experience for me, really learning from each of them who came from different programs and how to teach them differently and trying to be that kind of continue why all of us kind of came into brain injury medicine and cultivate that and make sure that they continue to thrive, which has been a really wonderful experience for me. So that's my journey and I think next is Rosanna. All right, last but not least, let me see if this works. Okay, so hello everyone. Thank you for joining us. I'm the last one on the panel. So my contact information is right there. I'm at Northwell Health, Zucker School of Medicine. My journey began way back in 2006. I also did an unaccredited fellowship. So you're not that old, Dr. Greenwald. And so just to speed this up, I got a first job and there's not much to say except all the things that they tell you about making sure you have a good mentor is really key to succeeding. But I did get a call and in 2012, I moved back to New York where I am from and worked at Southside Hospital to mainly work on a BIU, inpatient rehab and consults, as well as outpatient. And the really great thing that's still happening today is that I developed on the first day of my starting the concussion program, which is now system-wide. So we move on to a few years later and I too opened up a brain injury fellowship program and soon after our brain injury unit closed, all the acute beds moved to one system location of not at my particular hospital, but we still managed to maintain the fellowship and give them a great experience. The department kind of grew smaller and now I am the local chair of our department at our hospital. I also became involved with the New York State Athletic Commission where I covered combat sports, which is something that not very much of our PM&R colleagues are involved in. So it was a fantastic opportunity. So then COVID happened and finally our hospital decided to upgrade to a university hospital. So I'm still doing big portion of acute care consults, which I think is huge to have a background in brain injury and inpatient medicine because you get to really understand the neuro rehab piece of managing patients and consults, as well as the neurotrauma. The outpatient is still going and I've evolved to have more and more chemo denervation patients, just because after you've been there for 10 years, people get to hear you. So it's really good to see that grow, continue to have the fellowship, which is great because we're constantly evolving and our hospital is getting bigger. And so the experiences are getting certainly much more deepened. And as chair, yes, there's a lot of meetings, but it's an opportunity to really network. And as you grow, you end up being part of more research projects, building community and education. We host a yearly brain injury conference. And now I'm actually part of the advisory board for the New York State Athletic Commission. So I'm involved with actually developing policies for the combat athletes. So in essence, I didn't really talk about my personal history into how I get into this. I suppose you can hit me up one day at a conference, but basically I couldn't have gotten here and have had the experiences that I've now come to have if it wasn't for the specialty that I chose. And I think once you have a really good experience, especially with the mentorship that you receive, things kind of fall into place. And I tell all my residents and all my fellows that just because you pick one fellowship doesn't mean you can't do X, Y, and Z. PM&R is so large that just expanding your knowledge into one specialty doesn't mean you always have to just stay in that specialty. So very diverse opportunities are available, whether you self-specialize or not, but brain injury is fantastic to open up many avenues for you. And that's all I have. I appreciate all of my panelists giving that information. And hopefully you have some idea about where people have been and where they are now. We're lucky to have Alyssa on the line here today also to tell us about this interesting program, Synapse, that I'm also still learning about that sounds like an interesting possibility for the field of brain injury medicine. Yeah, so I'm trying to be mindful of time. So I'll try and move kind of quickly through what I have to say, but thanks so much for having me. I'm the current brain injury medicine fellow at UPMC. I'll be going back to Spalding where I did my residency training to practice as an attending next year doing acute care consults. And so I'll just be saying a few words about some of the work that I've done during fellowship to build capacity and really attract talent to our field through education and outreach. So I'm gonna start back in 2010 when I was an undergrad studying brain and cognitive sciences at MIT. I joined a student group which provided a safe space for people with brain injuries to come together to share their experiences and support one another. And a big part of actually what they're also doing is educating the students about what it means to have a brain injury and what is the care for people with brain injury and kind of what is the need out there. So I really got exposed to this kind of when I was 19 or so, the really big lack of access to care for this population, both because of the high prevalence of brain injury, the lack of brain injury providers that were available for them. And then also a lot of these comorbid issues that disproportionately affect this population. So when I saw this enormous need as a college student, I decided that I wanted to become a brain injury doctor. I was already pre-med, so I'd already made that jump, but I really became set on specializing in brain injury medicine at that point. And we know actually these days, I'm not really unique in choosing my subspecialty early. This was a 2021 study of graduating PM&R residents, which they managed to get information from almost 80% of the US residency programs. And as you can see, like around 73% of graduates match into fellowship and most of them are going into pain, spine or sports medicine. And I think the important statistic here is that 72% of them didn't change their subspecialty focus during residency. So there are certainly some residents that are movable, but that portion seems to be potentially kind of small right now. So when we're looking at the whole pipeline for attracting talent to our field, I think the residents are certainly a piece of that, but I think it's also important to look back at what are these early formative experiences that people might be having that are causing them to choose their subspecialty and to kind of be set on that once they arrive in residency. So my work actually stems from that early experience that I had as an undergraduate. When I was in medical school, I established a national organization called Synapse, which establishes student organizations like that one at universities across the US. And so students serve as leaders in their communities and they establish programs for people with brain injury in their local area, including peer support and a couple others that I'll talk about. We're at 19 chapters across the US currently and growing. The chapter model really provides students with an opportunity to serve as leaders in their community. And many of our students tell us this is one of their most formative experiences in college. Chapters offer three core activities typically for their communities, including a buddy program where students are paired with people with brain injuries and meet every couple of weeks. And over the course of years, form a very supportive relationship that's highly educational for both parties. They provide twice monthly peer support groups, which are hosted by trained student facilitators. And we have had them in both virtual and physical in-person format. And then our students also provide community lectures, bringing in speakers for their college and for their community members. I'm gonna shift now back to kind of the Synapse national side, because this year as part of my fellowship year in one of my big education projects, I organized the first Future Leaders in Brain Injury Conference, which is going to be an annual conference, but this is a free national virtual conference for medical students and undergrads. And this allows us to reach students and really to target that pipeline on a much larger scale than the individual chapters do. So we have a lineup of speakers, including faculty from PM&R, neurosurgery, neurology, allied health professions, a patient panel, physician scientists. And then we had a mentoring session where we had a lot of faculty, medical students, residents participate as mentors for our students. And we were really excited. We had 145 students attend the conference in this first year. And we administered a survey to assess their knowledge of brain injury professions, because that was our goal is to improve knowledge and interest in brain injury related careers, specifically being able to identify PM&R as one of the specialties that are involved in this area. So this is an open response question that we surveyed students before and after the conference. And most students were able to identify neurology and neurosurgery as specialties involved in the care of our patients. But you can see that we did make a difference in terms of helping out the low number that were able to identify PM&R as an important specialty as being involved in this care. And the interest in PM&R also did increase for this student group, which I anticipate was heavy in neuroscience students. So I'm really excited to speak to this group because I think we have a lot of opportunities for collaboration with our existing chapters to helping support the development of new chapters. And we're specifically hoping to establish more chapters in places with brain injury fellowships and brain injury departments that we might be able to collaborate with. There's certainly opportunity for everyone in this group, including residents and medical students here to support the future leaders in brain injury conference. And I think so many of our program directors have spoken about the importance of mentors and their personal journeys towards brain injury medicine. And so I think for all of us serving as mentors is such an impactful way that we can help recruit talent to our field. So different, there's several different ways that we can collect, but for anyone from the medical student to faculty level to collaborate with chapters, including hosting students for shadowing, lecturing at chapter events, serving as faculty advisors, helping spread the word to patients about synapse programs. And here's just a quick list of the Brain Injury Medicine Fellowship sites that do have local chapters, which we actually have six of them. But as I mentioned, we're really hoping to expand chapters to other sites that have fellowships, and we'll be targeting those in our upcoming recruitment cycle in August. So thanks so much. I'm really happy to talk, and I'm happy for people to reach out if they have questions or are interested in collaborating. I would welcome that. This is my email as I'm transitioning between being a fellow and being an attending. I don't have my new email yet, but this is my personal email, and I'm really happy to talk. Thanks so much for having me. Well, thank you so much, Alyssa. That was great, actually. I think it's a fascinating opportunity for the field and certainly for patients and expanding the group of people who take care of these complex patients. As not unexpectedly, we're running late. I appreciate everybody being here to talk about their work. I have also Katie El-Tanji on the line, who's my former fellow. I just wanted her to give a little bit of information about, in her more recent past, how she ended up doing her fellowship and where it's brought her to now. Hi, everyone. My name is Katie El-Tanji. I am currently a brain injury medicine attending at Shirley Ryan Ability Lab, and I recently completed my fellowship with Dr. Greenwald at JFK, graduated in 2021. And I'll actually be one of, I'll be the associate program director this upcoming academic year at Shirley Ryan Ability Lab, which I'm looking forward to. So I, during residency, I was interested in a wide variety of areas within PM&R, but what I really found was my, I really loved neurorehabilitation and specifically taking care of patients with brain injuries. And so I decided to do a fellowship because I wanted to know when I graduated from my residency or fellowship training, that I was providing the highest level of care to my patients. And what I loved about fellowship was that I was able to take care of patients with the full, throughout the full spectrum of severity of brain injury. And so I had dedicated training in acute concussion management. I took care of more severe traumatic brain injuries, including disorders of consciousness from consults in the ICU to acute inpatient rehab, subacute rehab, and also the outpatient setting. And I also had dedicated time for spasticity management, including baculine and toxin injections, interlegal baclofen pump management, including interlegal baclofen trials. And so what I found is that, and then also had wonderful mentorship and also dedicated time and education within research. And so it felt like I was able to really grow in my research skills too. And so I'm very glad that I did fellowship. I felt by doing the fellowship, I've now been able to really shape my clinical practice to focus on my areas of clinical interest. And so I have an inpatient traumatic brain injury service, which is a teaching service. I get to teach medical students, residents, and our current fellow. I also have an outpatient practice that includes our acute concussion program, and I do baculine and toxin injections and spasticity management too. So I feel like by doing fellowship, I've really been able to focus on my clinical areas of interest and within medical education too, which has been a goal of mine. I greatly appreciate that, Katie. I think Katie was a great fellow. But these are things that people should expect during their fellowship. Katie, it was nice to see all that she got to do during our fellowship at JFK, but kind of that cross-section of education, across the spectrum of brain injury and all those different clinical and education and research pieces is what you should really hope to learn during your fellowship. I appreciate everybody staying a little late. Do people have questions? I know myself, I'm very available through email or any other mechanism that people wanna communicate with me just in general. But are there any questions that people wanted to put out to the panelists this evening? Let me see, I'm gonna put up my email address again. I have a question, Dr. Greenwald. Yeah, sure, please. Yeah, so just asking a question from the general audience, kind of like what everyone's been saying about how the importance of mentorship is in PM&R, but obviously specifically in the brain injury world. And Melissa and Katie even mentioned how it was so important for them during their fellowship. What do you have as like suggestion for those residents who maybe don't have a brain injury fellow on their faculty at their residency, or maybe they don't have someone who's really involved in the brain injury world, but they wanna get more exposure to brain injury. They're not sure if they wanna do a fellowship or maybe they do wanna do a fellowship, but they need a mentor. Do you guys have any suggestions for that resident? I think the people who are here tonight who are giving up their time are all the type of people that you'd wanna talk to. And that's a great question. I think are all the type of people that you wanna talk to. I've really gotten to know the fellowship directors from across the country. And in the same way that I try to keep myself very open for when people contact me and wanna know about my own fellowship or about brain injury medicine just in general, this is the group. And I think if you go on the AAP website now, I'll give a little shout out to the AAP. But if you go out to the AAP website, it lists all the fellowship directors there. And I think as a fellowship director, it's really our responsibility to be there for people when they wanna learn more about brain injury, whether that be telling them about our own program, about the field just in general, or even directing them to someone who's more local to them so that they can learn more about it. But there are certainly lots of opportunities that way. I think in the same way that people in PM&R just in general tends to be nicer overall, people in brain injury medicine, I think I have the same feeling I have about the passion for the field and how we can sort of interest more people in it and have people learn more about it. Hope that answered your question. And Brian, I just wanted to piggyback on that too. And I know when thinking about fellowships, some people may feel like maybe they can't switch tracks because perhaps they've started building their CV in a particular direction. And now they may struggle to identify activities or extracurriculars or other things to get more familiar with the field, but also demonstrate their commitment to the field. And I think something like, even as a resident getting involved in something like Synapse could be a great way to begin to build some meat to the CV and the brain injury area. And I think any of us on the panel too would be willing to help each individual think about ways they could get involved early on if brain injury is their first choice or later on if they feel the need to switch horses and go a different direction, we can provide them some ideas and directions for doing so. And then if I may add, and just, I think some of us are also part of the AAP's mentoring program and there are a bunch of us on there. So, and I think it lists our specialties. And so it doesn't have to be just brain injury, but obviously if you're interested in brain injury, there are a bunch of us on there, reach out to us that way. There is more of that formal mentoring program to help decide, but obviously as others have said, we are very happy to answer any questions for those who are interested as well and reach out to me at email. Thank you. Are there other questions that people wanted to get answered tonight? Dr. Greenwald, thank you to the whole panel for all your stories tonight and kind of your path. Would you guys have any specific advice for those of us who are considering going through the upcoming application cycle? Cause it does start kind of soon. Well, I think I have a couple of questions. What's your thoughts, Katie? Do you have any suggestions that way? Yeah, I would say, I would, you know, my recommendation would be to look at programs, but I would apply broadly. So you can really learn about each of the programs. And I would think about, you know, what are your goals with the Brain Injury Medicine Fellowship and whether that's, if there are specific areas of interest with acute concussion or spasticity management or disorders of consciousness, or if there are different specific areas, I would think about where you're interviewing and do the programs offer training in those areas? And I think most of them do, but also just finding a location that matches your interests. And then I think too, you know, starting to think about as well, if you have research interests or specific clinical interests, having a sense of what those are, so you can match, you know, think about focusing your, where you think you, you know, focusing your interviews and focusing where you might go based on that, based on your specific interests. And so for me, I was very interested in acute concussion, very interested in disorders of consciousness and spasticity management. And so JFK was an excellent fit because I was able to train in all of those areas. I think it's one of the advantages of now the interviews all being virtual is that you're able to interview potentially at more programs and kind of learn about more programs that way and try to find one that'll be more specific to your interests and needs. Ben, did you want to share something? I'm sorry, it was along the same point that you were mentioning, Brian. With everything being virtual, there's a lot less cost. So I would encourage you, unless you have a geographic restriction, to look around and interview as many as you want. Because like Brian was mentioning earlier, when I interviewed a fellowship in 2000, there were only, only went to four programs. But now with virtual, you can go to as many as you want. Thank you. This is Amy. I would say too, that with a virtual format, I agree, apply broadly, but also do your homework about the different programs and make sure that you're asking, pointed, insightful questions that will really kind of help you discern whether or not that program has some of the particular strengths that you really want to focus on. And hopefully too, the programs will provide a little bit of opportunity for casual conversation and intermingling, even online, just to give you a sense of culture. And that might not be a bad question to ask about culture, philosophy, how are the units managed? What are the services provided? What do the associated rehab, allied health teams provide? How are they treated as members of the team? You really try to kind of pull out of it as much as you can in the virtual format, what the culture's like. We also in our interviews format and have people interview with our current fellow just so they can kind of have that informal conversation of what it's really like at our program. And if there are a couple of programs that you're really debating about, it might be reasonable to, if you weren't already able to do so as a part of the formal interview process, reach out to the current fellow or some recent alum to get a sense so that you can get a better idea of how at home you'll feel in that particular program. Yeah, I know people reached out to me afterwards, but also after the interviews and I did phone calls with them and the other faculty, including the fellow, I could do the same. So there's more opportunities like you bring up there. There's more opportunities than just sort of the interview itself to get to know about the program. Might be things that you learned about another program you wanna ask if they have it in this program. So there's opportunities beyond just the interview day itself to continue to learn and find the program that's right for you. And also, if you have the ability, once you narrow down the interviews, the fellowship place, I would encourage you to fly out there and take a look to make sure that it feels right for you because you're gonna be spending one to two years there. So make sure that you're gonna be happy there. Let's see, there's a question online asking if there is a specific region we're wanting to practice in after fellowship, is it in our best interest to do a fellowship in that region or is that not a requirement? What's your thoughts, Rosanna? Is that something that you could, a question that you could take on? Sure, so- Can you move around a little bit? So for someone who's moved a bit back and forth, no, I don't think that being in a specific region for your fellowship is absolutely necessary. I mean, it may increase your options for the local areas, but certainly I think you should consider the fellowship in its own one moment decision because I think it can really, because you never know how it's gonna go. And so you should pick a place that you feel is the most similar to what your values and what your interests are and making sure that your mentorship opportunities are available because once you have that, then you can pretty much go anywhere. So I think building the good foundation is gonna help you. I still mentor my former fellows and I advise them. And so that's what you want for you to perpetuate ongoing career development. So no, I don't think so. You interview broadly and you pick the best fit for you. Yeah, I definitely agree. I know my fellows have come from across the country and have returned to wherever they wanted or gone wherever they wanted afterwards. And it's not been a real restriction. There may be some subtleties of, let's say for my own program, it's nice to know who we're actually hiring, but I think there's lots of opportunities that way and going to a high quality fellowship that way you feel like you're really getting the best training is probably the more key part. And one thing that you told me Dr. Greenwald is maybe not train at the same place that you're gonna do your fellowship just because sometimes you never know. You kind of may have maxed out on some of the training that is to offer and certainly going out into a new place, learning how other people do it at a different place with different administration and different ideas as to how things should be run. It's just a good perspective to have. So certainly expanding and diversifying prospects is also a good idea. I certainly agree with my thoughts, yes. Any other questions that people have? I appreciate everybody staying so late this evening or at least still late East Coast time. Cherry, we're here for you. Yes. And please, if anybody has questions, I know myself and my panelists are very open to that. And the people who are the Brain Injury Fellowship Directors and former graduates I know are all feel the same way about that. And let's make sure that people get the questions answered that they need answered. Thank you everybody. Thank you, good night. Thank you. Thank you. Thanks so much. Have a good night.

brain injury medicine fellowships

panel discussion

experiences

mentorship

subspecialty

fellowship

specialized training

personal journeys

research

procedures

long-term patient relationships