Welcome, everyone. Thank you so much for joining tonight's webinar. We're so excited to have you all. Tonight is the pediatric rehabilitation medicine fellowship Q&A series, led by the AAP, doing our AAP summer series. A friendly reminder that we also have another Q&A fellowship series coming up on Monday, September 18th at 8pm Eastern Standard Time, and that will be pain medicine. And then on Monday, September 25th at 8pm, we have the asbestos city medicine Q&A fellowship series. Tonight we're honored to have so many wonderful field in the wonderful, wonderful people, excuse me, in the field of pediatric human are here to join us. So please put any and all questions you have in the chat. Or if you feel free, feel free to turn your microphone on video on and ask them yourself. Otherwise, we'll do a more focused Q&A session at the end. And without further ado, here's your wonderful peds. My name is Dr. Carl Clamar, and I am the pediatric rehabilitation fellowship director at Nationwide Children's and Ohio State here in Columbus, Ohio. I also currently serve as the president of our chair or whatever. I get I am the one who has to organize meetings of the pediatric rehabilitation fellowship directors. So it's a it's a thankless job, but it means I get to speak first. So for those of you who don't know, Pediatric Rehabilitation Fellowships are a ACGME certified fellowship. They do lead to board eligibility and pediatric rehabilitation medicine. It is a two year fellowship. So in the in this fall, we're all currently gearing up for our interviews. We use the AERES system and we participate in the match. So there are and correct me if I'm wrong, guys, there are currently 24 ACGME approved fellowships. I think San Diego is the 24th, right? I don't know if there's 24. I know there are 24 spots. I'm not. But some people may be recruiting for more than one spot. So there are at least more than 20. Yeah. So San Diego is our newest program, not actually participating in the match this year. We hope to have them in the match next year. The number of slots that are in the match varies year to year, because there are some programs that that either do two one year and one one year or one program that does one every other year. So my program, we are located in Nationwide Children's Hospital, which is an independent children's hospital, but closely affiliated with Ohio State University. We take one fellow per year, which is a fairly common size of program to take. And, you know, we're we're very proud of the fact that 100 percent of our fellows have passed the certification exam. And nearly all we do have one who no longer practices pediatrics, but nearly all are still practicing in pediatrics. And the vast majority are practicing in an academic setting and helping to teach the next generation. So several of my colleagues here from other fellowship programs tonight, and we're going to give everybody a chance to kind of kind of tell you how their things go. So, Josh, do you want to go next? Since you have your microphone on? Oh, boy, I shouldn't have had my microphone on. Well, if somebody else wants to go next, I'm flexible. No, I mean, I can go next. I mean, I do have a. Our formal presentation, if you'd like me to do that, but I can just talk generally about the program. It's up to you, man, whatever you do, you. Yeah. Well, I'll take a small poll because I don't want I don't want to be the only self-serving slob here. You know, are you going to do something formal? You're going to talk. I'm just talking. All right, then I'll be I'll be a talker. I'll do whatever, you know, she's my hero. So my name's Joshua Bova. I am the medical director as well as the pediatric rehabilitation fellowship director here at Children's Health Care of Atlanta in Atlanta, Georgia. We were the program that took one person every other year, but now we take somebody every year to just like most other programs to have a junior and a senior fellow, if you will. I my background's a little bit different than most of the people I have. I was a pediatrician first and then continued on and did a rehabilitation residency. There are lots of ways you can go into pediatric rehabilitation medicine. You can do pediatrics first and then do a rehabilitation residency. And then I was the really neurotic person and did a fellowship as well. You can also do a combined program, which is a five year program to do pediatrics and rehab. Or you can do the more traditional way of doing a PMR residency and then a pediatric fellowship. We at Children's Health Care of Atlanta have the, I guess, the honor, for lack of a better word, of having the largest inpatient unit in regards to census, meaning we have even though we have 28 beds on our inpatient unit. There are some places that have 30 beds, but when it comes to ADC, which is average daily census, we seem to have the record of having the most acute inpatient rehab beds in the country at this moment. So if you like inpatient rehabilitation medicine, we're a fun place to hang out in. Our program focuses a lot on not only doing the medical portion, but we also do a lot of procedures in our program. A lot of people don't realize that about pediatric rehabilitation medicine. It actually can be very procedure oriented. So, for example, in our program, we do EMGs. We do botulinum toxin. We do phenol injections. We're working on doing cryoneurolysis. We finally got a machine. Yay. Now I'm just going through dealing with legal to do something that is... Oh, hello, person's face. I see that just popped up. Now we're working through legal in order to get something that's not approved yet for pediatrics, but hopefully that will be done before the end of the year. We also sit in in SDR, so we do interoperative monitoring. Hi. Hi. And so, again, a lot of good things. We have a lot of things that people don't also realize about pediatric rehabilitation medicine is that we also have a lot of interdisciplinary clinics. And I think that's really a big advantage of this field over many is that we get to actually work collaboratively with a lot of people. Most pediatric rehabilitation medicine fellowships are within children's hospitals. Some are in pediatric versions of adult hospitals, but it gives us that opportunity to work more collaboratively in a setting so that we're able to get a very multidisciplinary approach and really take a team approach into seeing our patients, some of the advantages that many of our adult colleagues don't have. The only disadvantage of doing a pediatric rehabilitation medicine fellowship is eventually you have to watch your patients graduate and go into the world of adult medicine. It's evil, it's horrible, adult medicine, but we try to keep them preserved the best that we can. Or sometimes we just hold on to them forever. Did I miss anything, Younoma? I don't think so. All right. Atlanta's pretty great, too. Forgot that part. Yes. Younoma comes to visit her mom and eventually, sometimes she'll call me and we can hang out together. Hi, everyone. I'll take that as a pass the mic moment. My name is Younoma Kamaguna. I'm the program director at Texas Children's Baylor College of Medicine in Houston. So a little bit about my background. I did one of the combined programs that Josh mentioned. Mine was in Colorado. We think we were joking that we need to track our lineage for pediatric rehab positions and I tracked down the lineage of Dennis Matthews. So a little bit about us. So we have a program that accepts two fellows every year. So we'll have a total of four fellows at any given time. Texas Children's Hospital is the largest, I believe, pediatric hospital in the country as far as I know. Up until September. Oh, man. And then you guys are taking over, right? Yeah. And then in 2028, we're going to blow you all away. We just broke ground this week. Oh, wow. Well, I don't know. We're building one in Austin, too. So we'll see. It's a constant competition. It is. From our program's perspective, I think Josh also mentioned this. One of the beautiful things about PEDS is you don't have to pick one thing to do. So you don't have to pick brain injury. You don't have to pick sports medicine or spinal cord injury or spasticity management. You get to do all of that as part of our training. And I think that's also a part that helps to keep things interesting, that along with the environment that we work in and really getting to engage with kids and follow them as they grow up and really just be a part of that. And I think that's a wonderful opportunity. And I get to play every day at work. And I don't think everyone gets to exactly. I don't think everyone gets to do that. From our program perspective, other than VOVA, if you still do Tutu Tuesdays. Still do them. Other than that, our program, I think one of the equally unique things is we have, I believe we're up to 14 faculty, potentially even 15 or 16 faculty in total. And our faculty get to have trained from many different places. So we really have a diversity of experience. As you'll find as you start to learn more, your individual practice ends up being born a little bit of this from somebody and a little bit of that from somebody else. So I think that diversity really enhances our richness. We have a gait lab at our Woodlands campus. And so with that, we have our multidisciplinary clinics. And we have a really close relationship with our neurosurgeons and our orthopedic surgeons as well. And we have monthly video rounds where we talk about complicated spasticity cases. And so we do intrathecal baclofen management, SDR, selective dorsal rhizotomies, hemi-selective dorsal rhizotomies. We've been getting into tibial anorectomies and some other colon-U things. We also have DBS, so deep brain stimulation, for our dystonia patients as well. We have, I think, close to 200 baclofen plant patients. And so we get to manage those. And our neurosurgeon colleagues get to help us with putting them in. The other components that I think are really stronger also are exposure to procedures. And so we have procedures both in clinic and also sedated in the OR. And we do quite commonly join our orthopedic colleagues or other colleagues who are doing other sedated procedures to also do our part. So we can kind of combine those for the patients. For us in our program, in addition to kind of getting the robust education, we've also incorporated a leadership curriculum. So our fellows in their first year got executive coaching. So they have six executive coaching sessions. We paired that with a leadership book club. So we read and worked through the Dare Lead by Brene Brown workbook last year. And then this year we're working through Crucial Conversations. And so we have monthly meetings towards that and kind of talk about challenging moments that we might encounter being leaders and budding leaders in our training program. We also have an additional focus on the humanities. So you may not be familiar with narrative medicine, which is the use of humanities to help us process some of the things that we go through and also connect with our patients a little bit more. So we use those reflective tools as well as part of the training program to really help enhance ourselves holistically as PM&R physicians. I think that there's a lot to offer there. Houston, while hot, you might hear my fan in the background, and that's because the A.C. can't really stand up to the heat right now. But in the wintertime, we are not we're not cold. So we do have that. And there is every type of food that you can imagine in this city to the detriment of my waistline sometimes. But I definitely enjoy living here. I look forward to answering any questions you'll have. Would you rather hang out in Atlanta? That's a good pitch for Texas right there. And my mom just moved to Houston. I mean, we're not going to be hanging out as much. So anyone else? Kim, does that mean I get to go last year? All right. Yes, Kim. I'm Kim Hartman. I am the program director here in Kansas City at Children's Mercy. I also come from a combined program in Cincinnati. So kind of a parallel route that Enoma took, but through Cincinnati. So a residency where you do both pediatrics and PM&R. If you are a medical student and definitively know that you want to do pediatrics, it's something that you could certainly look into. There's only a handful in the country. And by handful, I mean three-ish right now. There are three. Yes. There's rumor of more coming up at some point. But three and I believe there are four spots through those programs. So if it's something that you know you're interested in, it's definitely something to check out. But like others have said, most people go a more traditional route and do PM&R first and then do the pediatric fellowship afterwards. I guess I wasn't fully prepared to talk about our program, but I can certainly talk about Kansas City all the time. I just thought we were going over PM&R or peds rehab in general. But Kansas City is certainly not the biggest city. It's not the smallest either. So I think it's a very nice Midwest city. Our hospital is a good side hospital. We have all of the major clinics, live differences, all the ones that have been mentioned as well. I think in peds rehab in general, we have a lot of good fellowship programs. And I don't know that you can really go wrong. It really just depends on what your interests are. And if you lean more towards inpatient or outpatient or certain diagnoses, the feel of the city, that kind of thing. So I do think there's a lot of opportunities out there if you're looking into pediatrics in general and just meeting with former fellows or current fellows or any of the program directors. I think it's a very collegial group and everyone's happy to answer questions and kind of help point you in the right direction for what's going to be the best fit for you. But come to Kansas City. It's great. If you love barbecue, if you like the Chiefs and Super Bowls, you know, there you go. I don't like the NFL. I'm a Dolphins fan. I'm a Lions fan. So here we are. But yeah, if anyone has questions or kind of how we got to where we got. I know a few people have kind of where they are in their training process. I think any of us would be happy to answer how we got to where we are in our practices as well as anything about like fellowship specifically. So I guess I'd, I'd like to hear from everyone if they have anything specific they want us to share. I made myself there. Yes, definitely. If anybody has any questions, just unmute yourself if you feel brave or take your video on or put your question in the chat. We're here for fun time. In the absence of any questions, I'll just reiterate something that Kim said, which is that there is a diversity of programs in pediatric rehabilitation when we wrote the common requirements for the program. For the ACGME, I'm old enough, I've participated in that process twice. And we left a lot of things purposefully vague, which allows each program to have a difference in terms of what they want to emphasize in their training. So each program has its personality and personality fit is a really important thing, I think, when you think about going on in training. So, so we all tend to get along very well but we each have our own different style of practicing and like Enoma said, it's great to have people who've been trained in different ways and trained to do different things and to bring those people to get together to make sure that kids are getting the best treatment they possibly can. I think one of the hardest things about being a pediatric rehab doc is that there aren't many of you, right. And if you look at people around the country, I don't know what the current number is about 375 ish or so. And so when you're looking at that number of a group of physicians, there aren't many. And so it has its advantages and its disadvantages. The advantage is, it's never hard to find a job, right? You know, but it also makes, gives you that disadvantage, well, I would say disadvantage, but you always have to be very well-versed in your practice. So when you're looking for a training program, wherever it is, you need, what I always tell people is look for one that's really gonna give you a great exposure to a lot of different opportunities to learn and to learn how to be self-sufficient because you never know if you want to join a big practice like Yunoma's or if you want to go and practice by yourself, maybe somewhere closer to where your family is, but you really wanna look for a training program that's gonna give you the opportunity to feel comfortable that you can do what you wanna do and wherever you wanna do it. The other nice thing about, to mirror what Yunoma said, is it gives you a lot of variety in your practice. You can see, you can be specialized in something specific. You can see a large variety of things and continue to have a lot of variability in your practice. So, you know, it's not like, I don't know, doing pain medicine and you're doing epidurals all day. It really gives you a good opportunity to explore, be creative, and just do a lot of different things and not feel like you're going to work to do the same thing every day. You know, I'm still in my scrubs because I was in the OR all day doing botulinum toxin and phenol. You know, and tomorrow I'll be hanging out in my brain tumor clinic, you know, seeing kids who are recovering from brain tumors. So, like I said, there's a lot of variability in what you do and I think it's something that most fields cannot offer. The other thing to build on that even further, Josh, is that 10 years ago I wasn't doing what I'm doing now and five years ago I'll probably be doing other different things. Some of the things have been constant, but I'm constantly finding new interesting things, new things that keep me really enthusiastic about continuing to treat kids. You know, I have built programs in non-accidental traumatic brain injury, in concussion, in myelomeningocele. I've participated in building all different kinds of programs and it's nice to be able to do different things as you go along. Keeps me feeling very vibrant and constantly learning. The other nice thing is it's a very small, because it's a very small field, we all collaborate a lot on different projects. We talk to each other a lot. You know, I can say I've had three different conversations this weekend with other doctors around the country, me asking them questions, them asking me questions, working on and just exploring knowledge. So I think that's really something that a lot, PM&R in general has, but Pediatrics PM&R really just owns is the fact that we work very collaboratively. Even when it comes to interviewing for very competitive spots, we still really worked on saying, I know that we're gonna keep things virtual, we're gonna keep everything on a level playing field. And I think it's, you know, a good environment in a world of competitive medicine. Great, we do have a question from our group chat, a really interesting question. The question is, what are the advantages slash disadvantages of doing the combined five-year program versus four-year PM&R residency followed by P's Rehab Fellowship? I mean, I know you, I have my own personal opinions, but Kim, since you did it. Yeah, I think a lot of it is your personal preference. I think at the end, you will get good training either way. So for those of you who aren't aware, the five-year combined pediatrics and PM&R programs typically start with a year of general pediatrics. So instead of your intern year being in medicine or surgery, it's in pediatrics. And so you would be just like all the other pediatric residents doing all of those rotations. And then the remaining four years alternate, slightly different at each program, but you're switching back and forth between general pediatrics and then PM&R with P's PM&R mixed in to that. And so now you can do up to a full year of just pediatric PM&R within the program. And so you're getting a little bit of general pediatrics and then a little bit of the adult PM&R and then the pediatric PM&R as well. So I think if it's something you are dead set on from the beginning, it's certainly something to consider. If you're still questioning whether that's right for you, then you might not want to commit yourself to that right away. For me personally, I chose the combined program because I knew early on, this is what I wanted to do. I also knew very early on that I really liked inpatient medicine. And I felt like having the general pediatric background really helped me with the inpatient side of things and the complexity of some of the kids that we admit. So I thought that was an advantage for what I was interested in. I think some of the disadvantages of the five-year program- Talk right. Sorry. So in the fellowship, you have a little bit more dedicated time for research. Some of the things like Enoma was mentioning, like some of the leadership training and that type of thing, which I think is a little harder to squeeze into the five-year program. It's also more challenging to get into a five-year combined program because there are not that many slots. And I think one of the disadvantages or advantages of doing the fellowship is you get a little bit more on the adult side in terms of your MSK and some diagnoses that maybe you don't see quite as much in pediatrics, but are still pretty important and helpful to have that background there. So I don't know if anyone else has any additional thoughts on that, Carl? No, I just, one question, Kim, and I don't know if you know this, but is it, in the combined, it's a minimum of six months of pediatric rehabilitation and a maximum of 12 now, right? Yes. So I think most, so the three places that have programs are Denver, Colorado Children's, Cincinnati Children's, and then DuPont slash Thomas Jefferson in Philadelphia, who now takes two residents per year. And so I'm pretty sure that all three programs do the full 12 months of pediatric rehab when I've talked to them last. As somebody who went the long way and did pediatrics first and then went to PM&R, I would mimic a lot of what Kim said, but I would usually, when people ask me, I usually say, well, what do you wanna be when you grow up? Do you wanna be a pediatric physician that specializes in children with disabilities, or do you wanna be a PM&R doc that specializes in pediatrics? And those are two totally different things. And yet they also combine and meet in the middle. So when you're deciding what you wanna do and which career pathway you wanna take, if you could be one, what would you, if you could be a pediatric rehab doc, would you rather be a general pediatrician or would you rather be a PM&R physician? And I know that's kind of a hard thing to say as you're trying to develop your careers, but that's usually the way that I look at it in terms of trying to help people decide what they wanna be when they grow up. Now, when I did it, I thought I wanted to, I was a pediatrician, I practiced pediatrics at the same time I did PM&R residency, don't tell anybody, but I think you all start to develop a style. And I think it just takes time to figure out what that style is going to be, but it really depends on how you wanna define yourself. I have a question. Can you... I think we lost somebody. Yeah, whoever is asking the question, you're cutting out, so. Josh, we lost you. Oh, hi, can you hear me now? Yes. Well, thank you all for coming. Can you all touch on some of the challenges that are facing the field and what you all see like in the next five to 10 years that are gonna be challenges for you all? Well, I can speak. Speaking for myself, I think one of the challenges is that there are a lot of people in the field who are my age, who are not gonna be able to do this for another 30 years. And so we need to make sure that we're recruiting enough people into the field to sustain what we've been doing and what we've been building on. Really strong candidates that we've interviewed the last several years, but right now the numbers aren't growing. So we need to figure out how to continue to increase those numbers to make sure that the field remains strong. I think with any field, you always have to have the challenges of insurance and less being provided for kids and continuing to be a child advocate. And I think that's the most challenging is more and more we're fighting continuously for dollars and children with disabilities and there are other people that have better lobbies. And so I think that tends to be a continual problem is trying to make sure that children continue to get access to resources, to research. And I think as dollars start to get more scarce as time goes on, it's gonna be a bigger and bigger challenge. Great, we have another question from the, oh, Kevin Murphy has his hand up. Well, thank you. Can you hear me all right, guys? Yes, we can hear you. I don't wanna butt in. I appreciate your time and learning a lot. Thanks. A couple of thoughts. I went into the fellowship track back 30 years ago after the PMR training cause I just wanna do more with adults, transition and adults as they got older. I didn't wanna say goodbye to the kids at 21. And I wanted to focus a little bit more on Musco scale to which this kind of why I chose that road. It seemed like Kim kind of hinted that that might be a little difference between the programs also. I'm not sure if it is, but that it served me well overall in that direction. And maybe a question I have for the group is, are there programs that are focusing more on the adults or on the transition to adulthood also? And then number two, I practice rural. I serve eight different Native American reservations in North Dakota and Northern Minnesota. So when the kids come in, we're the first to see them before anybody. And do any of the programs are more sensitive or are developing any kind of outreach or rural kind of exposures for the residents cause about, or the fellows, about 40% of the kids live rural and that's still a huge population that's underserved. Thanks. So from our standpoint, from our program is, and I think a lot of hospitals around the country are still working on improving their transition. There are very few programs that have good transition from a pediatric program to an adult program, especially as many of us are more associated with children's hospitals as opposed to adult rehabilitation residencies. But I think that is actually one of our goals for 2024 is improving our program. Now, in terms of rural medicine, we actually have a program here in Georgia. We just started calling. Specifically, it's called Georgia for CP. And it's really working with the rural community trying to improve access, but also improving education for the general pediatricians on how to medically care for children with disabilities. Because, so we may be able, as a pediatric rehabilitation doctor, and again, as those with the pediatric background tend to do more of the general pediatric management or at least advice in their clinics as opposed to managing it. So in that, we're trying to help our rural physicians understand children with disabilities and give them better education. And I think that you would be hard pressed to be a pediatric practice without having some form of transition, just because at some point your patients will hit that age. And so, like Josh said, it depends on the hospital in terms of what their transition program looks like. And so what I've seen is it's in some parts diagnosis specific, it's a very large and complex issue, but having providers on the adult partners to send patients to, having patients, a lot of our patients end up having Medicaid. And I think that that is a challenge to the field. I think that was something that I caught when I was going in and out, is continuing to find coverage for those patients when they cross over to the adult side. In terms of training wise, I know that for our training program, we always have our fellows start thinking about what does transition look like? And for us, we encourage as a practice to start looking at that at age 14 and start thinking about, you know, what is the self-efficacy of the kids you're taking care of and the ones that aren't able to care for themselves, how are their parents starting to mentally prepare for that change so that things are not quite as abrupt at 21. So the question about rural practices, we don't outreach to rural areas in the classic sense. We have a lot of families that we serve that come from lower resourced areas. And so we really heavily incorporated telemedicine into our practice, thanks to the OVA. But with that, we're better able to serve families that can't make the several hour drive from the Valley in Texas all the way up to Houston. I will say though, to kind of harken back to an earlier point, having training in both pediatric and adult really does help. Because at one point in my practice, I was one of two pediatric rehab providers in the state of West Virginia. And my other partner was in the door next door. So when I was in that practice, I saw adults. I took care of, because there was nobody else to see them. And I actually used my Gen-P practice a little bit more and I did some autism evaluations and things like that. But being fellowship trained in Peds Rehab really gave me an opportunity to understand where they were coming from, especially for the adults with CP that I took care of. And then having done the adult component of Peds Rehab, excuse me, PM&R, I was also able to help address things on that side as well. So I think that being trained in Peds PM&R really puts you in a good spot to do that. One of our graduates actually, I didn't win, but one of our graduates actually left to start a transition process of sorts in Cincinnati. And so she is seeing the adult graduates in partnership with adult PM&R and Cincinnati Children's. Oh, way back when I did training, Colorado used to fly out to the rural parts of the state. I don't know if they still do that. It's been a little while since I was in training, but I do know that they had that average outreach. Yeah, I think Amy told me that they're back to doing it. They're back to doing it. Yeah. So yeah, the discussion about transitions of care is one that we've struggled with for a long time. And so there are starting to be a few people. So we have a brand new attending coming to Ohio State, Jessica Prokop, who trained at Pittsburgh. She was in medical school in Columbus, so she's coming back. And she's coming specifically to do transitions of care. So she'll have privileges both at Wexner Medical Center at Ohio State and also at Nationwide Children's so that she can be the bridge for those people. But it's a tough thing. And we've had other times when we thought we had the problem solved and things collapsed. So you gotta build a team in both places to really do that transition well. Great discussion, guys. One final thought before we close it. Are there any opportunities for ultrasound with any of the programs for some of the more complicated injections, salivary glands, and if you're doing your scalings or getting some of the forearm muscles and things, sometimes ultrasound's pretty helpful. I don't know how many programs have an opportunity to learn ultrasound if the fellow or the resident wishes to. Yeah, we teach ultrasound to all our fellows and residents as part of our program. Again, we're venturing into the world of cryoneurotomies, which you can't do without ultrasound. And even in our inpatient unit, we've actually done a lot with diagnostic nerve blocks, which again is also ultrasound heavy. So I am, and I occasionally teach ultrasound on the side for other people. So like I said, I think it's a very important of PEDS rehabilitation practice. And I would highly recommend learning it if you can in your training. It'll definitely help you. And then obviously expanding your fellowship or residence or wherever it is that you're going. Yeah. We use ultrasound for salivary botox. So we, in addition to ENT, also do salivary botox. So we have a few faculty that do and teach the salivary protocs. We have not used ultrasound as much in our spasticity injection practice, but it's something that we are wanting to grow as a group. The residency training program does have an ultrasound course every year that's several days long that our fellows can participate in. All right, you know I'll come out and teach you guys. Yay, I'm going to take you up on that. Absolutely, I'll come out. Seriously. We're kind of the opposite. We use it in spasticity management, but interventional radiology does our salivary gland injection. So if fellows are interested, they can certainly learn with the radiologist, but no one in our practice is doing that. Yeah, so interestingly, we do a little bit differently. So one of our attendings actually lives in sports medicine, and he uses diagnostic ultrasound in his practice, so our fellows get good exposure to that. And we use it on a very limited basis currently in procedural. So there's, again, lots of diversity, but I think we all agree that it's an important skill to have and one that everybody should have exposure to. And in all honesty, I was not a big believer in ultrasound until I started using it, until one of my former partners bulleted me into learning it, and I won't go back. I see a question in the chat about advice for Pima residents that are interested in Peds rehab, but their program doesn't have a robust Peds rehab rotation. I would say that I second the reaching out to groups at conferences and doing it away if you can. If you cannot do an away rotation, really try to attend a national conference. I think, and I'm curious of your thoughts, I think AACPDM probably has one of the higher concentration of Peds PM&R folks, other than that, AAPM&R and attending the PEDSYNC is another really good way to network and kind of establish relationships that way. Yeah, I think those are your best bets. If you like smaller conferences, ACPOC is also a good conference to attend. It's the Association for Children of Prosthetics and Orthotics Clinics. So if you're really into orthotics, that's a smaller conference, but there's usually about 10 or so PEDS rehab docs that attend that. But it's also a really good opportunity for new learners in terms of learning about prosthetics and orthotics, which a lot of people don't get a good exposure to. So Noma just jumped me in the chat, but AACPDM is a very resident-friendly conference, and a huge representation of pediatric rehabilitation there. I think if you're interested too, you can certainly use any of us here. And there's a few of us that aren't officially on the panel, but are still practicing in pediatric rehab here. So I think I would ask your program director or look up on AAP's website, has all of our contact information on it. And I don't want to speak for everyone, but I'm sure most folks would be open to someone just reaching out and saying, hey, I want some more experience. Do you have a case report? Do you have an article that you need help with? Things along those lines. Or we may know someone who's close by to you that we could connect you with, that even if they're not kind of right within your program, you could at least kind of meet up with them and hear more about what they do. Sometimes you can also find some like rehab adjacent type rotations that may be helpful in the pediatric side too, like pediatric neuro or sports medicine or things like that. If there's opportunities to do that, if you're looking for more kind of hands-on experience and not just at the conferences. But I think I'd be willing to bet them more, a majority of folks, if not everyone, would be more than happy to chat or set you up with additional resources or kind of point you to a person who's closer to you or get you connected if you're interested. And I believe the AAP still has a mentorship program too that you can reach out and get a mentor. There are bunches of physicians that are signed on for that. And if you want to get really creative and you don't have any elective time, you can always use your vacation time once you've established that relationship. And if the program you're interested in allows it doing a week of observership, there's different rules and things for different programs, but that's always a possibility. Great, great tips. Another question we have from the chat is, do research opportunities involved in gait analysis slash labs exist among programs and are fellows able to take advantage of those opportunities? Yes. Oh, absolutely. Yeah. So, yeah, my current first-year fellow is putting together a proposal for something that he had started looking at as a resident and now wants to turn into an actual research project with our gait lab as a fellow. So, yeah, absolutely. Great. And then kind of going back to the question earlier about residents who might not have like a great exposure at their own home institution and would be interested in doing an away rotation. Do you feel like most people's information is on their website where they can reach out to get connected to you guys? Okay, yeah. Yes, yes, yes, yes. Yes. And even if you don't find the person you're looking for, you can probably reach out. Like we all know each other and just like, you know, it was mentioned before, if you're, I don't know, let's say in Alabama and I'm, you know, I'm in Georgia, you can say, hey, I'm looking for somebody in Alabama. I could probably tell you who's in Alabama if you can't find their information or anywhere else. So like I said, it's a very small community and we can pretty much find you a place to go because we work really well together in that respect. Great. I think Candice just put the link in the chat to the page that has all the fellowships listed. Is that what it was, Candice? Yes, it was. Thank you. And then common questions that applicants have, when applicants are applying to Pete's Fellowship, does geography play a role in how much you would consider someone for an interview, whether like geography of where they're from or geography of where they've trained in the past? Not at all. No, none at all. I think I can speak for most of us that we pretty much interview everyone who applies. Anybody not doing that? Yeah. So when it comes to getting interviews, our numbers are small enough that most of us are willing to interview anyone who's interested. And that's one of the advantages of doing it as a virtual interview is it does allow us to interview a lot more candidates. And I, for one, can say that I've at least matched one fellow who I don't think I would have even interviewed in prior years. And so it can be a really great thing that virtual interviewing has done for us. So I hate to give COVID any credit at all, but... I think I'm a big believer in training, going to where you think you're gonna get the best training. I mean, I'm originally from Miami. I went to New York for pediatrics. I went to Chicago for rehab and I went to Denver for a fellowship. So go where you think you're gonna get the best, where you think you're gonna get the best training and where you find a program that best matches your personality. And I think everything else will work itself out. Great, awesome. Another question we commonly have from applicants is does your program or do you know of any programs that sponsor visas? Any programs sponsor visas? You know, it really depends on the quality of the applicant. And I think, you know, as a former residency director, I've sponsored people with visas and I was very fortunate to find those candidates because I don't think they would have had the opportunity. So I think that shouldn't stop somebody from applying, but it is a little bit harder for them to prove that they're going to be worth the effort because it's an expense on the program's part and it's a lot of paperwork. But I think if you're a strong enough applicant, you can make your case. Mm-hmm. I hesitate, I know we do, but I have to remind myself which ones specifically, but if there's an applicant interested, please feel free to reach out to us and we can just answer the question directly and do the research into it. Great, awesome. And an overall question, and feel free if you guys have any other thoughts too that you want to mention about your fellowship in general, feel free to mention those. But a fun question, while I don't see any other questions in the chat this time is what is it that you just love about being a pediatric PM&R physician? I love playing. I love to play and I don't know how to do an exam without making silly noises. I mean, sometimes I have to catch myself with the teenagers because they'll look at me like, what? I love the fact that there are dogs at work. I found that these people are particular types of people. I mean, when you want to take care of kids and you love taking care of kids, that tends to pull a certain type. And so like every environment I've ever been in, and I've been in many different environments, has always had that kind of warm and collegial atmosphere. I love that all my hallways are brightly colored and brightly painted, and that there are toys for me to play with, including train sets that I go to and push the button to make them go and do fun things. And genuinely for me, it truly, like there's a special honor for me in being able to be a part of a family's life at a point when they think everything is devastated and everything has changed, and really watch them come to that point where they love their child and triumph in everything and every success that they do, and become such passionate advocates for them and just watching them grow. So that's kind of, I could wax poetic about it, but yeah. Unomi, you left out that everyone dresses up for Halloween. Yes, yes, yes. Very important, very important. No, but it's really, it's mostly about playing with the kids. I mean, I play with kids every single day. I run races with them in the hallway. I have demonstrated in the last five years a somersault in the hallway, but since I had my shoulder replaced, that's a little less frequent, but yeah, you get to play with kids every day. It's so much fun. That's wonderful. We have a question from the chat. What makes a strong candidate slash applicant for PM&R Residency Fellowship? Showing up. Showing up. In all honesty, what you're looking for is somebody who really understands what they're getting into. I mean, it is a fun job. It is the best job in the world, but it can be emotionally taxing at times. It requires learning skillsets that people don't often have, and so looking at a strong candidate is somebody who really knows the commitment of what it takes to really want to be the best they can be. Well said. Great, and then another question is, we've talked a bit about some of the challenges that face Peds Rehab, but in contrast to that, what are y'all most excited about in terms of the future for Peds Rehab? Technology. Because in terms of advances in technology, advances in just medicine and chemistry, really knowing there are so many exciting things coming out in what we know about the body, and we've learned so much more about the body and muscles and really being able to utilize that knowledge to be able to change children. And it doesn't have to be like a big exoskeleton as simple as it could be, how we help improve the, the muscles in children with CP, the new advances we have in muscular dystrophy in terms of gene therapy. There are so many great things that are coming out that it really makes our job exciting. Yeah, someday not having to care for kids with SMA. I mean, the genetic treatments are really, really exciting in terms of what they're doing for our patient population. Yeah, yeah, definitely. Great, all right. Well, any other last thoughts or closing remarks that any of you would like to mention? I would say, I know one of the concerns that I've heard before is the time for the training has been being two years. And I always say time passes no matter what you're gonna do, right? And a year in the grand scheme of things, it's not, you know, the path of your life is not the longest time in the world, especially if you get to do something that you truly love. So I think that's exciting. Ooh, by the way, speaking of elements, let me tell you, chat GPT, fantastic. Letters of medical necessity, I just thought the question in the chat. You know, Rachel, you don't like it? Oh man, it's written some beautiful letters for me. Yeah, no, I would agree that I've tried it a couple of times and it's better than my form letter that I modify. It takes less modification to the chat GPT letter than to my form letter, so. See, technology, awesome. Yes. And just to piggyback on what you Noma said, you know, a lot of people do get turned off about the two-year fellowship, but I can tell you, I've had a lot of friends who went into pain or some other field and they don't love it anymore. And they've done these things and they're working hard hours and maybe there were some other incentives that made them choose a different career path and they're already burnt out. I love my job. Unfortunately, I love my job too much, you know? And I don't, you know, I don't feel burnt out. I love going to work. I have fun every day. And I can't say that for most other careers and I would change this for the world. So I would, it's a decision you will not regret. Simple, period, simple and pure. It's a great job. Yeah. Two years is nothing across an entire career. Right, Kevin? Absolutely. Time flies by pretty quick. You can ask Vicky too. I'm sure she can validate that well. And I think the biggest change I've seen is the awareness of the field. You know, 30 years ago, people didn't even know what you did or what you do. They weren't sure if they needed you, but nowadays the awareness of the field is much, much more than it was three decades ago. That's right. I think that's one of the most exciting things, how aware people are becoming of the field. We used to just, everybody just thought you send the kids home and mom and dad take care of them three decades ago. And obviously that's not a good choice. And people are just becoming much more aware of what we do. And I think that's part of the reason why there's a growing demand and we're still looking for more kids, more people to come into the field. But thank goodness for the new awareness and the vast awareness of our field. Awesome, awesome. Well, if there's no other questions, I just want to do another shout out for our next Q&A fellowship series for Pain Medicine, Monday, September 18th at 8 p.m. And also our other Q&A fellowship for spasticity medicine on Monday, September 25th at 8 p.m. The links are in the same location as the link for this one on the AAP website. And I just want to give a huge shout out to our wonderful panel speakers tonight. Thank you so much for being in the field of Pete's PM&R. It's an amazing field. We need so many more people just like you. So everybody apply. Everybody apply and become amazing Pete's PM&R physicians just like these guys. And I hope you all have a great night. Bye. Thank you. Bye everybody.

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