Letter from the RFC Chair: On Batons and Transitions

By Charles A. Odonkor, MD, MA

Source: https://www.pinterest.com/naturalherb/snow-pics/

Dear Colleagues:

One of my favorite events to watch at the Olympics is the relay race. I ran this event myself back in college and enjoyed that it involved interdependence of all members of the team. In a relay event, the first runner passes the baton to the next team member after completing his leg of the race. The timing of the pass is critical! The exchange of the baton must happen within a specific area called the exchange zone, otherwise, the whole team risks being disqualified. While winning depends on each person running their fastest on their leg of the race, it is even more crucial that the baton exchange happen seamlessly. Therein lies the secret to winning. Persons involved in the baton pass must both be in motion, strictly adhere to the rules, trust and know each other’s abilities, and have confidence that the baton would be passed successfully.

http://ow.ly/SnrV308sWYN

This past year, I’ve had the absolute pleasure and privilege of running my leg of the race. As Chair of the RFC for the 2016–2017 cycle we have accomplished a lot together. Resident health and wellness has been a unifying thread of my term and we have laid the groundwork for various initiatives highlighted in the Holiday Edition of the newsletter. I enjoyed hearing from residents and fellows from all across the country who are passionate about our field and are working diligently to move physiatry forward.

On January 20, 2017, I witnessed the transition of power as a new administration took over the reins of control with the inauguration of a new president of the United States. Leadership transitions done properly help to safeguard continuity and progress for the success of the community. Although it may not be clear what the presidential transition of power holds for the healthcare system in the United States, at the AAP RFC it is our firm belief that physiatry must continue to evolve as we champion the role of function and advocate for our patients in a new healthcare economy.

As incumbent, I am pleased to pass on the baton to the chair designate, Dr. Kunj Patel, whom I’ve closely worked with throughout the year. I am confident that he will run his course well, help continue the many good projects started in 2016 and rally the incoming council towards excellence and a successful 2017. I will be staying on as immediate-past Chair, to provide counsel when needed and help the new team hit the ground running.

I hope you will join us in Las Vegas on Friday, February 10, 3:00 pm — 4:30 pm at the Mandalay Bay Hotel, Oceanside D, level 2, as new candidates present their bid for the 2017–2018 Resident Fellow Council. We are really thrilled about the high quality of applications this year and feel reassured that with your help, a new set of motivated leaders will be elected to serve you on the next RFC.

If you’re an RFC Alumni, please join us at the RFC Alumni networking social, which takes place on Thursday, February 9th, from 8:30 pm to 10:30pm at the Border Grill at the Mandalay Bay Resort, in Las Vegas.

We also have a fun trivia night and networking event planned for everyone on Friday, February 10, 7:00pm to 9:10 pm at the House of Blues, followed by an after-party at the Light Night Club, Mandalay Bay starting at 1030 pm.

I can’t wait to reconnect with you at the annual meeting in Las Vegas. I look forward to hearing from you, learning about all the exciting innovations in our field and welcoming the new 2017–2018 Resident Fellow Council.

Thank you again for the privilege to serve you as the 2016–2017 RFC Chair.

See you soon in Vegas!

Charles A. Odonkor, MD

Charles A. Odonkor, MD is a fourth-year resident in the Department of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. His interests include interventional pain management, healthcare policy, administration and leadership.

From Doctor to Dr. Mom — Not Really that Big of a Deal, Right?

One Female Resident’s Perspective

By Emily Boyd, MD

This is an article I started writing almost a year ago when I was at the height of my emotional transition from resident physician to ‘working Mom’…now, over 12 months later, it has found completion. Despite the time delay, I still feel that those same questions I pondered last year remain ever present, not only in my own mind, but also at the forefront of today’s society. Here you have it:

As I sit here half-naked, with what was no doubt concocted as some medieval torture device strapped to my chest, otherwise referred to as a ‘breast pump’, I contemplate my passage into motherhood, as well as a number of other things — 1) how ridiculous I feel, 2) why I even bother putting a shirt on these days, and 3) the fact that there is absolutely no way to prepare anyone for how drastic of a change it is to become a parent. I feel like I am constantly overwhelmed with all sorts of emotions (maybe it’s the hormones?), but most of all, I was already sensing the dread creeping in as my thoughts drifted to returning to work and leaving my precious little one, with whom I had become so well acquainted, but yet was just starting to get to know.

Through all the emotion and contemplation, I was left pondering, am I doing the right thing? Are we, as a medical community, embracing the role of motherhood to the best of our ability? The career demands placed on women and men of today’s society are fairly equal, yet there remains a seemingly striking inequity in the world of child rearing, often forcing women to choose between sacrificing their career or sacrificing their family. This is especially not an easy choice in the world of medicine, where most females have amassed the same amount of debt and committed just as much time and energy to their training as their male counterparts.

When I was pregnant, people frequently inquired about how much time I would have off for maternity leave. I found that I was usually faced with one of two responses…either “What!? That’s it?” or “That’s pretty good.” I took 6 weeks off which was a combination of all of my vacation, sick, and personal leave days. I could have utilized FMLA to have an extra six weeks; however, this would have prolonged my training and would have been unpaid time off without benefits, which quite honestly we couldn’t afford to do financially as a family on a resident’s salary.

After returning to work, I had a fairly constant and overwhelming sense that I was doing it all wrong — there had to be a better way. I found myself continually comparing my abilities (at least internally), with all those “working moms” who had come before me, and I was convinced that they had managed this transition (or maybe transformation is a more suiting term) much better than I. Perhaps it was the sleep deprivation, but I really just didn’t understand why there seemed to be no “pause button” so I could just catch up! Was I putting all this pressure on myself? I have a wonderful, task-accomplishing husband (who is self-employed, and in an effort to keep his business from suffering, took all of 3 days off when the baby was born). Unfortunately, even with his assistance there were many tasks that required my attention alone. I was left attempting to give 110% to breast-feeding, residency training, extracurricular activities, managing household duties, and really just trying to remain sane. I often wondered if I was being realistic with my expectations of myself?

One of the most stressful and anxiety filled components surrounding this new chapter of my life was breastfeeding, which is practically a full-time job in itself. Although breastfeeding is temporary, it is not meant to be a brief endeavor when you take into account those recommendations set forth by the American Academy of Pediatrics (AAP) (1). As I embraced my new job as a mother - on top of my already existing roles of wife and resident physician - I have to also try to juggle and accommodate the hours required for breastfeeding and pumping. I would also like to note here that I birthed only one child (not two, three, or more) and I was fortunate enough to have an uncomplicated birth, where everything went “according to plan”.

I’m now back at work, lugging this ever so important sidekick (my breast pump) everywhere and treating every last drop of breast milk like it is pure liquid gold while hoping I just don’t mess it all up and if I even have enough time to “get it right”. Did I do my son justice by going back to work when I did? I knew having a baby during residency would be a challenge, but after completing undergraduate education, followed by four years of medical school (especially when you decide on medical school a little later on in life) residency is ultimately when many women are at their prime reproductive age (2).

Then there is the sense of guilt that I am not getting more out of my“time off”. Because I utilized essentially all my days off for the year, I had some very idealistic goals of studying and being incredibly productive (e.g. completing research, reading, etc.) during this time away from work. However, then reality sets in and I realize that the only self-education I am actually doing is learning how to be a Mom, which really doesn’t leave much time for anything else.

I know my story is not unique, and I am quite aware that many other women have faced situations even more challenging, which I think makes this topic ever present. Through all of this turmoil, trials and tribulations, I continue to wonder as members of the healthcare industry whom are supposed to be proponents of health and well-being, are we doing all we can to ensure that those female physicians, who also choose to become moms, feel supported and encouraged? Instead I wonder if there are other mom’s who feel like we are being asked to compromise one dream in the pursuit of another? This is especially important during a period when nearly half of all medical students and residents are women (3). What better time to reflect and ask ourselves, “is this the best way”?

Emily Boyd is a 4th-year resident at Emory University. She is interested in acute inpatient and sub-acute rehab and will be pursuing these interests in her new job upon graduation.

References:

  1. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx
  2. https://www.acog.org/-/media/NewsRoom/MediaKit.pdf
  3. https://www.aamc.org/members/gwims/statistics/

AAP Delegate to the ORR: A Recap of the 2016 AAMC Annual Meeting

By Venessa Lee, MD

The mission of the Organization of Resident Representatives (ORR) is to improve resident physician education and training for the purpose of improving the quality of health care. The ORR is a committee within the Association of American Medical Colleges (AAMC). The ORR provides a platform for residents to provide input into the development of Association’s policy. It also provides leadership opportunities for residents interested in academic medicine and supports its members through professional development activities. Each eligible academic society appoints two residents for a two-year term, representing 46 residents from a large variety of geographical and medical backgrounds. The AAP resident delegates to the ORR this year are myself and Ryan Mattie.

Learn, Serve, Lead

All members of the ORR attended the 2016 AAMC Annual Meeting, held in Seattle, WA. The theme of this year’s meeting was “Learn, Serve, Lead”. I found the annual meeting to be a great networking experience and it brought together all the stakeholders who have significant influence and impact in academic medicine. There were insightful discussions about a myriad of complex issues that affect all aspects of academic medicine, with the dissemination of new concepts and tools for leading innovation and cultural change in academic medicine.

For ORR members, the week started with membership networking and Peer Module Presentations. Members of the committee prepared interactive learning sessions with topics including: residency and career transitions, unconscious bias and tips on how to be an effective facilitator. The opening plenary was an incredible presentation by presidential historian, Doris Kearns, on Leadership Lessons from the White House.

A major focus of the 2016 conference was exploring resilience, wellness, breaking cycles of negativity and preventing burnout. As has been discussed elsewhere, burnout continues to be a major health risk among trainees and practicing physicians.

In relation to burnout, the ORR reviewed and made official recommendations regarding the recent proposed changes to the ACGME Common Program Requirements Section VI. The focus of the discussion and recommendations from the ORR was on wellness for both residents and their families.

The proposed changes can be viewed on the ACGME website and are related to patient safety and supervision, professionalism, wellbeing, fatigue mitigation and clinical experience and education (Duty Hours). Members of the ORR felt that commitment to the well being of healthcare providers and their families will allow them to better care for their patients.

Other proposed changes included changing work hours for PGY-1 residents by eliminating the current 16-hour workday and replacing it with a 24-hour continuous clinical assignment limit, as is currently in place for upper level residents. The ORR voted to support this change with the addition of resources for resident wellness, and a focus on personal and family needs, as well as, provisions for improved maternity and paternity leave.

The next ORR event will be the Professional Development Conference, which occurs in Orlando, FL, from March 9-11 2017. It’s a great privilege to represent the AAP at the ORR and I’m grateful for the leadership experience. The ORR has two PM&R residents serving on the committee, with each delegate serving a two-year appointment. The next call for applications will be in May 2017 so please stay tuned for more information and consider submitting an application to serve in these exciting leadership and academic roles.

Venessa Lee is a third year PM&R resident at the University of Utah.

Physical Medicine and Rehabilitation Fellowship Spotlight: Pain Medicine

Adam Susmarski, DO, Association of Academic Physiatrists Resident Fellow Council Secretary Academic Chief Resident, University of Pittsburgh Medical Center (UPMC)
Herbie Yung, MD, Pain Fellow University of California Los Angeles (UCLA / WLA VA)

Pain Medicine is one of the sub-specialty areas in Physical Medicine and Rehabilitation (PM&R) with fellowship training programs offered throughout the United States.

I connected with Dr. Herbie Yung, who is currently completing his Pain fellowship at the University of California Los Angeles (UCLA) to discuss his experiences pursuing a fellowship and career as a PM&R pain physician.

Dr. Adam Susmarski (AS): What attracted you to pursue a Pain Medicine fellowship?

Dr. Herbie Yung (HY): I like the large amount of versatility in the field of Pain Medicine. I get a chance to work with a lot of different types of medical professionals and patients. Additionally, I enjoy working with all of the exciting technology out there, with not only fluoroscopy and ultrasound guided injections, but also neuromodulation, intrathecal pumps, radiofrequency ablation, and regenerative medicine, just to name a few.

AS: What are the aspects of fellowship that applicants should carefully consider when making their rank order list?

HY: I think it’s really important to look at how you fit in a fellowship program, for example, is there good mentorship to help guide you for the rest of your career whether it’s academic or private practice? Does the program offer the procedural training and exposure to the patient population (e.g. cancer pain, palliative care, pediatric pain, and/or pain rehabilitation) that you are interested in integrating into your future practice? Are there research requirements or an opportunity to teach medical students and residents? Is location a factor? Completing your fellowship in the region you want to end up long term can help with your job search.

AS: How did you choose which fellowship was the “best fit” for you?

HY: In addition to the above factors, I think it’s important you find that you click with the attendings at the program. Even in that one short year, you will spend more one-on-one time with them than you did with your attendings during residency. If possible, talk to someone who completed that fellowship to get some insight into what that program offers you that no one else can.

AS: What has been your favorite experience as a fellow?

HY: The whole year is just a whirlwind of new information, terminology and procedural techniques to absorb. I think my favorite experience thus far is taking the next step in my medical career and starting to make the transition from resident to fellow to attending which means taking in further patient care responsibilities and autonomy.

AS: Now that you are approaching completion of fellowship what is some advice you have for residents applying for fellowship?

HY: Try not to stress and enjoy the journey! Go to as many interviews as you can afford (time and money wise) so you can really see what all the programs have to offer, and make the best decision you can. You’ll meet many great people along way including other applicants like yourself. Pain medicine is a small field and you’re guaranteed to run into everyone again, who knows, you may even one day apply for a faculty position at an institution where you interview.

Rehabilitation Research— My MSSCE Experience

By Shelly Guhar 

MSSCE Members (from left) Jerald Gomes, Shelly Gulhar, Christen Samaan, and Dr. Robert S. Mayer

PM&R. Truth be told, I did not understand the significance of these three letters until I stepped foot at Johns Hopkins Hospital for my two month Medical Student Summer Clinical Externship (MSSCE). I initially applied for the externship because my friend after finishing her first year of Physical Medicine and Rehabilitation (PM&R) residency described PM&R as “the coolest field ever”. She had piqued my curiosity with her enthusiasm for her profession and I was determined to experience PM&R for myself.

Each week during my externship I experienced something entirely new as I learned PM&R encompasses numerous subspecialty clinics including Brain Injury, Spinal Cord Injury, Pain, and Pediatrics just to name a few. I found out the hospital even had a clinic just for patients who were a fall risk! While during residency each resident physician spends a month or more on each unit, I unfortunately only had a week to experience as much as I could in each area of PM&R.

My first day during general outpatient clinic exposed me to the world of intrathecal Baclofen pumps and ultrasound guided injections for the treatment of spasticity. It was a short time later when unique medications common to the field such as Gabapentin became second nature to me. I also learned how to do a complete American Spinal Injury Association (ASIA) exam while on the inpatient spinal cord injury unit. In the pediatric clinic, I saw how paraplegics used electrical stimulation, aquatic therapy, and/or a robotic exoskeleton to help them regain their mobility.

One of the most surprising facts I learned about this field was the use of a multi-disciplinary approach to patient care. A patient’s care routinely includes the coordination of care between a physiatrist (PM&R physician), a physical therapist, occupational therapist, speech therapist, a prosthetist/orthotist and more! In a meeting, the entire team would discuss not only the patient and their current status but also their individual lifestyle and goals to come up with a unique rehabilitation plan that worked just for them. This is very unique to PM&R and something I really appreciated given that a common complaint from patients is the diminished time spent with medical providers in the current health care climate.

However, the most important lesson I learned came from using a wheelchair for an entire day. I found that although using my hands would ultimately leave them sore for days, there was a psychological impact that I could never forget. Almost immediately, I struggled with making turns and rolling backwards into an elevator. Some people would notice my struggles and jump to help, but others would avoid me or look down at me. It also didn’t help that it was raining all day. How do you move the wheelchair and hold an umbrella? How do you go up a ramp when your wet wheels keep slipping as you desperately try to keep a hold on them? My experiences that day opened my eyes to the struggle that some people face everyday.

The rewarding benefits of targeted therapy and the more individualized doctor-patient relationships were immediate indicators that this is a field of medicine where I could best utilize my years of medical education and training to make a positive difference in the lives of my future patients for years to come.

Shelly Gulhar is a second year medical student at Howard University College of Medicine. She is active in the Physical Medicine and Rehabilitation interest group there and seeks to pursue her interest in spinal cord injuries in the future.

The Medical Student Summer Clinical Externship (MSSCE) program has been developed for medical students with a strong desire for clinical experience in the field of Physical Medicine & Rehabilitation (PM&R) and who are eagerly seeking opportunities in the field. The program aims to provide a wide range of inpatient and outpatient clinical exposure and to allow students to explore the human side of patient care and the psychosocial environments their patients face. More details, including the application process, can be found at the AAP website.

An Introduction to “Ability Science” for Physiatry in Motion

By Jim Eubanks, DC, MS and Mike Farrell, DC

Jim works on the Science Twitter page

1. Who is behind Ability Science?

Jim Eubanks, DC, MS is a third year MD student and Clinical Research Scholar in the Department of Physical Medicine and Rehabilitation at Brody School of Medicine at East Carolina University. He earned his Doctorate of Chiropractic (DC) and a Master of Science (MS) in Sports Science and Rehabilitation from Logan University in St. Louis, MO in 2009.

Mike Farrell, DC is a fourth year MD student at Ross University School of Medicine and is completing his clinical clerkships at Jamaica Hospital Medical Center in Queens, NY. He is entering the 2017 NRMP Match in hopes of obtaining a residency in Physical Medicine and Rehabilitation. He earned his Doctorate of Chiropractic (DC) from D’Youville College in Buffalo, NY in 2010.

2. What is Ability Science?

MIKE: Ability Science is a social media platform. Our specific goals include raising awareness about the field of physiatry among students, healthcare professionals, and patients.

JIM: Additionally, we aim to increase understanding of physiatry and rehabilitation medicine as a whole. Most of medicine has focused on quantity of life, and done a remarkable job towards this end. Physiatry adds to the health system with a focus on quality of life and function.

3. What inspired you to start Ability Science?

JIM: From 2011 until his untimely passing in 2013, I studied under the direction of the late Craig Brigham MD at OrthoCarolina Spine in Charlotte, NC. Dr. Brigham was the spine chief for the Carolinas Medical Center’s orthopedic residency and a founding partner of OrthoCarolina. He was a committed advocate for disciplined, sensible spine and musculoskeletal care, and focused on evidence-based practice. He would ask two key questions to every patient: 1) “When was the last time you felt your best?” and “What are YOUR goals with your care?” It was this spirit of evidence-based care coupled with a desire to empower patients that led him to envision a spine and musculoskeletal medicine educational organization that would address these goals with medical students and physicians. Mike and I exchanged ideas about this concept over the years, and it eventually led to the creation of Ability Science in 2015.

MIKE: There is a huge need to increase awareness about PM&R. Physiatry is a relatively new specialty within medicine and has really only been around since the 1940s, and got its start primarily for veterans returning from WWII. But it has had to evolve to meet the physical medicine needs of the public. An example of this is the Polio epidemic in the ‘50s. Today, it continues to evolve, and as medical therapies improve, people are living longer following a trauma or with historically lethal diseases such as cancer. There is a much needed focus today on maintaining function as these patients age.

4. How has your medical institution supported your interest in PM&R?

JIM: Brody School of Medicine at East Carolina University is one of the 30% or so of US medical schools that have a PM&R clerkship, including early exposure in the curriculum to PM&R through lectures given by PM&R physicians on topics of spine anatomy and spine conditions, chronic musculoskeletal pain, and behavioral medicine topics on disability and rehabilitation. Currently, I am working with our PM&R department and Brody administrators to expand the amount of spine and musculoskeletal education offered in our core clerkships. While this is not yet the typical experience of medical students, it is a powerful model of what can be done.

MIKE: Mine is a more common experience; really I had no exposure to what a physiatrist’s role is and what they do on a daily basis; no required rotations and I was forced to seek them out on my own. Jim and I both had a unique perspective entering medical school of wanting to do physiatry, and I recognized that most of the students around me had no idea what it was. When comparing our two experiences, we have realized that there is still a lot of work that needs to be done in the future to increase awareness of the field.

5. Who is the prime target audience?

JIM: Our target audience is primarily medical students and physicians, and we have a general goal of educating all health professionals about the work that physiatrists do and the essential role they now play in the health system.

6. Your team has created a few vlogs to discuss things like clinical pearls and case diagnoses What exactly are vlogs and how does one start a vlog? What are some ways you envision that vlogs may help improve learning experience during medical training?

MIKE: For years, people have been publishing their thoughts on the internet with blogs. The word “blog” itself came from the term “web-log” and the w-e was eventually dropped. Video-Logs or VLOGs are just a more visually appealing incarnation of blogs. The format is appealing because there are tons of influential people on Youtube who have used the VLOGing format to captivate a younger generation. My inspiration was a YouTuber by the name of Casey Neistat who famously snow boarded through NYC during the blizzard last year. I feel that the upbeat music, interesting visuals, and fast paced tempo grabs attention much better than just printed words on a screen. As online learning sites such as Khan Academy and Osmosis become more popular students are relying to the internet for new ways to consume information. I think that our goal is to captivate our audience with the Vlogging format while dispensing some information at the same time so that the learning is subconscious and not forced. The good news is that anyone can start a vlog with a camera and free software like iMovie. I had no experience with shooting or editing videos before starting the VLOGs and have really enjoyed learning as I go.

7. PMR is said to be medicine’s best kept secret. What excites you about the specialty as medical students and how can we get more trainees excited about the field?

JIM: For me, the expanding awareness within 21st century medicine of the importance quality of life plays jives with my own experience with chronic illness. My personal health journey informed me about the kinds of values patients have, and often chief among these is living well. Rehab medicine gets this, and is uniquely equipped to empower patients as they cope with changes in their lives and overcome challenging conditions. Mike and I know that getting this message out to medical students and other health professionals will illuminate the logic of rehab medicine and inspire a new level of interest as the field expands.

MIKE: When I think about my own state of health, what matters most is my ability to wake up each morning and live my life without limitations. If tomorrow I couldn’t ride a bike, or drive a car, I would feel that impact more than my LDLs increasing or my HbA1c dropping. That interface where your state of health meets your ability to truly live life is what physiatry is all about to me. For patients to buy into their healthcare they need physicians who are passionate and I entered medical school passionate about the areas physiatry addresses. Trainees will get excited about the field by increasing awareness! It’s an extremely rewarding area of medicine (with broad applicability across a range of fields) and as more students get exposure they will realize that.

Learn more about Ability Science at www.abilityscience.org, and connect with us on Facebook and Twitter.

Also check out our “Leaders in PM&R” Interview Series.

AAP News & Physiatry in Motion published on Medium

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The AAP 2017 Annual Meeting is in Las Vegas on February 7-11, 2017

94% of past attendees would recommend the AAP Annual Meeting to their colleagues and AAP 2017 Las Vegas is no different. Physicians, residents, and other PM&R professionals from around the globe are making plans to attend the 2017 AAP Annual Meeting in Las Vegas, February 7-11, 2017 - don't miss out on the 'can't miss' physiatry event of 2017!

Registration includes ALL educational and networking events including the President's Welcome Reception, two Poster Gallery Receptions, the Resident/Fellow Trivia & Networking Night and complimentary breakfast, lunch, and coffee breaks throughout the meeting.

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