Well, thank you guys for coming. Welcome to our session. We're super excited to have you here. And we're here to kind of talk to you about how you can make 100% of the best decisions at all times ever. And that's why you need your mission statement and your vision. So with that being said, we have no disclosures. And what we want to talk about today is the concept of a mission statement and why that's going to be important to you. So in our session, what we want to do is first have you talk about how you create a mission statement for yourself and walk through what a mission statement is. This is important because it can kind of help you achieve your goals and kind of find clarity in getting to those goals. So that's where we want to kind of guide you to. And then the last part is we want you to ultimately help you achieve your professional aspirations. And we believe that using a mission statement and having visions and values will be the best way to do that. So with that, again, our outline. We'll start off with a brief presentation. And after that, we're going to break out into just a short period of time where you'll be able to craft your own mission statement. And then finally, we'll have a wonderful panel where you'll be able to ask questions and just hear us reflect on our journey in creating our mission statement. So with that, let's start with us. So I'll start first with introducing myself and then pass it along to everyone else. So I'm Kuntal Chaudhary. I am currently a sports medicine fellow at NYP Columbia Cornell. I did my residency at UPMC and, yeah, finishing up fellowship in June 2024. Medicine Fellowship and I am now a faculty member at JFK Johnson Rehab Institute. Hey y'all, super excited to be here. I'm James Gardner. I went to Vanderbilt for residency and I'm currently a sports medicine fellow at Emory University in Atlanta, so that's me. Hey everybody, my name is Josh Romero. I did my residency at Mayo Clinic in Rochester and I'm also there for sports medicine fellowship as well and I'll be staying on staff there next year. Awesome, so with that let's talk about professional development. So just a quick survey, how many of you here are med students? Awesome. Residents? Awesome. Fellows and attendings? Awesome. All right, we've got a whole group. That's fantastic. So when we think about professional development, it's different for everyone, but usually there's this very similar underlying theme. So typically with professional development, it's important to note that it's multifaceted. So you have several aspects to it, such as ongoing practice, using medical education, mentorship, huge aspect of professional development, and building leadership skills. All of these facets of professional development are things that you can usually gain from talking to others or networking or just being a part of your medical program or your residency program. So that's something that's often obtained externally. However, there's a very important part of professional development which relies on figuring out your personal goals and self-reflection, which is not typically taught in medical school or residency. And just again as a survey, has anybody been taught on how to self-reflect on their personal goals in any level of training? All right, oh kind of? Okay, well that's awesome. So but typically when you're looking to achieve a goal, for example, whether it's getting into residency, whether it's getting into fellowship, whether it's getting into job, you can get a lot of information about what programs can offer, but what you want out of a program is something that often you don't think about. So you'll see a program and it has X, Y, and Z, but is that the right fit for you? Is that what you need to achieve those professional aspirations and goals? That's what we want to figure out today. So with that, let's talk about self-reflection and goal-setting. So there's a systematic and almost algorithmic way that you can approach this, and that's through organized reflection. So with that, what exactly can you do to reflect, self-reflect? So that's where the mission state, mission statement, the vision and value statements come into play. So just to sum this up briefly, what you want to do in a very, very quick summary is describe your convictions, describe what you stand for, and describe how you want to create a life that embodies your values. So with that, when you're describing your convictions, that's where your mission statement comes into place. It's a short summary of your core purpose, focus, and aims. It is the what and how. To achieve that, you need your vision, which is how are you going to create that life that you want, professionally, personally, whatever it might be, that embodies those values. So that's a short description of your aspirations and goals and explains the why. And the last part of this is your values, and that is what do you stand for. And that is what underpins the why, the what, and the how. So it's a very systematic way in which you can approach this and find what you want that will help you get to where you need to go. Another way to look at this is there's a set of questions you can ask yourself. So with your vision, again, your purpose, you can ask, who am I? Why am I here? Who do I want to be? And what do I want to accomplish? With your mission, that's what gets you to where you want to go. That's your path, your plan, and your goals. So with that, we're going to pivot into talking about mission statements from a broader sense, because this is not something that we've really reflected upon on a personal level for most people, but something that's very prevalent in the business industry. So with that, I'll pass it off to Dr. Harris. Thank you. So like Kunthal was suggesting, the idea of mission statements, vision, values, it's not something that we as individuals really came up with or started implementing routinely on our own. It was really first implemented in the business setting. So I'm going to start by going over an example from business. And just a fun fact about me, before I went into medicine, I actually worked in advertising for several years, so this is something that I'm pretty familiar with on like a day-to-day basis. Now, Nike wasn't one of my clients, and I can't say that this is necessarily their current mission, vision, and value statements, but these are published as a marketing case report and available. So I'm going to go over this, and then I'm going to go over a piece of Nike advertising to show you how that's reflected into action on a business level. So Nike's mission statement is to create groundbreaking sports innovations, make products sustainably, build a creative and diverse global team, and make a positive impact in communities where we work and live. Their vision is to bring inspiration and innovation to every athlete with an asterisk in the world. Their values include innovation, team, social and community impact, and sustainable business innovation. So you can see that for Nike, which is obviously a major global company, their mission, vision, and values are large. They're multifaceted, and they're certainly not singular. When you look at a piece of their advertising, and again I chose a piece of advertising that's not necessarily super well-known or iconic for Nike, but I think it's really reflective of certain aspects of their mission, vision, and value statements, you can see that you have a kid, right? He's falling on his skateboard. So this is an athlete with an asterisk. It's somebody who is just getting out there doing something, going back to one of their core slogans. He is still an athlete even though he's in the middle of falling. He is skateboarding in a community setting, right? So this looks like it's in his neighborhood. He's just doing what he loves, and it goes back to that aspect of the Nike values of community, and serving the communities where they work and live. And then finally, one of their values is innovation. Now you may not see skateboarding as innovative. It's something that people have been doing for years, but for Nike, skateboarding isn't really a part of their core branded identity, right? When you think about like skateboarding shoes, you're thinking about vans like other brands, and for them to try to break into this space is actually quite innovative. So again, just a way that the self-reflection on a business organization level can translate into action in this way, advertising. So what can we as individuals learn from businesses? Well, you can develop a personal strategic vision statement to help define your goals, and then you can use this at different points in your career to help prioritize activities, because it can be really difficult when you're in training and even when you're in faculty later to prioritize activities and decide what to do and how that aligns with your goals. You can also use your mission, vision, and values to measure your own progress and success, so that you're reflecting and understanding if you're doing the things that you truly set out to do, and also to keep looking forward. So what are some of the differences between personal and business mission statements? Because they certainly are different. So personal mission statements are going to speak more closely to your personal values than organizational mission statements, right? So ultimately, values are like a common word, and so we may share the same values with what a business is hoping to achieve, but our values are going to come from who we are as people, how we were raised, what we care about in the world. Also, personal mission statements are more likely than organizational statements to change over time, because we change over time, right? It is an organization's purpose to actually be like a major cruise ship and maintain a steady course. They have to be able to change to some degree, but they succeed by being stable. We succeed by being a little bit more nimble and flexible, but your mission statement can help you stay on task. So from trainee to junior faculty to a more senior leadership role, your perspectives and your potential effect on others changes over time, and such your mission statement may also change over time. Your statement can become more specific or directed to a broader population, depending on the role that you're in. For instance, actually, as we were preparing this presentation, I had given a similar presentation a couple of years ago when I was in a residency role and I was going through some of these slides to get ready, and I was like, oh, yeah, I'm in a totally different role now, and as a result, my mission statement has shifted slightly. So why bother identifying your mission and vision in medicine in particular? Nurturing your vision will result in passion and resilience, and we know that those things are incredibly important in medicine in particular to try to avoid burnout. So understanding why we're doing the things that we're doing. You can maintain your meaning in both life and medicine, and in general, goals and achievements that align with your vision and purpose result in meaning, and deriving meaning out of work ultimately makes people happier. So how do you find your vision or purpose? In general, it's something that's often built and not found. It's cultivated and grown over time, and you focus on what's most meaningful in your life. Sometimes it may be that fate delivers a higher calling, whether there was some traumatic event or mentorship driven. You may reflect on what brought you into medicine in the first place, what brought you into PM&R in the first place, what brought you into your subspecialty in the first place. So those may help you identify what your vision and purpose are. It also doesn't have to be one thing, right? So think about the things that you value overall, and whether it's personal, professional, or even recreational, right? Because when you think about different aspects of physiatry, there are lots of ways to blend the things that we care about outside of work into our work, and that will ultimately give you more meaning in the workplace. And I think that this in particular is very helpful because I'm sure you'll find as you've interviewed, you know, for medical school, for residency, for fellowship, for jobs, everybody's asking you, why do you want to do this? So trying to understand and reflect on that before you're asked to the question is very helpful. So why actually go through the work of writing it down? Well, it helps you identify and define your values. Oftentimes those are sort of nebulous things that we have a hard time like saying, it feels a bit awkward to identify, but if you force yourself to write it down, then you can actually look at it and say, yes, that's what I care about. It helps you set your milestones and goals. It informs your decisions. It clarifies your actions as you go. It also gives you a set of guardrails that prevent you from wandering off path and keep you on focus, right? So as you're going through training, there is a constant influx of activities, of opportunities that come your way, and a lot of them can be meaningful and help you gain experience in different areas, but a lot of them may potentially steer you off path, and having it written down can help inform your decisions and make sure that you're choosing activities that align with your vision. So if you want to develop your own mission statement, there's something called the Inspire Framework, so we'll go through that. If you want to develop your vision and mission statement, the I is for identifying your core values. So if you think about the base of the pyramid, the, you know, lowest level is going to be identifying the values, the things that you care about. Then N is for naming the population that you serve. So, you know, in my case, obviously, I take care of brain injury patients. If you're in sports medicine, athletes, depending on the patient population you serve, you really want to look at that. S is for set your vision. So look at what you want to achieve. What is the ideal practice environment that you're hoping for? If you could create a sort of utopian practice environment, what would it be? P would be for plan how you'll achieve your mission. So think about how you'll achieve your mission. Now, again, I think at different points in your career, this can kind of feel overwhelming. You're like, am I really so crazy to think that, like, at X point I want to maintain a, like, obtain a professorship, or I want to be a residency program director, or I want to be, you know, a physician for a sports team. Like, sometimes these goals feel sort of lofty, but writing it down helps you say, those are things I actually care about. That's what I want to achieve. So then, how do you actualize your vision and mission? The I for inspire is identify activities that align with that mission. So choosing things that actually fit. R is for review, revise, and refine your mission statement. So again, over time, we're allowed to change. It's okay to say, hey, actually, now that I've gone a little bit further and obtained a few more experiences, I don't think that's as meaningful to me anymore. And then E is enlist others to help you accomplish your mission. So you're never going to do it alone. Mentors along the way, everybody around you are going to have a huge impact on your success. So when you're setting your vision, think big. What would the world look like if you had the effect that that you desire on the population you serve? Again, you're allowed to be lofty. So we're going to go over a couple of examples from the group here of what mission, vision, and value statements might look like before we ask you to just spend a couple of minutes to think about it and try it out on your own, okay? Okay, I'm just making sure. I'm going to start with mine. So I kind of use the same like inspire framework, but I'm just going to share kind of my mission, my vision, and then kind of the values that underpin those. And as you all know, I'm in Sports Medicine Fellowship, so that kind of like reflects, you know, why I'm doing what I'm doing. But my mission, I wrote, become a highly skilled sports physiatrist, and that means developing advanced skills in head-to-toe diagnosis and treatment in physical medicine, kinetic chain evaluation, musculoskeletal ultrasound, especially diagnostic ultrasound, and decision-making around interventional procedures and doing them when needed, and then spending time caring for athletes at all levels and abilities and supporting their return to play slash activity. For my vision, I said, you know, my aspirations or my why is to help athletes and patients of all abilities achieve and then maintain the highest levels of activity and competition that they can. And then the values kind of underpinning all of these are that, you know, patients deserve really accurate diagnosis and appropriate treatment in sport, which is something I'm really passionate about. And then keeping people healthy and active is good for society, and it helps promote like a healthy, safe society. And then supporting equity in sports and society helps everyone in society to kind of basically have like a better life and, you know, achieve the goals that they want physically. So those are all, that's kind of the framework that I use, and then I'll let Josh share his also. And so one thing to highlight here is you're gonna see that, you know, even despite us having a framework, we approach this just a little bit differently. And so there's a lot of value in customizing this and personalizing it for yourself. So starting with my mission, again, this is kind of the what and how. So for me, and one thing I'll say is that the tendency is whenever you write something down, you start off with something that there's multiple sentences, it starts very long, and I think similar, what the goal of this is to help you really stay focused and put up those guardrails, if you will. And so one of the challenges, I would say, is taking what all of these lofty goals that we have and condensing it to maybe one or two sentences. And so I think that's something else, too, is even just in the mission statement, being very intentional and clear with what you're trying to do is, that's part of the battle, too. And so, and that's part, that's part of the fun of why this can change over time. So if I think about all the things that I want to do, and I've kind of tried to simplify this into really two sentences. So for me, the mission statement was be an innovative sports medicine physiatrist who provides evidence-based and compassionate care to patients, is a dedicated educator and mentor to trainees, ancillary staff, contributes with clinically meaningful research to advance medicine, and prioritizes my family health as an active member of my local community. When I get to my vision, again this is your why, so I want to be able to provide the highest quality care to my patients, I want to empower the next generation of physicians, I want to contribute to advancing medicine, and prioritize aspects of my life that feed my soul outside medicine. So what are the values that drive all of this? I want to focus on humility, always maintain a good work ethic, always be curious, be precise in what I do, focus on becoming over being, otherwise known as a growth mindset, and be consistent. So those are the values that kind of drive all those things. All right, so with that, and thank you for sharing your mission and vision statements, they're so fantastic. Well let's talk about you now. So now we want to talk about how you can kind of plan to achieve your vision. So the first thing is, think about a big goal that you need to accomplish. So that can be landing a residency program, or a fellowship, or a job. So what is that big goal? Second, what are some of the challenges you need to overcome? If you're at a residency program, again from a sports perspective, since I'm in sports, if you don't have that many coverage opportunities, what are opportunities you can find for yourselves? And how can you turn those into achievements? Maybe you're the person who creates this opportunity that wasn't there before, and you are the one pioneering it. And lastly, what you want to do is take those big goals, again those very lofty goals, whether it's being residency program director one day, or team physician for XYZ professional team, you're going to take those big goals and make them into smaller goals that you can incrementally achieve along the way. And that's kind of how you will get to that ultimate lofty goal that you have. So with that, you want to use your mission statement again to focus your time and energy, and make sure that you're focusing it on areas of life and work that you actually enjoy. Because the individuals who are spending their time doing things that they like are having less burnout. So it's very important to make sure that you're prioritizing what you want to do and what you enjoy. And finally, it's also a way that you'll learn how to say no to certain opportunities. And I know that as med students and residents, even you know fellows and first-year attendings, we all want to say yes to everything, because that's kind of what we've been trained to do. But when you have that mission mission statement, and you've got your vision, you know exactly what fits into that. And you can say no to taking on that stroke project when you're trying to go into a sports fellowship, from personal experience. So with that, developing your mission, vision, and value statements is a very key and important part of your professional development. As key as the external parts, when you're talking to your mentors and going to activities where you're improving your knowledge. This is as key as that. It's what keeps you moving forward, it keeps you focused, it keeps you within those guardrails. And it's something that's a continuous process. It's not that you write your mission statement once and then you're done. No, you keep revising it and you keep modifying it as you change. We're not Nike, we're individuals. So you keep modifying it as you go. And finally, you're going to use your mission statement to drive your goals. So with that, we're going to open it up for you to write your own mission statement. We'll take a couple minutes here. We've got some flashcards that we can distribute if you want to actually write it down tangibly with pen and paper. Otherwise, you feel free to use your phone. I'm going to also put up this slide as a reminder of the basics of the outline of how to create your mission, vision, and value statements. And we'll keep this up so you can reference this in the next couple of minutes. So please let me know if you want like a flashcard and I'll come by and give it to you. It's And you may not be done, but if we let you sit here for too long in silence, it's just gonna be too awkward So I encourage you to continue this journey On your own because like I said, it's I understand It's kind of a hard and sometimes awkward thing to do I found that as I was writing mine in the past I would like write it and come back and look at it again like Josh was saying It's really about sort of calling down and getting to the core of what it is So sometimes that means writing a lot and then cutting back So that will be a project for later but for right now what we're gonna do is we're going to transition a bit and we're going to have a panel discussion where some current fellows reflect on finding the right fit and Talking a bit about how mission vision and values play into finding the right fit So I think that like I said, these are three current fellows and they obviously will be speaking to their experience But I think it can easily Translate to finding the right fit for residency and finding the right fit in a career or faculty position So I'll start by asking a couple of questions and at the end I'll open it up and invite any of you to ask whatever questions you have of our lovely current fellows who are practicing all across the country so Would somebody be willing to share one thing that they struggled with when they were trying to write their mission vision and value statements? Okay, I'll jump in I think for me the like the most challenging thing is feeling like you have to like say something like grandiose and That seems like really exciting But I think like that's kind of like antithetic I had to remind myself when I was kind of, you know doing mine kind of updating things for this presentation that to just like really get down to the nitty-gritty of like what are the things that I'm like most motivated by and you know trying to Focus on during my fellowship for example, because that's kind of like what I'm spending my day-to-day working on So I think to being too big and too grandiose was like my biggest challenge initially. Yeah Absolutely And at what point did you find that in your training process or fellowship application process you really reflected on your values and your mission for training and Was that like an explicit organized process or did you find that it was just sort of happening organically over time? Yeah, I think so for me I think this really reared its head last year when I was applying for fellowship And I think that I wanted to really think about You know I think just whether wherever each of you are and in the process whether that be for residency for fellowship or if you're applying for Careers, I think it's very easy for us to try to fit the mold of whatever we're applying for So you're applying for a residency program you try to fit that mold You're applying for fellowships and and the same is true And so I think that each place obviously has pros and cons They offer all these great things and we always try to fit into whatever this is offered to us And so I think for me actually had somebody say that one of the most valuable things you're gonna do this year is take some Time reflect on what are your priorities and then see retrofit to see which program fits those the closest And so I think for me, I really tried to be very diligent about last year's. I was going to the process I had a lot of Necessary confusion, but it was challenging to sort through all the there's so many variables consider in this decision that it's hard to sometimes To make the decision and so I think for me I just sat down and I really tried to write a mission and vision statement and define What are my top three priorities because we can't have 15 that are gonna match but you can have you can for sure have three And so I wanted to really decide what who do I want to become and what are the things that kind of feed my soul? and so Doing I certainly did that during last year going to the fellowship process and then I was I was kind of early on looking On jobs saying the same thing held true And so I think that that was the first time that I really took intentional time to develop this before then. I think it was You know, I had thoughts about it, but I certainly didn't take the time to actually write it down One other thing I'll add is that one of the great things so we were all in sports and one of the things that we Did while going through this process, which I completely agree like fellowship was where I was like, oh I really need to know my mission and vision statements We would talk to each other for hours and discuss our various vision and mission statements and they were all so different like each one of us wanted something different out of fellowship and that's where we kind of you know, Also came up with this idea of like a session where we can Kind of translate those hours long talk with you guys because that's really what helped me truly like having those hours of discussions with James And Josh helped me figure out exactly what I wanted in the end. So I think that was very key during fellowship realizing that Did you find that as you were interviewing with each of the different fellowship programs it was clear that and this is true for residency to actually that there were sort of different personalities at different programs and Did you think that it was important to match at a place that fit with your personality? I mean, I'll jump in and say I think that Kind of just like what Kunthil and Josh were saying I really I Think I felt a lot of pressure to and this is kind of the conformity like you go through med school You go through residency like trying to like fit the mold and like be the best and I felt a lot of You know, I think of myself and I think most doctors think of themselves as like Oh, like I I'm a pretty high achiever, you know, like I've done some things that are maybe like useful and And so you think oh I need to go to the best place, you know We're like them like the biggest name and I did find myself maybe Gravitating initially towards like oh, what's the place that's gonna give me the most like prestige and then it was nice Actually having you know a soundboard to talk to who was really said well James Aren't you really focused on doing this and didn't you just tell me that this program that you're saying is like a really great program Isn't really gonna be as good at that as this program or this program, you know So I think it was a good maybe not our personality thing But like a prestige thing definitely came up and kind of that was something that helped me kind of focus on Oh James, like these are the things that you're really interested in And just because somewhere has a big name or maybe like I guess I mean personality could certainly be part of it, too That might seem like a good option, but maybe it wouldn't have been the best option for me, you know, James Gardner So I think that's something that was really helpful Yeah, I'll go ahead Yeah, I think one quick thing. I'll just to build to echo and build on that is I think culture slash personality cultural personality, what does that look like at that place? And so do they, how much do they prioritize education, or how is the mentorship, what is the style of mentorship, these different components, and so it's hard to sometimes gauge that, but I think that that's something I certainly, for me, I heavily considered. So I think that leads me very well into my next question, which is when you're trying to gauge a program's personality or how it may align with your mission, vision, and values, what types of questions did you ask the program to see how they may fit? And I think this is relevant not just for fellowship but for residency, too. I'm sure as you go through the process, you find everybody says, well, what questions do you have for me? And they're not just looking for one question. You've gotta have a few questions. So I think if all of you could answer this one, that would be helpful. Oh, go ahead. Go ahead, go ahead. No, no, no, you go ahead. I have a couple. Yeah, I guess, so I guess a few things. So number one would be I'm always very curious to see how responsive programs are to feedback and to our improvement based on what the trainees say. And so I'd always ask, can you tell me about a recent change you made in your program based on feedback from your trainees? And so if they could not give me a recent example, then that tells me that they meant that, yeah, maybe that's not as true as what they're saying. You know, if a program, one of the things, at least from a sports fellowship, was thinking about procedural numbers. And so if a place is saying, oh gosh, we do X number of procedures, or we do a lot of, we get a lot of hands-on exposure to this thing, I would try to have them quantify that for me. So if they say, oh, we do a lot of procedures of X, so well, how many of your fellows get on average of that procedure? Or how many times are they covering this event? Try to quantify it. And I'm not expecting like, you know, 373. I'm not expecting that. But more just a general idea of what that looks like. And then I would usually ask, too, what's your mentorship model in your program? Like, how would you describe your mentorship model? And I feel like that was really a helpful tool to just kind of gauge like how that, what that looks like at that program, so. One question I really liked was, what does your ideal candidate look like? So I would have the program tell me what they're looking for in their ideal candidates. And that was a good way for me to see if they, what the program is looking for is what I'm looking for. Like, does that ideal candidate match who I am and what I want to get out of that program? So that was often a good gauge for me. And sometimes the programs were pretty generic and I'd kind of push them on it. Well, you say you're interested in research, what kind of research are you expecting? Or, you know, like in terms of, you know, teaching responsibilities, what exactly does that look like? So that really helped me figure out like what the program was about. And it also was a good way for me to gauge like, you know, how they viewed their future fellows. Like if they just gave a generic answer, I'm like, well, that doesn't really, you know, seem to fit one person that, you know, you might have thought was your ideal candidate who's going on to do great things. It was just a generic answer. So that was really helpful for me to gauge a program's fit for me. And I'll just add a couple of things. I mean, I definitely agree with the things that Josh and Kunthal have said. I think one thing that, I think this is applicable to even like residency applications, maybe in some ways even more than fellowship, but I think it's really great to ask, you know, the person that you're interviewing with or someone that's involved with a program or even like a job, like what are the, you know, what are the clinical interests of the people that tend to leave this program and kind of getting a sense for whether the person that could potentially be training you, whether that's in residency or fellowship, or even like in a faculty position who's like, you know, early career faculty development is really important. But if you can get a sense from them, whether they have a pulse on what kind of clinical interests their trainees have or their young faculty have is, I think, really useful if, because they're gonna give you the vibe whether they kind of, you know, maybe they give you a generic answer and you maybe get the sense from them that they are looking for a very, this is a cookie cutter place where, you know, it's a come in and don't rock the boat and you'll come out and you'll be well-trained, you know, or if it's somewhere where they can say, oh, well, like, you know, two of our grads this year are really interested in spasticity management and these are the things that I can tell, like, that they care about and they're able to kind of demonstrate to you that they know the people that they're training and that they know they have specific interests or is it that, oh, well, everyone comes out of here, you know, really well-trained in general, PM&R, which I think that's the kind of cookie cutter answer that I tended to give people when I was like chief resident, for example. But I think as someone that's, you know, interviewing a program, whether that's for residency or fellowship or even, you know, for a job, if you can get a sense from the person that's gonna be training, get a sense for if they know the people that they're working with and what their goals are and kind of how they're supporting them or at least, you know, being aware of what their interests are, I think that's a really good indicator of how interested they're gonna be in supporting what it is you wanna do specifically as opposed to just meeting their goals for you, you know what I mean? So that's what I would add. Yeah, thank you. I think these are all great. I'm sure you can all relate at some point of having had that dreaded question of what questions do you have for me? And it's nice to think about what you could say in those moments. So I'll ask another question and then I'll open it up to you guys and then I've got some more questions I can ask too. So could you all tell me what your perceptions were of what's important in training when you were going into the process and are those perceptions of important components of training still true now? Yeah, that's a hard question. That is a hard question. Yeah, I can start again with that. So I think when you're going through this process, we all gravitate towards, we look at the website, when we're interviewing, we look at how many reluctant rotations do I get? Where am I rotating? We look for these really things that we can, that are easy to put in a pamphlet or easy to put on a website. But that doesn't tell you, again, about the culture. That doesn't tell you about who you're gonna become after you leave that place. So I think that one of the things that, and I started to implement this for fellowship was, certainly I tried to focus on what are the rotations I'm gonna do? What are the kind of tangible things that I'm gonna have to be exposed to? I focused on that. But I really took a step back to say, when I'm talking to these people, are these gonna be my mentors now and moving forward? When I'm having a tough day, when I have a project that is maybe too big for me to take on, when I need someone to push me, are these gonna be the people that support that? And I think that I tried to focus more on that. And again, that might take a little more time and dialogue to facilitate that, but that was something that really came to me. And so I think, looking back, when I talk to people about, what should you focus on? What should you be talking about? I always say that you really wanna think about, is this place gonna mold you into the position that you envisioned when you first started this process? When you first started this process, you didn't say, oh, I'm gonna go to, I really wanna become a doctor because I wanna do six rotations in this place. You became a doctor because you had your own mission when you, way back when, when you decided that. So go to a place that helps you become that doctor moving forward. So for me, just like at Mayo, the simple thing I always say is, for me, I thought that was the place that helped me become a very highly competent but compassionate physician. And that's when I decided day one who I wanted to become, that was my vision. And so I felt like Mayo has really supported that. And so not that other places wouldn't, but I'm just saying that's an example of who I thought I was gonna become and then who I'm trying to become now. So yeah, I guess that's one thing to think about. And I can kind of talk to how my idea of what I wanted in a program changed. So when I was going into residency, I had one singular focus. I wanted to go to a program that would get me the best research experience, and that was it. So that's pretty much all I looked at. I'm like, which program will get me the best research experience? Which program will get me X, Y, or Z, give me that research track, et cetera? And that's all I cared about. And that was it pretty much for me. So that's how I went into residency. And now that I went through this fellowship process, I had a completely different outlook. My outlook kind of became, well, I've done all the hard work in residency. I grinded, I know I'm capable of doing, I'm achieving my goals, I'm capable of starting something new. In fellowship, I was actually looking for someone who was okay holding my hand and helping me understand things. So I didn't want to go to a fellowship where I'm like, oh, I'm gonna do a lot of independent learning and sit there and struggle to figure this out. I wanted to be able to go to my mentors and be like, hey, can you show me how to find the luckle on ultrasound again, which I still have trouble doing. But that became a big priority for me was the mentorship aspect of things. Because I wanted the mentors that would be there during fellowship, but also beyond. And another thing I looked at was when I'm going to these conferences, who's teaching the step one courses? Who's participating in these sessions? Who's leading these panels? And I wanted to go to a program where I saw alumni of that program in charge. So that became a huge factor for me. Yeah, I think that those are all excellent points. And I just want to reflect for a moment and say that you can tell that a common theme of the responses is around mentorship. And mentorship, I think, becomes incredibly valuable throughout your training. For those of you who are medical students, you may already have excellent mentors now. But identifying mentors to support you through your entire training journey will only benefit you and introduce you to more opportunities. So I'll pause for a moment and allow any of you to ask questions. So there is a mic in the middle aisle. You're welcome to come up and ask whatever questions you have. If you're feeling shy, I've got more. Why don't you go, just so people in the back can hear. Yeah. Hi, yes, I have a question. How did you guys decide what fellowship track you would wanted to do going from residency into fellowship, like where you wanted to go? Like what stood out to you or why did you choose what you chose? I'll jump in to start. So I went into like applying to residency. I was pretty much 100% sure I was gonna do like acquired brain injury fellowship. Stroke is what got me into PMNR and I still think stroke is like the bee's knees. I really enjoyed my TBI and stroke rotations during like medical school at the University of Utah. But yeah, I think I've always been, I think it's good to be curious and have a lot of interest. And I remember like during PGY2 year, it was like early in the year. There was a big, it was during the pandemic. It was like the first year of the pandemic. And there was a big shortage of doctors to cover all the like contracts for the football games for like Metro Nashville. And so they just needed bodies basically at the football games. And so I was like, I like sports. Like I have weekends off sometimes now. So I volunteered and, you know, I had like done a tiny bit of sports coverage in med school. I just had a really good time with it. And kind of at the same time, I was getting exposed to musculoskeletal ultrasound. And I just realized like I really am passionate about musculoskeletal ultrasound. And that was kind of something I wasn't expecting. And I think things just kind of snowballed from there. And I kind of realized there's actually a session, I think after this in the next group that's kind of talking about it's death of the generalist, which it looks really interesting and I'm hoping to go to it. But I think that it's hard in PMNR to really hold on to all of your skills and get a job where you can do kind of everything. And I kind of realized if I really wanna develop high level skill and diagnostic musculoskeletal ultrasound and do that, that I was gonna need to do like sports and probably, sacrifice is the wrong word, but like, you know, probably not gonna get to do as much brain injury and like spasticity management and all those other things that I think are really fun and interesting as a career. And so I kind of knew like sports was kind of the direction I was gonna be going for my career. So I think it's just identifying the, you know, the patients you enjoy working with the most, but also, you know, the procedures or the medical science that is most, like you're most passionate about because that's something you're gonna be doing and developing expertise in day in and day out. And if you're not really excited about it, then I think that you're not doing yourself a service and that's just my two cents. Yeah, I wanna sort of build on what James just said, because I think he highlighted two really important things from our presentation so far. The first one being that he said that he started doing this sports coverage because he liked sports, right? So do things that you enjoy, take on opportunities that seem interesting to you because you will be happy if you like doing the things that you're doing. And then the second point, you know, we talked a bit about saying no to things that don't align with your mission, vision and values. And obviously, you know, taking on some sports coverage may not have like aligned with his goal at the time, which was an acquired brain injury, but when you're sort of undifferentiated and unsure, I think it really is a good idea to take on different things if you're trying to explore different passions, just make sure that you don't overextend yourself and can't complete tasks. Other questions that people may have? Squad, all right. So y'all all seem to be doing sports fellowships, is that correct? This is a more personal question because I'll be applying for sports next year. I'm currently a third year resident. So you talked about fit and culture and kind of finding, you know, what the program wants to see from the fellow as much as the fellow wants to see from the program. And then with a lot of the sports med fellowships being family medicine based and then a smaller amount of that being PM&R based, did you find like on a macro level, like the fit and the culture and the goals of the program being different for these family med programs as opposed to the PM&R programs and vice versa? Did you put it for me? Yeah, yeah. So I primarily interviewed PM&R, but I did interview at some family medicine based fellowship programs. It's a little difficult to answer that question purely in the fact that it's so variable. So there were certainly some, and I don't want to generalize, but there are certainly some family medicine based programs where maybe the procedural experience was a little bit less, but that's not true across the board. I mean, there are certainly fellowships where they're getting just as much procedural exposure. I also think where the sports medicine fellowship, the department it was based in was big in terms of referral patterns. So being based in like the department of orthopedics, for example, is a little different referral pattern than if you're based in the department of PM&R or maybe department of family medicine. And that's not true again across the country, but I think that that is a big piece in terms of like referral patterns. And I also think if you're, like for some of the family medicine based programs, they were really built into like collegiate teams. And so that was something, but again, that's not saying that PM&R ones aren't, but I just felt like that was more common for sure with the family medicine based program. So I think to your point, it's really hard to talk in generalizations. I think the biggest thing would be, you're gonna see there's just a lot of variability in terms of procedures, sports coverage you're doing, different levels of sports coverage, how much medical experience you're getting. And so I think that that's why it's important to come back to again, kind of this mission vision statement. And that's the reason why we, that was why we struggled because there was so much variability and all of it's cool. I mean, all of it's great. You know, we're talking in three, we all really geek out about some sports medicine stuff. And so it's all really good, but we can't have it all necessarily. And so if you like of all the things in the bucket, what are the things you really, really want to put, you really want to prioritize? And I think that that's something that I come back to. So talking in big generalizations there, but it's because this is coming back to that mission vision statement, so. Other questions from the audience? Hey guys, sorry, I might've missed some of the introductions so I don't know where everyone's exact backgrounds are, but just kind of wanted to see thoughts on if you're coming from a place with a home program in your fellowships, staying someplace that you're comfortable with that sort. Maybe Josh, you can talk about your experience since we can compare and contrast. So for me, I knew day one, I'm like, OK, I really want to venture out from my home program. Just for me, it was opportunity and, again, seeing what I could get at other programs that I couldn't really get at my home program. There were a lot of great things about my home program, but I wanted certain things that fit in my, again, my mission and vision that weren't available at my home program. So again, it just goes back to, all right, my home program's offering me x, y, and z, but I really want w, and they don't have w. So that's where I was like, OK, for me, it was an easy decision. I need to go find w. So that's how I kind of determined that I wanted to go somewhere else. Yeah, I think, you know, so I'm doing fellowship at the San Francisco Residency, and so I think there's pros and cons to each route. And I think that, you know, I think regardless that step up from being a resident to a fellowship is a big learning curve regardless of where you go. Maybe some of the logistical things in terms of not having to move or learning the system, I think that probably in those first three months, that transition, I imagine, just is easier. Now, I still think that there's still a challenge of going from a resident to being a fellow. You know, I think that at least, I can only speak to my experience, but in my experience, because I know the system very well, I knew how to capitalize and how to make the most of it right from the get-go. So for me, kind of day one, I was knowing how can I optimize and take advantage of things moving forward. Now, that being said, you know, I think there's a lot of value in being exposed to multiple ways of thinking or looking at problems. And so I think that that's why there is value in training elsewhere. So again, I don't think that there's one right answer. I think it depends on a lot of variables. But I think that each of us can speak to why there's value in going somewhere else or staying where you're at. And so again, that kind of comes back to that fit. And I think one thing I just wanted to say, too, is realize that fit is not just professional aspirations. For people, fit might be your personal situation, too. Maybe you have kids or you have a spouse that you need to stay somewhere. That's part of fit as well. And so I think that realize that fit is beyond more. It's larger than just your professional aspirations. And so that's part of that whole piece of the pie as well. So just keep that in mind. Any other questions from the audience? Hi, I was curious about what your thoughts are on the value of having a true ACGME accreditation fellowship of, you know, versus, you know, I know you're all in sports. So, you know, that certification versus a NASS fellowship without that certification. Or just, you know, not doing a fellowship and if you want to do general MSK type stuff and you feel like you can get some little additional training at an institution without a formal fellowship or, you know, that kind of idea of what kind of things maybe drove you to do that certification and what some of the pros and cons are. I think it's a good question. You know, I think it's good to think about what your goals are and kind of, I mean, like Kunthil and Josh and Chris Neville said, I think that, like, for example, I think of my situation, I knew that I wanted to get a lot of advanced training in diagnostic ultrasound, like really high level diagnostic ultrasound, which I got, you know, basics during a residency. But I also got a lot of procedural training in residency. Like I feel out of coming out of residency, I had probably like over a hundred like fluoro cases in lumbar spine. So I felt like pretty confident doing like bread and butter stuff without doing like a spine fellowship, but I'm not really interested in doing spine necessarily. And so when I thought about like, what are the things that I care the most about, it kind of, the story kind of writes itself, you know, like if I want to learn really high level diagnostic ultrasound and focus on the appendicular skeleton then I'm doing a sports fellowship, you know. If you're someone who doesn't care to get, you know, really high level ultrasound skill and maybe you got some of the basics in residency and you went somewhere where you feel like you got a pretty good head to toe, you know, exam and kind of ultrasound procedure or fluoro procedure training, maybe you'd feel comfortable going out and practicing without doing a fellowship. But if you're someone who wants to do like really high level cervical procedures, you're probably not going to find a hospital that's going to credential you without doing some kind of fellowship or at least have a pretty strong case log. But I think there's plenty of, I mean, there might even be other sessions that talk about whether to do NAS or pain in that scenario, which I don't think I could speak to. But I think it all goes back to what are the things that you care about and want to do the most, you know? Do you want to practice in the community? Do you want to be in an academic setting? Do you want to be at a big hospital in a large metro area where there's probably going to be a lot of like, you're the second or third opinion sometime or if you're like the only game in town in like a city of 20,000 people, you know, out in like rural Kansas or something. I mean, that kind of what your personal goals look like would also kind of, I think, inform that decision a little bit. So I would say it kind of goes back to what are the things that you care most about? I'll build quickly just to say, and for those of you who came in late, so I'm brain injury medicine, so I'm the lone like non-sports perspective here. And obviously brain injury medicine fellowship is ACGME accredited. And so if you're pursuing that, there's only one option. There are other options in like spasticity management that are non-accredited. And I think that pursuing something that you're passionate about is never wrong. To go to your other question about doing fellowship versus not, I certainly think that there are lots of practice opportunities immediately after completing residency. And I don't think that you have to do a fellowship if you feel comfortable with your skillset. And for those of you who are medical students and are applying for residency, I do think that's one very important component is to look at what the residents are doing after they graduate. So does every single resident do a fellowship or do some of them go on to practice immediately? Because in my mind, that's a good sign that people feel comfortable with their training by the time that they graduate. There is an asterisk with that, which is that like James mentioned, there's a session later about the death of the generalist. Like I do think we all have this tendency to wanna do the next step. So it's not necessarily the fault of the program if people wanna go on to fellowship after. Other questions from the audience? Yeah. In talking with your fellowship programs, was there anything that you had flexibility with or bargaining? Like if a program didn't have W built in, you asked them, oh, could I do this? I know this other department has it. Something of that nature. Yeah, I actually have a pretty good example of that. So my co-fellow was really interested in ski medicine. And we're in New York, like Manhattan. There's no slopes in Manhattan. So our program was super flexible in that he got a two-week ski rotation. And like that was another big thing for me, just like, oh, will you be willing to help me find that W if W doesn't exist? And my program was absolutely very happy to send him off to wherever he's going to do ski medicine. So yeah, so I think that's also really important to see. And that's also a great question to ask, like in your, do you have any more questions for me? Like, hey, this is one thing I'm interested in. I see that you don't have it. Is there any way you can help me find that opportunity? You can never go wrong by asking, both in the interview and once you've actually started. If you're interested in something and you don't feel like you're getting the opportunity, ask your program director if they'll support you in finding that. And in general, I've learned that when asking a question, it's best to do a little bit of research beforehand. So you're saying like, hey, I want to pursue this headache clinic. I know that there's already a headache clinic with neurology on X day. Is it okay if I join that? So you're making their life easier and sort of helping them say yes to your decision or your question. Any other audience questions? All right, I'm gonna ask just two more questions and I think we're about time to wrap things up. So I think like we talked about, mentorship is obviously really important and helps shape us as professionals. How did you all identify mentors in training? And do you feel like your mission, vision and values have to align with those of your mentors? I think an important piece of this too is realizing that mentors can hold different roles and there's different mentors for different aspects. So you might have a mentor in research, you might have a mentor who helps you kind of say no to things, you might have a mentor who says, tell me about your personal life, how's everything going in your personal life? And so I think that you can have more than one mentor. I don't think one person has to do all the things for you. I think at the most basic level, I think mentorship is really, it's a two-way street. So I don't think that a mentorship is not somebody that's superior to you, giving to just you. As a mentee, you have a responsibility as well. And so I think for me, I would find people that when I was talking about my goals or my aspirations, would they kind of mirror match what I brought to the table? So if I was putting forth effort to a component, did they also bring forth the effort? And did they find a way to support what I wanted to do? And so there's certainly been people who are really well known in their field or they have a lot of publications or they've been practicing for 25 years, but that doesn't mean that that person is always the best mentor. Because being a mentor takes intentionality, right? They have to be intentional to be a good mentor. And so I would find people that would take the time to be intentional and really try to support me in what I wanted to do. Yeah, I'll just jump in and say, I think that, I can't remember the exact wording of the question, but basically like the general kind of thing that I'm thinking about is that, a mentor can, I agree with Josh, like be a lot of things. And I remember like by the end of residency, it seemed like most of the faculty that I worked with who were all awesome people to work with, this is a side plug for Vanderbilt, but it's an awesome program. And I was really, really well supported there and just felt like I got really like just rockstar training and got to work with a lot of really nice, smart people. A total side note. But I feel like by the end of my residency, I kind of had like little things that each faculty member I worked with, like it was something that like they helped me with and that I would continue to kind of go to them for. So I think about like, one of the pizza tangs at Vanderbilt was someone who, like it wasn't someone I got a lot of like personal life advice from about specifically or anything like that. But she was just really good at kind of helping me see the way that the organization was set up in the department and how power dynamics worked within the department, which is the kind of thing that, I mean, when you're looking for residency programs, that's not like something you like check off, like, oh, this is someone that's gonna help you understand the way that interdepartmental politics works, you know? But that was something that I ended up talking to this person after my peds rotations, like pretty frequently about kind of what the, about how things looked and how to navigate certain situations. And actually I've gotten, I've used some of the kind of skills and advice that she has given me, like even during my fellowship to kind of, you know, get some opportunities that maybe I otherwise wouldn't have gotten. But, you know, like I think of that person as my mentor, even though I loved my peds rotations, but I'm not gonna be a pediatric physiatrist and I'm, you know, and the things that she was teaching me weren't in that clinical area of expertise, but like certainly it's affected my career. So I think it's just good to kind of find people who guide you in specific things and just kind of notice what are the things that this person is really good at and that I, that you need help from and kind of let that kind of guide the way that you interact with these people that are smart and forthcoming and willing to kind of help you in whatever way they might best be able to. That's kind of a meandering answer, but that's my answer. I was gonna add one last story of how I found one of my mentors. And it was actually at like this conference last year where I was basically a volunteer for ultrasound or either that or I was at the resident bootcamp or something. And I was learning how to ultrasound, you know, the median nerve. And I basically just, you know, started chatting with this individual who is teaching how to ultrasound the median nerve. And they just did it in such a way that was so easy to understand, even though it can be super intimidating if you've not really used ultrasound as much. And they did it in a way that I felt very psychologically safe. And I'm like, okay, this is a person I know I can go to and someone who will, you know, answer any question I have. And it was just that one interaction and that's kind of how I found a mentor. So one of the things I would say is when you're at these meetings, like meet the people and go to these sessions and volunteer and, you know, go meet everyone you can because you don't know where your next mentor will be because they might be, you know, the person you just, whose booth you randomly go to to learn how to scan the median nerve. So. So I actually think that's a great note to end on. And I feel like it should go without saying, but I'll say it now. Obviously, this is something that all four of us are very passionate about. If you ever feel like you're looking for support in any area in your career, any of us would be happy to help. So please feel free to find us and reach out. Thank you for listening to us today. Thank you.

mission statement

vision

informed decisions

professional goals

values

Inspire Framework

training programs

careers

choosing a fellowship

finding mentors