Good evening, everyone. Thank you for joining us tonight. We are excited to share our journey in residency track systems and creating some residency tracks. So hopefully all of you are here in the right place, ready to learn more about the residency track system that we have here at the Shirley Ryan Ability Lab. I am Monica Rowe. I'm the residency program director here at Northwestern University and the Shirley Ryan Ability Lab. Joining me today is Dr. Sarah, starting from the left, Dr. Sarah Wong, who was the associate residency program director for our program for a number of years. And then Dr. Matt Haas, who is now the assistant residency program director of our program. And then Dr. Leslie Rydberg, who is also an associate residency program director here. And I think one of the themes of this is it takes a village to create a track system. And so I brought my village of help with me to talk a little bit about how we created these systems. And hopefully we can have a nice discussion about what our journey was like, and then hopefully inspire some people, give people some ideas. And hopefully this is a really nice exchange of ideas session as well. So none of us have any disclosures to share. I'm just going to give an overview of residency track systems. And at the Shirley Ryan Ability Lab, we actually have four tracks. And so we will go over the four tracks that we have, which is a five-year research track, a medical education track, a leadership track, and a quality improvement track. And then we're also going to share, Dr. Haas was a recent graduate of our program, and we want to share his perspectives as a recent graduate of one of our tracks and how he's been able to utilize it so far in his career. So the learning objectives that we want to cover tonight is we want to understand the value of specialty tracks within a PM&R residency program. We want to highlight the structure of the tracks, curriculum, and learning objectives for each of the four tracks. We want to discuss the outcomes of the participants of each track, at least the outcomes that we have so far, in order to determine success of each of the And then we want to review the perspective of a graduate of the residency track program to see how it's affected their experience as a junior faculty member in academic physiatry. So I pulled a couple of articles about residency track systems. Some of you may or may not be aware, but really emergency medicine has been doing this for years. And I think probably the residency program that has the most robust data has been ER. ER started their tracks system in the early 2000s. In 2010, they actually published this study in academic medicine, emergency medicine. And in this particular article, they cited that there are administrative tracks, there's a disaster medicine track, there's a medical education track, emergency imaging, EMS, global health, public health, research, simulation, toxicology, and ultrasound. So they have quite a number of tracks. We are not at their level yet, but definitely they found that the specialized learning tracks for ER residents have been very beneficial. And so certainly there have been studies that have shown kind of the outcomes of it, outcomes of women's health residency tracks, and then also global health tracks. And then I think we're also pretty familiar with a lot of residency programs having research tracks specifically for people interested in careers in academic research. So our program, one of the things that we really tout with our residents is that we're committed to providing education opportunities for our residents to grow in the direction that they want to go in their careers. And we recognize there's a lot of different directions you can go within PM&R. That's actually why a lot of people choose PM&R, because they like the diversity that is offered to them. And so we recognize that this was something our graduates were doing, and we thought that we had unique opportunities to provide them with training within their residency program to help prepare them for what they were about to face. One of those articles that I showed earlier actually had some recommendations for creating residency tracks, and they summarized it really nicely. They said, you should always have clear goals and objectives. You should have matching track topics with faculty expertise. And this is where I've brought my village along, because it is impossible for one person to run all these tracks. And then you have to provide adequate mentorship for the residents in these tracks. So getting your faculty involved is really important to this. And the literature out there shows that there are benefits to residency track systems. It does actually improve overall resident satisfaction. It increases production of scholarly work. The scholarly tracks are actually associated with academic positions immediately following residency, at least in an ER program. The odds ratio is 1.8 if you participate in a track. There were some perceived benefits of participating in EM tracks, and that included advanced training, career guidance, mentorship, and preparation for an academic career. And then in the women's health track in internal medicine, the study that I showed on the other page, they demonstrated that their track participants were more likely to present nationally, and they were more likely to have a leadership role in the future. So hopefully I don't need to sell you too hard on the benefits of residency tracks. I'm going to talk a little bit about how we evolved into our track system. And the first track that we actually developed was our five-year research track. So I'm going to take you back in time a little bit to kind of follow our history. Back in 2010, that was when our CEO at the time, Joanne Smith, announced that we were going to build a new RIC. So at that point in time, it was not called the Shirley Ryan Ability Lab. Orange was not the official color. But the one thing that she did say is that we are creating a clinically translational research hospital. I know this, and they said, we want to have clinician scientists all throughout this building. And I know that this was a huge push by the CEO at that time, because I was one of the first clinician scientists hired at my job, much to most of my residents' surprise. I was actually hired here to be a clinician scientist and not a clinician educator. And so the goal at that time was to just hire clinician scientists moving forward. That's literally what the CEO told me at that time. One of the things that they ran into early on was that it was very hard to find clinician scientists, as we all know, within our field. And so in 2010, 2011, they started talking about, or 2011, 2012, they started talking about the idea of a five-year research track. Because if we are going to have difficulty finding people to recruit to be clinician scientists in our institution, maybe we should start training them. Maybe we shouldn't complain about the problem. Maybe we should be a part of the solution. And so they developed Dr. Jim Sliwa and Dr. Rick Lieber in partnership with each other. Dr. Rick Lieber is our chief scientific officer here. Dr. Jim Sliwa is the former residency program director at the time and the chief medical officer here. They came together and established this five-year research track. The first participant started his residency in 2012, did five years, so did an intern year and then four additional years in PM&R and graduated in 2017. He then went on to pursue a neuromuscular fellowship because he didn't have enough of training. And then we hired him back on as faculty. Since that time, we've had two additional track participants. One graduated in 2020 and the other graduated in 2021. All participants of our track have been maintained and retained as faculty clinician scientists here at the Shirley Ryan Ability Lab. And the track participants are actually part of Northwestern's physician scientist training program as well. So the goals of the research track was to provide the right environment, opportunities, and time for a resident predominantly interested in pursuing a career in research. So we have a research curriculum for our residents. All of our residents get our research curriculum, but we really wanted this track to focus on the person who thought that more than 50 percent of their career was going to be dedicated towards research and that a smaller percentage of their time was going to be dedicated towards clinical work. So it's really intended for the resident with aspirations of a funded clinician scientist. And so the whole idea for those of you who have been on the research path, who understand what it's like to try to get funding. It is hard to get funding without preliminary data. It's hard to get preliminary data without time and funding. So it's like you're in this cycle. And so the goal of what we were trying to provide is we were trying to give people a leg up and give them time to collect their preliminary data to apply for a research training grant by the end of the five years to help launch their academic career in science. So the details of our track is that it is actually internally funded. This program does require approximately $100,000 to support the additional year of training. It does extend residency training by a year. The residents are not matched into the track. What they do is they are just matched into our program regularly. And then during their PGY-2 year, we tell them if you're interested in the five-year research track, use your PGY-2 year to explore different mentors, explore different research labs in the area, see if we're a good fit for career development. And then by the end of their PGY-2 year, they do talk to our chief scientific officer who actually does make the final decision about whether or not they're accepted into the track because there is a significant financial investment into the resident researcher on this track. And just to note, having a PhD is not a prerequisite for this track. So far, our track participants have only been PhDs, but it is not absolutely required. And so the way that we figure this out is the PGY-2 year is essentially just like everybody else's PGY-2 year. But when you get into the third year of their training, we give them eight months of PGY-3 rotations, and we give them four months of research that they can kind of split out to whatever works best for whatever research they're trying to conduct. In their PGY-4 year, we give them four months of the rest of their PGY-3 year, and then we give them the start of their PGY-4 year, so four months of that. And then we give them four months of research time. And then in their fifth year, they finish out all their PGY-4 rotations, and then they're given an additional four months of research. So essentially, we put four months of research throughout three different years, and that's how we get the additional fifth year that's supported. We do find that we are very flexible with our track participants in where they put their research months. For some of these residents, it makes sense to clump them all together because of the studies that they're trying to accomplish. For some of them, it makes sense to spread them out. So we give them a significant amount of flexibility given their research demands. So again, in terms of outcomes, we don't have a large end. We have three people. We like to consider them very successful. Dr. Colin Franz currently runs a technology-oriented regenerative neuroscience laboratory that employs preclinical models, including neural organoids derived from human pluripotent stem cells to model neurotrauma, neural degeneration, and regeneration. Dr. James Cotton is running a lab here studying wearable sensors and machine learning for rehabilitation, specifically focused in the domains of therapeutics, outcomes monitoring, and assistive technologies. And then Dr. Ishan Roy runs a cancer rehabilitation lab that focuses on understanding physiologic mechanisms that cause functional decline, in particular, cachexia. He does a lot of basic science work in cachexia and muscle physiology. So again, all three of these individuals are funded scientists within our program. They are more than 75% research and less than 25% clinical. And so they are all bringing in grants. They're all publishing papers. And they're all supporting the overall mission of our hospital to integrate clinical care with research. So again, I think it's more to be seen how successful this research track has been. But so far, we do find that these individuals have been great additions, not only to our residency program, but also to our faculty. So that is our five-year research track. I'm going to turn it over to Dr. Leslie Rydberg, who's going to talk about our medical education track. We will have time for questions at the end. And we're also going to have time for some small group discussions as well. So if you have questions, you can also put in the chat, and then we'll address them at the end. So Dr. Rydberg? Hi, welcome, everyone. I see some familiar names and faces. So thanks for joining us on this Monday, right? I work this weekend. So hopefully, I have the day of the week, right? So I'll talk a little bit about our medical education track that we've developed and been running since 2018. So this track really started back when we were talking about what our program aims are. And so, as Monica said, we really want to provide a strong research background, obviously, a great clinical background. But thinking about what makes an academic physiatrist for not for everyone is research. And as a non-researcher, as someone who would not do well in the research track, my passion within academic medicine is really the education piece. And so I was lucky enough to graduate residency, end up in an academic program, and end up with some education leadership roles, which is really where I wanted to be. But I realized how much I was learning on the job. And I really just didn't have that foundation to know what was the role of the ACGME? What does the LCME do? What do these organizations do? How do we think about curriculum development and assessments? And there were so many pieces that I got to learn, which I love learning new things. And so jumping in was really a fun thing. But I realized how great would it be if we could start this educational process a little bit earlier on. And so that's where the idea for the medical education track was born. Although hearing Monica talk about the different emergency medicine pathways, how they have so many different ones, I think that we should next, Monica, start a medically complex rehab track, because I'm a medically complex physiatrist, and I know that everyone would be dying to join my track for medically complex rehab. So that's up next. All right, next slide. So what we did was think about what were the types of medical education skills that might be important for our graduates to have. And we did a survey of all of our PGY-3 and PGY-4 residents at the time, looking at what was their confidence level in these different skills. And so this was a classic five-point Likert scale. And there was quite a range of confidence in different tasks. But really, on the left side, mentoring, wellness, professionalism, giving feedback, these are the kinds of things that our residents are exposed to all the time, right? They are actively and doing a wonderful job of mentoring medical students who are thinking about PM&R, right? So they are always thinking about their own wellness, wellness and learners in general. Professionalism is important. And they're on both sides of giving feedback, right? So giving feedback to students and accepting feedback. And so these kind of standard processes, they had pretty good confidence in. But then looking at the other end of things where they were less confident was really these educator skills. So what is the ACGME and LCME? How do we write test questions? How do we develop curriculum? What about program evaluation? How do we implement new strategies? How do we evaluate residents and programs, things like that? And so there was clearly a deficit that we saw in more of the educator-type skills. Next slide. And so we came up with kind of our learning objectives. And the problem was we had so many learning objectives that we ended up with several pages. And so we kind of tried to break them down into some larger groupings. And so one thing we really wanted to provide was this medical education framework, right? So who kind of sets the guidelines for medical education at the different levels? How are we instructed and regulated in terms of what we teach, how we teach, things like that? So really, what are the educator roles even within medical education in terms of aspirations and developing careers? Then thinking specifically about program evaluation and learner evaluation, how do we know if we're doing a good job, right? Are we teaching the things that we think we're teaching? Is program effective? Are our learners effective in terms of competency and performance? And then curriculum development is one of my favorite things to think about. How do we create content? How do we add content? Making sure we're doing that in a thoughtful way. And then teaching, of course. So lots of different ways to think about teaching. We want our residents to be successful teachers in inpatient, outpatient procedures, whatever the setting may be. So we hope to spend a lot of time on teaching. And then mentorship and leadership. So these are topics that our residents think about all the time, but not just how to be a good mentor, but how to teach mentorship, how to teach leadership, how can we as educators pass that on to the next generation. And then same thing with professionalism and wellness. So not just be professional and be well, but how do we ensure that culture of professionalism and how to teach about providing wellness experiences for our trainees. And then kind of the meta objective that we came up in addition to these specific goals for our trainees was if we can get our faculty pulled in and talking about their areas of interest and expertise, then we can actually work with the faculty on active teaching techniques so that we can do a lot more discussion based small group cases, things like that, which will hopefully go outside of the track and translate into the general learning environment of our facility. Next slide. And so then, you know, the most important thing was to get it up and running, right? So how are we going to actually implement this? And so the first thing was thinking about the space, where were we going to hold it? And obviously that was before COVID when we transitioned the many things to Zoom. How was this going to fit in schedule wise? So not just physical space, but space within the curriculum, because we wanted to make this something that was doable for our residents and not just extra busy work or something that was going to take away from their educational curriculum. We had to recruit faculty for each of the sessions, design what we wanted our sessions to look like. And then for each session, we actually had a medical education mentor assigned to each faculty member for session development. So the track leadership was myself and then Dr. Erin Gilbert and Dr. Jackie Neal, who are both other faculty members in our department. And so one of the three of us would meet with each faculty member before the session to kind of make sure that it had some pre-work and then some small group component and discussion component. So we set it up so that there were about one session, one small group session per month, where we all sit down and go over specific content at that period. And then we had to advertise the program and get started. And so we started in January 2018. And the fun part was is that there was such enthusiasm for the program that all 12 of our PGY4s joined. And so they only got to be a part of the program for six months, but there was such excitement that they all were a part of it. And so it was kind of a great ego booster to get things started. All right, next slide. So what we designed really was an 18-month program that cycled. And so you could join in January, and then you would run through a year and a half content. And so you would be done 18 months later, but then we would have an overlap of residents so that you could have PGY3 residents and PGY4 residents participating at the same time, so that you could have the experiences of different years of residency training. And it actually was popular enough that we actually allowed residents to start in January or July. And then we also recruited the fellows and got the fellows involved for the duration of their fellowship. And so over that 18-month period, we would meet once a month for an hour, and we do 7 to 8 a.m., which I know is a tough time for early mornings, but it works really well because it does not conflict with any of the other educational opportunities that our residents and fellows are involved in. And as I said, they're hands-on, discussion-based, problem-solving, with some pre-work to leverage some active learning techniques. And then we have kind of grown our mentorships through the program over the last few years, so that each resident is assigned a medical education mentor who can help with their educational progress as they go. We require them to give and receive feedback on our sessions. So for every session, we ask for feedback, but then they're actually required to give and receive feedback on their teaching. So when they're doing their musculoskeletal lectures, when they're doing chair rounds presentations, when they're doing journal clubs, they can ask other members of the track to give them feedback, and then they're required to practice giving feedback to other people, because it's always important to get out there and do it. And then we do require a scholarly educational project. And this, I don't want to, you know, give too much work for our participants, but this has really been fun, because this has been very small things, like develop a handout, a hands guide for our visiting student rotators, for example, with some orientation material and guides for different rotations. But this has been big projects, too. So our residents have a required scholarly activity for graduation. And so if this is, you know, data collection, analysis, literature review, if it goes through all of that, it can count as their scholarly project for residency. And we definitely have had several residents go through that pathway. And then of course, reflection to make sure that this was a meaningful experience and to help us with feedback to grow the program. Next slide. All right. And then in terms of our curriculum, we looked at kind of educational overview, curriculum and teaching and assessment. And so lots of different topics that were exciting and fun. And this does continue to grow and evolve based on feedback and based on our areas of interest and based on what sessions that we thought went well. All right, next slide. And then for every session, we do ask for feedback, like I said, was it valuable? Was the format good? Did the lecturer encourage discussion and additional feedback? And even though we teach them how to give feedback, we oftentimes get this back with just very valuable or valuable highlighted and no specific comments. And some days I email them back and I say, let's practice our feedback and give me a little something more. And sometimes I give them a free pass. But we do collect this feedback and then send it back to the lecturers so that they can see kind of what worked and what didn't work and potentially change things for the following year. Next slide. And then this is an example of teaching feedback that they can use when they're giving and receiving feedback on their presentations. And so this is adapted from one of the feedback forms that UCFS uses. And I like this one because it gives, on the top left, you can see for the observer, focus of observation. So there should be an advanced discussion about what the lecturer specifically would like feedback on. And then it gives you a lot of kind of thought points, things that you may comment on if it was appropriate. And so this has been really helpful for our residents. Next slide. And the really fun part has been the medical education scholarship. And so we've had some really, really impressive and thoughtful projects within curriculum development, assessment, and different educational content. So we had a really cool project on simulation-based mastery learning for intracerebral baclofen. We've done some neuroanatomy, medical emergency projects, ultrasound, the medical student externship program, fellowship, influencing factors and fellowship, COVID education project. I mean, just really, really cool stuff. And so that's been, I think, one of my favorite parts of this has been seeing the projects that have come out of it. Next slide. And then thinking about outcomes. So most importantly, did our residents feel that this is beneficial, right? If we're going to put all this work into running this program, was it meaningful for them? And the highest score on a five-point Likert scale was the required time commitment. So they thought that the timing really fit in. So that may mean that I can actually make them do more. So that's something to think about in the future, but the timing seems to work for them. The content was very highly rated. The small group sessions were highly rated. And they actually really highly rated the education project and the organization of the program. The mentorship was the lowest rated, and it still got about four out of five on their Likert scale. And I think that this mentorship is something that we've actively worked to continue to improve so that there is more straightforward or expected mentorship so that it just happens and they are assigned someone to work with. All right, next slide. And so then thinking about looking at their confidence before we started the program and after the program. So this takes into account all residents who took the survey. So on the pre-survey, we had, I think, 28 residents who took it. And then on the post-survey, we had 29 residents take the survey. And 23 of those who took the survey did complete the program and six didn't. But because of the small numbers, all of these are grouped together. So for each chart, the left is the pre-intervention and the right is the post-intervention. And so for every type of skill, teaching skills, mentoring skills, educating skills, there was a significant improvement in their confidence post-intervention. So again, this is taking into account all residents who did the track and did not do the track. So it's not a direct comparison of the two groups because the numbers are small. But over the 18-month period where this program was introduced, where the vast majority of the residents participated, there were significant improvements in their confidence. So this has really been a fun program. I like to think it was successful. We'll see what Matt has to say later from his side. But what really has been successful is that it's encouraged medical education research at our institution. So new projects, new ideas, and it has created this culture of medical education growth. And that's what's been so fun for me because I always keep thinking of ideas of different things we can do. And that's why I'm probably a great associate program director because I can do all the fun things, whereas Monica has to do all the busy work and numbers and paperwork and everything. So I hope she doesn't kill me for all of this. I hope that it's improved the teaching skills of the residents and fellows. And we've actually had a high degree of interest from residency program applicants. So we do get asked about this all the time from candidates applying to our program. And there has been a remarkable degree of participation. So 50 to 70% of our current residents and fellows have chosen to participate. It's an optional program. So they're not required to do it. And there's no application process other than them saying, I would like to participate. So they're all welcome. It was really designed to be inclusive and a good place to get together, share knowledge and ideas and learn about these topics before they graduate. So it was not meant to be a highly competitive two-year certificate program where they really have come out with a miniature degree in medical education. But this is really to be a stepping off point for future educators. And I think that we've really accomplished that. And I mean, it sounds cliche, but had a lot of fun along the way. All right. Thank you. So you guys heard about the research track and the medical education track. When we thought about what other skills or different topics might be helpful for the residents, leadership was something that came up. It's something that we're asked to do even early on in our medical career and medical students. Monica, next slide, please. So if we look at the core competencies for medical students, they include things like communications and feedback. And I think this has improved over the years. But I think if we all look back when we were medical students, this wasn't something we were necessarily taught. We modeled a lot of these behaviors, but never had the education side of it to go along with it and to really develop and learn about those skills and get better at them. Next slide. And I'm sure all of you guys recognize these. These are the milestones. And when we look at the milestones for PM&R residents, things like communication, engaging a team, leading advocacy, seeking and incorporating feedback, and even providing feedback are all things that we are looking at our residents and saying these are things that we think are important for you to know when you leave residency. We also, as a, you can go to the next slide, as a department, when we reviewed our project, our program aims, one of the things that we wanted to really do as a residency program was to educate leaders in our field. And so when we came up with that as a name, we said, well, this might be the next track that we develop here. And so when we looked kind of at the literature, what we found is that there are, as Dr. Rowe mentioned, there are other specialties that are doing this in emergency medicine, just like they had the track system, they also are kind of leaders in leadership training. Harvard is another institution that really does a lot of leadership training. And these are five of the skills that they really stress are important when you're starting to develop and starting to look at training physicians in leadership. So emotional intelligence, which sure all of you know this, but the awareness of your emotions and the ability to manage your emotions, but also the ability to understand others' emotions in any given situation. Self-awareness or self-assessment is really important in leadership. So understanding your own strengths and weaknesses, this can be helpful for building a team of individuals that can compliment each other's strengths and weaknesses. Conflict management is important. We deal with conflict in one way or another all the time. And so teaching young leaders the tools and techniques to develop and to better manage these conflicts. Decision-making skills, so helping the learners understand difficult situations and what different tools and techniques they can use when making decisions and dealing with these types of situations. And the last one is influence. So rather than saying, this is what we're gonna do, influencing your group or your team to say, hey, this is our goal. This is what the end outcome is. How can we get to this outcome? This is what we're gonna try. This is what we're gonna focus on to get to this eventual outcome. And so when we developed our initial leadership track proposal, we identified a need. So we said, as physiatrists, we know that we're expected to be leaders early on. We lead the rehabilitation team, a second year residents at our program. But we also said that as a department, we really wanted to make sure that we were educating leaders in our field. And we didn't really have a learning pathway for this that was identified. We did have some different leadership opportunities or educational opportunities that were available to our residents. So like I said, that second year residents learn about leading team conference and they do that early on. We also had a grand rounds on giving and receiving feedback. And about a year before starting the leadership track, we started doing emotional intelligence training for all of our residents. And so these were things that some of the residents were already getting, but we said, how can we build on this to do more? And so our initial proposal included small group discussions. And I'm not gonna read all these to you, but you can see some of the topics that we wanted to cover. We also really wanted the residents to be able to apply their skills. So we utilize different cases or different case studies, utilize role play and wanted them to be able to take some of the things that they learned and use those when mentoring other residents. So we have a big brother, big sister program here at Shirley Ryan Ability Lab. And the hope was that some of these leadership skills could be used to build that program even more. And then we similarly wanted to do a project in the second year, things like a QI project or having the residents get involved in various leadership opportunities. So the year one plan, we wanted to cover topics like emotional intelligence, communication, both interpersonal communication, but also thinking about public communication. Because as we go further in our career as leaders, that's a big part of it. Team building and leading a team, negotiation, networking, advocacy, and then also getting involved at the hospital level and at the organizational level in different leadership opportunities. Self-assessment, as I said, an important part of leadership. So we wanted to make sure we were including that. And then discussions on implicit bias. So originally our track was one year of the short, or these small group discussions and lectures. And then the second year was outside of those discussions was supposed to be spent doing the project. But what we found is that a year is a little bit too short when things like holidays and conferences and things like those came up and we were missing months because of different things like that. And so what we actually more recently have done is it's been changed to an 18 month track. We also found that it was originally created for third year residents. We allowed fourth year residents in the first year, but what we found is that as they got further along in their third year or fourth year, attendance would kind of wax and wane for certain people. And so we made minimum attendance requirements. We kept the leadership project, but it has been now built into this 18 month curriculum. So they're more similar to what's done in the medical education track. The residents are doing these smaller discussions once a month in the morning, very similar to what you just heard from Dr. Rydberg. And during that time, they're also completing their leadership project. So that's a little bit about the track. I did wanna spend a couple minutes telling you about something else that we created here around the same time that we started the leadership track. We actually started a women in PM&R leadership workshop. So this was really aimed at, we saw a need for specifically women in medicine, but women within our specialty. And we see that there's a need for further leadership training to address some of the inequities in leadership, but also in academic medicine. And so we started a leadership workshop at our program. This was our first round of the leadership workshop, which we started in the spring of 2020, which I'll get back to in a little while. Next slide, please. We did a needs assessment with any of the residents in our program that identified as women. And we said, what are some things that you would like to take away from this? And based on that needs assessment, we created these goals and objectives. So they wanted to learn more about navigating relationships in the professional realm. They wanted to work on their personal leadership style and finding balance between professional and personal life, recognize the difference between mentorship and sponsorship, lead difficult discussions in the workplace, and then address gender bias where it exists. So based on that, we created a three-night workshop that included a little bit more lectures than what you see here. But unfortunately, as I mentioned, this was started in the spring of 2020. And so like everything that started in the spring of 2020, it was cut short. So these are the lectures that we actually were able to do in the two nights of the workshop that we got done. Looking back, I think our second workshop was actually like maybe the night before the whole world shut down. We got right in there and got those two sessions done. I remember going home that night and my husband's like, I cannot believe you guys got this last one in. But we had a personal leadership story of the hospital CEO, Dr. Joanne Smith. She shared kind of a story about her, how she got to where she was and what that looked like for her and some of the different hurdles that she overcame and some advice to the group. We had a session on defining your career path, a session on leadership styles and strengths. Another session on negotiation skills, a session on mentorship and sponsorship, and finally a session on combating gender bias. We were able to do some assessments of our program. So we did a pre-program self-assessment survey as well as a post-program. And we're able to look at some of these things that you see here, which I'm gonna show you a little bit of the data on. What we found is that residents, you can go to the next slide, please. Residents, their confidence improves statistically significantly in navigating interpersonal relationships as a trainee and finding balance between personal and professional interests. So these actually are kind of interesting things that improved because some of these sessions, like the finding balance between professional and personal interests were sessions that were cut because of having to cut our workshop short. But what we found is that just having the opportunity to have the residents interact with the fellows in attendings and really get to have these small group discussions about various topics probably made quite a bit of difference in what we see here for the numbers. Next slide. We also looked at the attendings that were at the first session and compared their baseline data to the residents and fellows. And I always find this kind of interesting. What we found is that attending positions were more comfortable before doing this workshop, navigating interprofessional relationships, leading difficult discussions in the workplace and finding balance between their professional and personal interests. If you think about it, I look at these kind of three areas as things that we have to do every day as attendings. We have to work with various people. We develop those relationships. We have to lead difficult discussions sometimes. And hopefully by this point in our career, we've been able to find some type of balance between our professional and personal interests. But things that the attendings were equally not, not necessarily more confident than the residents were things like recognizing and developing their own leadership style, recognizing the difference between mentorship and sponsorship, and then addressing implicit gender bias where it existed. So I think if you're developing a program like this, it's important to recognize that there are some of these topics that even as attendings were maybe not so comfortable with. And those are important ones to include because it probably means that we need some education on these topics. So we also ask the attendees, the resident and fellow attendees, just kind of overall satisfaction. And what we found is that all of the people that attended, all of the people that did the survey either agreed or strongly agreed that they were satisfied with the program. And 12 out of the 14 that answered felt comfortable sharing. Two of the people that answered were kind of neutral on if they were comfortable sharing their experiences. So these were two of the leadership programs that we developed at our program to help foster these leadership skills. And these programs are obviously still growing and still changing. We don't have data yet on our leadership track, but I'm sure that will be coming in the future, especially after we've made some of these changes and have grown to the 18 month curriculum. Thank you. Thank you, Dr. Wong. So I'm going to round out the newest of our tracks. It's the newest track on the block. It's our quality improvement. And I guess I should throw in safety track. You know, the evolution of this track was really interesting for us, as you can kind of see how the evolution of our other tracks came about. The evolution of this track actually came about because in 2020 at our annual program review, the residents highlighted significant dissatisfaction with transitions of care done within our hospital. And so as a result of that dissatisfaction that came on the annual program survey that we do yearly, we actually created a transitions of care committee. And as part of this transitions of care committee, we asked for two to three representatives from each class. The chief medical officer and chief quality and safety officer were present for these meetings. Our chief medical information officer was invited to these meetings. I was invited to the meetings. Our medical director of consults was invited. We had three attending representatives. And then because we have a robust presence of nurse practitioners and PAs in our system, we did have an advanced practice provider representative also involved in the transitions of care committee. So this TOC meeting, we met once every two to three weeks. It was led by our chief quality and safety officer. And we identified an issue with our transitions of care. Although to be honest, when we first started this process, they identified multiple issues because as you can imagine, there are multiple handoffs that occur within a residency program and within an inpatient rehab hospital like to the scale and size that we have. So we completed one PDSA cycle. We solved one issue. We implemented change. We sustained the change. We improved satisfaction amongst residents and attendings and APPs. And then in the process of doing that, we found three other issues. As you can imagine, those of you who are involved in QI projects, you know how this goes. We started a second PDSA cycle three months later, again, about a different transitions of care topic. Then we started a third one six months after that. And then finally at that point, we realized the work that our residents were putting into this transitions of care committee meeting was significant. They were putting together the surveys. They were helping put together the educational content to push it out to attendings, residents, and APPs. They were doing a lot of the data analysis. They were actively participating in all these discussions. And one of the things that we really, that struck us about a year ago was that some of the residents on this committee could lead a QI process better than some of the attendings on our faculty. And I think part of that is because QI, as we all know, has been a more recent addition to medical training. Obviously it's been a part of medicine for a very long time, but the emphasis on putting it within our training has really focused, has been a focus within the last five to 10 years and not within the last 20 to 30. So because of all the work that the residents were putting into this, we actually officially established an official track in the fall of 2021. This track takes a different form than the other tracks because it is very real world dependent, meaning that we don't ask them to come up with their own cases. We are solving the cases that are sitting around our hospital every day. And so we're currently on our fourth PDSA cycle in terms of solving different issues. So the goals of our quality improvement track was to be able to identify a quality improvement issue and lead a PDSA cycle from start to finish, which included writing a problem statement, developing an opportunity statement, determining outcomes for success, analyzing those outcomes, formulating an action plan, checking the outcomes and interpreting the success of the plan. We obviously also wanted to include safety. So we wanted our residents to be able to demonstrate the ability to lead a root cause analysis, not just participate in one and learn how to integrate this into their clinical environments. And it's essentially intended for residents with aspirations in a career of leading quality improvement initiatives in their future work, which as many of you know, really includes most leadership positions out there in clinical medicine. So, so far, again, it's a relatively new track. We graduated two residents with certificates in the program in 2022. Currently we have four PGY-4s in our track, three PGY-3s and three PGY-2s. We'll continue to follow our certificate participants longitudinally to see how they stay involved in QI and safety initiatives in their future jobs. So that is our QI track. So that rounds out our four tracks. I'm going to turn it over to Dr. Haas, who's going to talk a little bit about his perspectives as a recent residency track graduate. Dr. Haas. Thank you, Dr. Rowe. So as Dr. Rowe and Rydberg mentioned earlier this evening, I am one of the kind of early graduates from the medical education track. I graduated residency here at Northwestern in 2019. So I was in the first class that completed the full cycle of the medical education track. And now I've kind of joined as faculty and as Dr. Rowe mentioned, I'm assistant residency program director as of this academic year. And I think it would be, you know, I feel much more uncomfortable with assuming that role if I hadn't participated in the medical education track, but that's not the extent of my kind of experience. And so I kind of want to walk through a little bit of how I've gotten here and how the medical education track has played an important role in that. Excellent. All right. So I'm going to do a little bit of a dive into my experience through undergraduate medical education and residency with respect to med ed. So I did my medical school at the University of Pittsburgh and one of the studies that Dr. Rowe mentioned earlier, Farkas et al, came out of the University of Pittsburgh for the women's health and internal medicine program. And I, two of my biggest mentors in medical school or participants were kind of leaders of that track. And so, you know, there's big involvement at the medical or UME level for teaching to teach electives. So I participate as a third year medical student and then into fourth year. In a couple of electives that was more longitudinal, kind of teaching physical exam skills, similar to what our Feinberg Northwestern medical students I'm getting exposed to here, but it's more kind of the kind of exposure just to kind of teaching skills. You know, you're close in proximity to recently learning those skills. You may be a little bit more able to explain the nuanced pieces of it. With that, we also had kind of basics of adult learning theory and were required to give specific lectures on teaching topics. So mine was coaching in medicine, which I think is kind of only exploded since 2014 when I gave that lecture in terms of its utility. But I really was kind of immersed in a very robust medical education experience through UME and came into residency really kind of looking for that. And I think that's part of maybe what attracted me to the residency program here at Northwestern, even in the absence of a formal medical education track. So then kind of fast forward to my PGY3 year in 2017, that was at the start of kind of the building of the residency-based medical education track that Dr. Rydberg outlined, which I did participate in. I will also say that I participated in an additional institutional-based GME certificate program. So that was a longitudinal competency-based program and that did end up with a certificate kind of degree. That was a little bit more implementation science and curriculum development, kind of a pre-master's level type program. And I did feel like the two programs offered slightly different things. And I will kind of go on to what specifically the residency track program kind of helped with, but I did participate in both of them. And then from there, I did also serve my final year as academic chief resident, where I was exposed to a lot of kind of inner workings and a lot of kind of ECGME level things. But I think that there was some key points that Dr. Rydberg alluded to with kind of the needs assessments or things that would be especially important. And so I'm going to kind of highlight some of the key takeaways from my experience in the med ed track. So I think a key one was kind of adult learning theory. So it's not just kind of understanding the different types of learners and different ways to kind of prepare lectures, but more as I was still in training, understanding how I should best access and seek out information and kind of what I want to get out of the rest of my training. And then knowing that I was going to pursue a fellowship training, as well as be in an academic position, start to develop some additional comfort with teaching lectures and feeling comfortable giving lectures. I've subsequently been able to give lectures. I know Dr. Rydberg and one of my mentors from fellowship gave a similar lecture last year to the med ed community about adult learning theory. And I think that I wouldn't have felt comfortable that soon out of training without that exposure. Secondly, it was kind of mentorship. And while there was another resident my year participating in the institutional-based GME program, I think the fact that it was a core cohort within PM&R with PM&R faculty and PM&R trainees allowed me to really understand the importance of mentorship for pursuing kind of specifically clinician educator roles. And so that was really helpful when I came to fellowship interviews. And so didn't know that my fellowship director, Dr. Pruitt would be joining tonight, but he was a big influence in kind of my decision to pursue fellowship where I did. And I think not only him, but a bunch of other faculty from Dr. McMahon, as well as Dr. Bolger, who just really kind of invested in their trainees, not just from being helpful for mentoring me in my future pursuits, but also as a trainee feeling like they understood adult learning theory. They understood the importance of creating well-designed curricula and assessments. And then from there, having kind of a network of people that I could talk to and figure out kind of how to transition into kind of first attending jobs, both from the clinical piece, as well as just kind of pursuing additional opportunities for program development in my role here. And then second, kind of lastly, it was kind of assessment methods. And so that's kind of, not just program evaluation and methods evaluating trainees, but also really kind of a deep dive into ACGME kind of guidelines. And so through my fellowship with kind of the mentorship of Dr. Pruitt, I was able to participate in the annual program evaluation committee, which kind of reviewed multiple fellowship and residency programs at our institution in Cincinnati. And it kind of helped me understand kind of the inner workings of GME committee work. From there, I was also able to participate in the milestones 2.0 work group from ACGME for the updated pediatric rehab medicine milestones that just came out last academic year. And just kind of comfort with the nuanced pieces of ACGME, how we came up about creating the milestones. And then now in my roles as core faculty for our pediatric rehab medicine fellowship, as well as assistant residency program director, sitting on clinical competency committees and understanding one, the importance of them, two, just how to go about assessing and kind of reviewing clinical evaluations of trainees. And again, I think it's difficult to kind of parse out because of my certificate training program, which definitely was very helpful. And I would certainly not feel comfortable assuming this is assistant residency program director role without that. But I think having the kind of residency specific exposure and mentorship and just understanding of how to implement this into the first several years of training or time out of residency has been immensely helpful. And I definitely, I'm glad that I had so many people at our program who've been able to see the value of that and put a lot of hard work into developing these programs. Yeah, so as you can see, we brought our qualitative outcome with Dr. Haas here. That's it's not quantifiable data, but it's qualitative data that he's been able to use some of these tools in the tracks to progress his career. So that ends really the formal presentation part of this. We did want to leave a lot of time for discussion. We also know we're not the only residency program with a track system. So we would love to hear, I know that some programs have some research tracks and different specialty learning cycles, and we'd love to hear what's going on in all the other programs out there. So I first wanted to maybe open it up to questions. And if there are no questions, I have some prepared small group discussion topics. And it seems like we're a small group amongst ourselves. So we won't go into breakout rooms and stress out Zoom. We'll just stay in our group here. There was one question that came to me through the chat. Someone did ask whether or not, how we funded the research track the fifth year. Was it an educational track or did the hospital fund it? And I will say that the hospital did fundraising for it. So the hospital did secure the funds through fundraising and then the hospital did ultimately support the additional years of research. So that answers, hopefully that answers that question. Any other questions or comments or things that you might want to share after hearing what we're doing here? I think there was a hand raised by Dr. Oh, I'm sorry, Brian. Yes, I'm sorry, I missed it. Oh, no worries. Hi everybody, my name is Brian. I'm one of the chief residents for UW. Sorry I don't have my camera on paternity leave and currently solo parenting. The question I have for the, as far as the medical educator track is medical students rotating in the services here at UW, for example, I'm using us as an example. Obviously we don't really have medical students rotating with us that frequently. And you may even go a whole year without even seeing a medical student. How do you, one, is that an issue over there? And two, how did you go about it to make sure that the residents doing the medical education track were able to apply those skills? Dr. Ryberg, you wanna take that? Oh, sorry, we can't hear you, Leslie. All right, can you hear me now? Yep, we can. I was double muted because my dogs were barking. So I was trying to protect you all from my dog. So I think two questions. The first one, access to medical students for teaching. So we are lucky in that we never have a shortage of medical students. So we have a requirement for medical students and we have a required PM&R clerkship. So we have 160 Northwestern students who rotate through every year. And then we get about 40 visiting students per year and we run a summer externship program that we do through our institution. And then we partner, we're a site for SAM's AAP externship program. So we do get a lot of really great medical student opportunities. But honestly, the feedback, the teaching feedback that our residents get is usually on teaching to other residents. So it's on the journal clubs that they lead when teaching other residents, it's teaching at chair rounds, it's teaching their musculoskeletal lectures. So it's not necessarily teaching, it can be peer teaching, not just teaching to other trainees. So that is certainly something where you need to think about how to seek out additional educational opportunities if that's not something that's really done at your institution. And then the second question I believe was kind of how are we assessing this in real time? Are we actually looking at their teaching skills in some sort of objective measure? We are not, we are not officially looking at that. So that is absolutely something we could do to get better outcomes data, but I have not taken it that far yet. Thank you, that's really helpful. So we have another question on the chat by Dr. Mayer. Can a resident participate in more than one track? Actually, yes. I don't know that we've kept track of how many people are more than one track, but we do, because as Dr. Ryberg said, we have close to 50 to 75% of our residents in that medical education track. So because that track has been so popular, most people do that. And often the other people doing the other tracks are usually within, doing the med ed track already. For our leadership track, we're restarting the leadership track. Our cycle starts in three weeks and we have 17 people signed up for our leadership track. And that is out of 40 residents and nine fellows, so, or eight fellows. So out of 48 people, we got 17. So that's actually pretty decent for our leadership track. The research track obviously is, actually two of the three research track participants were also in the med ed track as well. So, yeah, there is easy crossover. As you could tell, like our curriculum is not so time intensive that it's, I mean, cause obviously all of our residents have to be residents first. So they are learning core material and we expect them to be busy that way first. And so we're not trying to bog them down, but it's almost like a little club that where they can come once a month and we talk about topics and get their brain thinking about something different in a different way. So it's not so time intensive that people can't do more than one track. I'm totally renaming it the Med Ed Club. Med Ed Club. All right, Delaney, do you have a question? Hello? If you're trying to ask a question, Delaney, we can't quite hear you. Maybe you could type in the chat. Oh, actually, oh, we just heard you. We can hear you now. Yeah. You can go ahead and ask your question. Sorry about that. Yeah, no problem. This is Kate. I'm one of the Associate Program Directors at UW. So I work with Brian and I have a couple of questions for you all. One, I'm curious in your typical didactic structure, if there are slots where residents are doing the teaching, if they participate actively in kind of the education at that level, at baseline, or if it's primarily faculty run didactics or teaching sessions and how that plays in maybe to this track. Yeah. Great question. Most of our didactics are faculty led. So I would say the vast majority are, we actually have a curriculum called Musculoskeletal Foundations. And in our Musculoskeletal Foundation, which is a yearly curriculum just on MSK topics, we do want the residents to give at least one presentation a year. And it is meant to teach them how to teach. So I actually, I give a lecture at the beginning of every year on how to give a lecture because we want all of our graduates at baseline to be able to do that. Whether you go into academics or not, we all have to advocate for ourselves as physiatrists. I know I'm speaking to the choir when I say that, but we all have to do a good job at advocating for ourselves and teaching other people about our specialty. So that is built into our curriculum for them to teach at least one course or at least one 60 minute lecture, I should say, not a course. We have journal club presentations that they present. They present one journal club a year. They present one anatomy session in the cadaver lab a year. So there are some teaching requirements that we ask them to do, but the vast majority of our didactics are faculty led. Specifically for the medical education track. I don't know if you're asking about how we teach in the medical education track. Those are faculty led. I actually would love to have the residents lead some of the sessions because that would really play into our goals of curriculum development, learning objectives, how to incorporate active learning, things like that. So I would love to do that, but then how do we get all of our track participants time to teach, right? And so I think it's a time thing. So I've prioritized having it come from the faculty. Yeah, no, that's interesting to hear about. Cause I think similarly here we have really majority faculty led didactics, which I think the residents value, but maybe thinking about how to incorporate more of the residents who are interested in teaching, how to get them involved in the curriculum a little bit more actively. So, okay. And then the other question I have is for these various tracks that you developed, I'm curious where you kind of got the content and how you put it together. I guess the reason I'm asking is because I'm in maybe my fifth, fourth or fifth year or so being an attending. It's my second year as APD at the residency program here. I feel it's really been in the last few years that I myself am formally introduced to some of these concepts about adult learning, medical education, et cetera. And so thinking about how to turn some of these concepts that are pretty new to me in terms of my medical education and development and how to turn around and teach them to residents. I'm just curious how you all went through that process yourself. Yeah, it's a great question. And this is why I say it takes a village here. Dr. Reitberg obviously leads our MedEd track, but has Dr. Erin Gilbert and Dr. Jackie Neal helping her quite a bit lead the track. For the leadership track, we now have a leadership curriculum design team. So there's four attendings that also help work on the curriculum for that. The quality improvement track is led by our chief quality and safety officer and their right-hand person, their associate director of quality and safety. And then obviously our research track is led by our chief scientific officer. So I think probably the best example though is because I feel kind of how you do right now, like we feel like maybe five years ago, I felt we're just learning this ourselves because we didn't go to med school or residency at a time when someone was giving us this information. How are we supposed to teach this? Actually, I do think institutionally, you should look around institutionally because I know from my personal experience, like Northwestern did a lot of faculty development in medical education that I know that myself and Dr. Rydberg, Dr. Haas and Dr. Wong, we all jumped on ship early on to attend a lot of that, the faculty development resources that they were offering. And that does help definitely with the medical education piece. Northwestern also just recently started a leadership program for junior faculty that are into junior and mid-career. I can't call myself junior faculty anymore, but Dr. Rydberg and I did that leadership program. It was for mid-career faculty. And so we went through those programs as well. So Dr. Wong and I did the AAMC, this was a while ago, but we did the early career development workshop, or early, I'm gonna mess this up, Sarah. Do you remember the early career leadership workshop for women at the AAMC? And actually that was a phenomenal resource. The AAMC really knows how to put on a leadership conference. I would say a significant amount of the leadership teaching that I do is based off of education I received from that particular conference. So I think it's also, one of the nice things, and I think Dr. Rydberg put this as one of her meta objectives is that when you start pushing, trying to teach your residents how to do these things, it actually grows your faculty knowledge base as well. And that has been a really nice outcome for all this, for us. I don't know if anyone else has anything to add to that, but go ahead, Kate. No, I was just gonna say thank you. And I think also that that touches on some of what we're considering now is also to update some of our faculty within the department faculty development sessions to talk about some of these concepts that we're being, in general, as faculty asked to teach about that maybe we didn't encounter earlier on in our own education. But I think similar to Northwestern, UW does have a lot of these resources and that's how I, there are different programs available that I've been just participating in through UW. So that's a great point. Yeah, helpful to hear your perspective. Thank you. I guess our one disclosure that we should have said is that we're not like the world's most experts on this, but we managed to put something together to at least spark people's interests and further some of the education. And I'm sure things will get better as kind of time goes on and things continue to evolve. Dr. Perl, you had a question, right? Thank you. Thank you overall for this great presentation. I think I was lucky to have a recipient of your training program in Dr. Haas. And he certainly brought a lot of what he learned through working with Dr. Ryberg in terms of the development of what we do with medical students and residents and so forth in our program. So I think it's, there's a lot of opportunity to grow and develop PM&R and education and leadership within PM&R through this programming. I was just wondering somewhat in relation to Kate and Kate's question, has there been any thoughts to taking this down the path? And perhaps you have already, and I'm sorry if I am missing the boat, but has there been any thought about pursuing the ACGMEs, Advancing Innovation in Residency Education with this project so that you can spread these thoughts and spread these ideas for other programs to grow and learn from what you're doing is question number one. Question number two is if not, and that may not be something that you're interested in doing, but is there an opportunity to think about spread of this project with the advent of Zoom and the world of COVID that we live in to other programs through the Shirley Ryan program? Yeah, great, great thoughts. We have not pursued, this is actually our first attempt at really just kind of showing the world what we're trying to do. And that's why when we got the invitation to present at MedEd Community, we jumped at the chance because we said, I don't know that we're fully baked yet. We might still be a half-baked idea, but I do think we, I see the value in continuing to push all of our trainees nationally to get better at this. Because if we all get better at this, then physiatry as a whole is gonna be represented in a more positive light in the academic world. And really that is a big goal of what I think a lot of us sitting here on this call right now have. It's a shared, it's a common goal that we all share, I should say. I hadn't thought of the ACGME, but that's a great thought. I mean, that would be a nice place to do it. I do think some of these concepts of leadership and medical education and whatnot, I have seen these topics pop up at national meetings a lot more. I know Dr. Rydberg and Dr. Wong was involved in an early leadership curriculum for residents through the AAPMNR. And I believe Dr. Rydberg has also been doing a lot of this in terms of med ed, I think at the AAPMNR as well. So I do think kind of little snippets of this is coming out. So yeah, I mean, it certainly could be something we could think of kind of even bigger than that. But I think that the national organizing bodies like the AAPMNR is a great forum to really have these discussions and share these ideas. Obviously what we sometimes miss is the longitudinal commitment, but who knows, maybe there'll be some form of this type of curriculum that we can offer nationally to multiple residents across. But you can also think of the PALS program is also something, and the RMSTP. I mean, those are obviously at the other organization. I hope Brian doesn't get mad at me for mentioning them. But PALS and RMSTP are obviously places where younger trainees and faculty members can go to and look to for that type of leadership education and research experience. So the QI I think is really brand new. And so ACGME actually had a big QI workshop for different specialties. And Jim Sliwa, myself and Priya Matre participated in it. And it was led by Chris Garrison in Texas. And there was probably six or seven programs represented. And we talked about developing QI curriculums and the ACGME had different talks for us to kind of really help lead that. And some of the stuff that came out of that meeting I really think should probably go nationally because I think a lot of people are struggling with how to develop QI curriculums and how to do this. And especially if you have attendings who haven't been officially trained in how to do this, like that's a problem. It's hard to train the trainees when you don't have enough attendings to teach it. So I do think, I think there's a lot of opportunities to share knowledge here. So that's my long way of saying I agree. Yeah, I think- AAP MNR, sorry, AAP MNR also has a future leaders program. Oh yes, that's right. So- Yeah, I was just gonna say, I think that what you're doing is great. And just to finish up my point, I think the quality improvement work that you're doing, all of the work that the ACGME is now doing in terms of clear visits, when they're doing their clear visits and they're going to institutions and they're asking residents or faculty questions about their involvement in root cause analysis, for example, I'm sure that a lot of trainees outside of MNR don't have that experience of even knowing the language, right? So I think that what you're doing is really great work. And I just, if I could just push you to spread your work, I mean, that's probably the most important thing to do for PMNR. I think you've done great stuff and making sure you get the word out to other programs about what you're doing. So that they can replicate or do something similar at their programs, I think is really the best thing for this field. So thank you again for your hard work. So Monica, thank you again. I just want to tag along, David, in line of what you're saying. I agree, this is an amazing, amazing opportunity for a lot of our chairs and also residency and fellowship program directors to learn from. What I would like to open up to discussion is, Monica, you and Dr. Reitberg and Dr. Wang and Dr. Haas, you all are doing a great job. But I think what we need is a little bit more of the support by ABPMNR, for example. Every physician who needs to be recertified has to complete a QI project. So it's not only that ACGME is where we need to create programs or processes for our training programs to do QI training. It's as a physician, as a clinician, we need to have the skillset to do that, to be board certified and keep our certifications. With AAP, that's where all the residency program directors, fellowship program directors come together. That would be a wonderful platform. But what I'm trying to say is we need their buy-in. As stakeholders, they need to be supporting you. They need to be giving you the opportunity to present your work and be the mentors or the leaders in the field. And I really don't know how to make that happen. I'm just grateful that you're here, you accepted our invitation, but I don't even see a lot of our program directors joining us tonight. So that's my personal challenge. As the medical educator community chair, how do I get our program chairs, our residency program directors to be more involved in discussions, in creating opportunities for others to lead on all these tracks that you've created? Yeah. Anybody, any idea? It's an interesting point. Part of me wonders if, in terms of engaging other residency program directors, I think, again, it's hard for me to know, but I would assume one of the issues that might come up is that I am acutely aware that I have a lot of resources to draw from and we have a lot of people to help out because truthfully, if you are one program director doing this, you can't, it's impossible. And so I do know a lot of program directors across the country where they are an island unto themselves and they are holding everything together by themselves. And I will tell you, they're doing much harder work than I am because they're holding the entire program by themselves. And clearly I have a lot of support. So I wonder if that's a challenging piece of it because the thought of trying to add something else that to their workload, which is already fairly high, might seem a little bit daunting. So maybe that's a little bit of this. I will tell you though, I do think, I do think since we started our residency track system, med students ask about it a lot. Like I do think we get a lot of interest in that aspect. And so I do encourage a lot of programs to consider starting even just one, something that they already know they have resources in and they can tap various people to help out because I do think it will attract applicants to your program if you do that. It does actually also look like Dr. Barr on the line. Also, I mean, UPMC, it seems like they have all these tracks as well. They have a research QI med ed track. I'd love to hear your perspective, Dr. Barr, if you're able to come off mute to share a little bit about maybe what your experience at UPMC has been like launching these programs, these tracks as well. Sure. So the one that I launched was the med ed track. That's our latest track. And I actually talked to your Leslie before we set it up to get some ideas and we did it very different structure. So we took three residents and three fellows and it's a two year program. We meet for half a day a month of protected time. And then we're basing the track around different teaching experiences. So for example, the track residents had a chance to observe the medical students learning to do history and physicals on hospitalized patients. And then they had their teaching observed and then got feedback on it. And we're developing a lecture to give the med students and then we'll observe them doing that and see how that goes and small group teaching and things like that. So we made our program smaller so that we were able to do more intensive mentorship rather than have it open to all the residents and then a little bit longer track. And then for the administrative track that's been going on here for several years and they do a QI project. And I think they meet monthly in an after work time. And I think they work on several QI projects as a group and then they go through some leadership topics as well. And I think a lot of their leadership teaching is around different book clubs. So they cover different leadership texts or popular press on leadership and then they'll talk about the books as a group. And then the research track is very closely partnered with the RMSTP program through the AAP. And so everybody on the research track is in that program as well and then has research, local research mentorship. So, and I agree with similar experiences that you guys have had that their residents really liked the different tracks. I think it's a chance for them to subspecialize. And so I think they've been really well received. And we only let our, because each track is pretty intensive, the residents are only allowed to do one track. So I think that's the hardest thing for the residents. Almost everybody's in a tract but it's hard for them to choose which one. But that's actually a great example, Dr. Barr. Thanks for sharing that in that you talked to Dr. Ryberg but then you ended up looking at what you wanna do and how it best fit in your schedule and yours probably looks totally different from our, it sounds like your meta track is completely different from ours. And that's a wonderful thing. And I think it's great that, I think part of what we hope is that we spark ideas and that people look at what they have in their program and what's gonna work for them because it's hard to pick up. I mean, we're happy to hand over our curriculums to different people. And I know that we've talked about publishing our curriculums and getting the word out there that way. And that's totally fine. But in the end, it's to implement, you have to have kind of, it has to fit in the system that you already have. And I think that's always kind of the tricky piece for a lot of people. I think you're absolutely right. You have to sort of read the local context and what resources are available to you because you're right. It's absolutely impossible for one person to just invent a curriculum and teach it and mentor it. And I know one of my big drivers is, I really wanted people to have protected time during the day, like during the regular work day. That was a big driver for our structure because the research track participants had protected time during the work day. And I felt like it would just be like this two-class system, which the educators among us are very familiar with this feeling, right? That education is something you do in the evening or on the weekends as almost like a side hobby outside of your regular job. And I didn't wanna have that. I wanted it to be like, no, this is a valid, important work that can be done during work hours. So that was one of the big drivers for our structure. Well, that's great. That's great. And I'm glad that, and I actually, I just recently read Matt Sherrier's article. He actually published the research track at UPMC. He was our fellow here last year. That's right, yeah. When I was doing my lit search to kind of look at the data, I saw, oh, there's a research track from Matt Sherrier from UPMC. That's right, yeah. So there are things, there are curriculum published out there and certainly, and there's actually one, I didn't put this on here, but Wash U actually published their QI curriculum as well. It wasn't a track, but they published our QI curriculum for PM&R. So there are some published things out there. And again, we are all trying to look to publish what we're doing here as well, but we're also happy to talk to people who are interested and happy to, I think we'll keep on trying to present at various venues and keep on going along that way. But we are at the 7.30 hour. So thank you for the very rich discussion we had and thank you all for stopping in and listening to what we had to present. And so I appreciate all your time and your interest in this topic and hopefully we'll all see you in Baltimore soon. So, all right.

residency track systems

Shirley Ryan Ability Lab

research track

medical education track

leadership track

quality improvement track

faculty clinician scientists

emotional intelligence

transitions of care

PDSA cycle

root cause analysis

women in PM&R leadership workshop