All right. Welcome, everyone. Feel free to throw your cameras on if you want. We appreciate you all being here. My name is Buddy. I am with the wonderful FIT committee, as you see some of these other FIT members here. We appreciate you stopping by today. I'm going to get the screen rocking and rolling. Let's see. Oh, we've got fancy buttons here. You can share. Okay. All right, Christina, I'm already feeling this tech stuff. If you could help me out here. Oh, no, I will share for you. Perfect. Yeah, I can just see advanced sharing options. Thank you. You're welcome. All right. We'll get rocking and rolling. Welcome, everyone. Again, this is your Member May session. The theme of today is I just matched into PM&R. Great. Now what do I do? I can distinctly remember I matched. I'm with Michigan Medicine. I'm PGY2. I remember my wife and I driving up to Michigan after I matched. I went to Ohio University for med school, went to a real small hospital for my community stuff. It was super cool. I remember driving up to the hospital and seeing the big block M and everything and just going, wow. I felt like the guy that lied in his resume real quick. Then people were like, oh, you're a doctor now? I'm like, that's weird. It was all weird. But it's good weird. It's a good growth. Growth should be a little uncomfortable. Appropriately uncomfortable because without it, you can't stimulate growth. So welcome the goal for today. Can we go to the next slide, please? Thank you. It's going to be pretty straightforward. It's meant to be a shared discussion. This is your guys's time. I can sit and talk to drywall for hours as these people wonderfully know. But the real the big goal is to just kind of introduce ourselves. While we're doing that, we're going to throw in a little voting thing in the chat of some topics that we kind of had prefabricated to help stimulate some conversation. Top couple few we'll start talking about. About 30 minutes or so, and then we'll open it up to the floor. If we can switch to the next link, that'd be great. Thank you. And ultimately, this is meant to be experience for you. We want it to be awesome for everyone. We want people to feel comfortable asking whatever questions they have. There's nothing too dumb. Trust me, I asked a lot of questions I feel dumb about, but you're better off just being brave and asking it and getting it getting the question addressed now. So these are the fancy objectives that we kind of put together that we're hoping to go over. Flip to the next slide, please. Here's our fancy link. I was not going to show up in this chat, Christina. Okay, just share. Thank you. So that's in the chat. Go ahead, people and start clicking on that, or do the QR code. If you want. I'll give you all a second to do that. Then we'll hop over to the next slide and start introducing ourselves. All right, people want to give a thumbs up or do the little thumbs up thingy on the stuff. Just so I know people got the link. We can kind of will this will be running for a while while we talk. I just wanted to kind of get things going. Cool. All right, go ahead, Christine, we can pop to the next one. If people need the link, it's right there. Go ahead and just kind of keep clicking through here. So this is me. William neighbor is legally my name. My dad goes by Bill. My parents are creative and called me buddy instead. So they weren't creative in naming me. They were creative and come up with a nickname. So that's pretty cool. Tell people buddy the redhead from Michigan Med. As I said, I'm a PGY2 resident. So very much in the kind of wiseful stage because sophomore is wiseful of my learning. But it's pretty cool to be finally a PM and are some couple fun facts about me from Ohio. All my letter writers were from Ohio. I went to Michigan for residency. I really wanted to be here. So that was an interesting thing to tell them. My wife and I are high school sweethearts been together for 14 years. My dog is a minimum of nine breeds. So he's truly like we got he got brought up from Mexico is truly Mexican street dog. He's awesome. So. All right. Next one, please. Hannah. Hey, I am a third year in San Antonio. I knew I wanted to come to San Antonio for a variety of reasons, one of which was my husband was doing this long distance commuting when I was in medical school in Houston because he is a San Antonio firefighter. So not only was the program a good fit for me, but it was a great move for my family overall. I started residency with a one year old and then I had another baby in my second year. So I have two kiddos, an almost four year old and an almost two year old. And I have four dogs. I guess that's my fun fact. It's just like a busy house. And my other fun fact is I'm really good at the arcade claw machine game. You know, the one where you like play and get stuffed animals. That's that's my hidden talent. Happy to be here. Ricky's currently tied up with some work stuff. He'll be kind of hopping in and out of the chat whenever he is in here. I'll give him the opportunity to introduce himself. So, Eric, you're up. Hi, everyone. My name is Eric Bonoiva. I'm a PGY4. So gosh, I can't believe I'm almost done. You're like getting excited to start residency, hopefully. And I am excited to be finishing residency. You'll be here before you know it. I am at the Shirley Ryan Ability Lab, and I'm going into general physiology next year at a community hospital in Omaha, Nebraska, where I went to med school and I met my beautiful wife. So we're both excited to be returning back to the land of corn. My interesting facts, a lot of my family is from Alaska. So I spent my summers growing up in Alaska. So I love doing lots of outdoor stuff, especially deep sea fishing. Not so much like deadliest catch, but kind of. Other than that, I'm just happy to be here. I'm on the Practice and Advocacy Committee at the AAP, or AAP MNR, excuse me. And I love it. I love being a part of this organization, especially the FIT Council Board. If you are interested in getting involved, just going to put this in here. I know Alpha is on the line. Applications are going to be opening up at the end of this month, I believe. So look for more information about that if you want to get involved, especially as you kind of start getting into PMNR residency side of things. But I know you got to get through intern year first. So hopefully you can answer some questions about that tonight, too. Kamari, it's all yours. All righty. Hey, guys, I'm Kamari Coleman. You can call me K. Basically, I'm from Memphis, Tennessee. I'll jokingly say I'm making my way up and down various rivers. I did my undergrad down in Xavier, Mississippi, came up to Southern Illinois, and now I'm in Arkansas, Arkansas River. So that's that. Some fun facts about me. I recently got a smoker, so I throw something out there like on the grill smoking at least once a week. My new favorite right now is smoked shrimp. Perfect. You can put it in tacos. You can make a little chipotle bowls. Anyway, there's that. And then another fun fact is I buy various like flowers every week and do like arrangements. So it gives me something to keep my mind centered and focused. So, yeah, happy to be here. Awesome. Wonderful. Thank you, everyone, for being here again. Christine, can we flip to the next slide, please? So just general disclosures. We wish we had them. That'd be pretty cool for that important. You could hit the next button. And the reality is we're all broke because we went to med school and we're in a pile of debt because we went to med school. So what does that equal? We're all in this together. So that's that. One of these days I can hope to have a disclosure because that'd be pretty cool. It means I do the important stuff. So, yeah. Awesome. All right. Next slide. So here's the kind of discussion points. Christina, do we have like some general data or maybe we flip back the other one initially, see what the top votes are so far. So we have let me pull up on my side. Numbers one, two, and eight. A, B, and H. That'd be one, two, and then eight. So we'll start with those three. We'll go from there. So that'll be kind of the first next 30 minutes or so for everyone. We'll run that till 845, nine o'clock range, see how things are going. Who from the fit people want to kick off number one? I can start. So that's the piece of advice for as an intern, right? So just realize that you're kind of starting a little bit over again, I think, with training and it can feel overwhelming a lot. I felt like I was kind of starting to learn a lot of things right off the bat, like day one, because I graduated during COVID and my first night was actually in a COVID ICU. So it was pretty wild. Hopefully that won't be your experience. I don't think it should be. But one thing I learned very quickly was, especially in kind of the chaos of that particular circumstance, is that everybody will start looking to you as a doctor. As a medical student, you're kind of like, well, there's the resident, there's the intern, there's someone else that's going to answer the question. You're that person now. Family will look to you. Nurses will look to you. Other allied health professionals will look to you. So you kind of have to take that role on and you can do it. You just have to believe in yourself to do it. And one thing I learned quickly, especially in emergent situations, which obviously you'll see maybe in your intern year when you're in ICU rotations or even on the wards when you're on a rapid response or on a code or gosh, even in rehab, I'm a bit of a black cloud. I've actually had like five different codes during my time, two in like a 24-hour in-house shift. So that wasn't fun. But one thing I always tell myself is you can give yourself a minute or two, like not a minute, but just a second to take a deep breath and think about what's going on. And one great way to do that is to ask for vitals. That is always a correct answer, regardless of what's going on. Take a minute and people are like, okay, doc, what are we doing? Ask for a set of vitals. That'll give you some time to take account of the situation, maybe get some information from the nurse or from the chart, and then kind of go into what do we need to do now? What do we need to do in the next five minutes? What do we need to do down the line? So gives yourself a chance to kind of assess the situation, think about what you need to do next. And so you're not just standing there like, oh gosh, with a deer in the headlights look on your face. So that's a tip that some seniors gave me when I was becoming an intern. I definitely have used that in my practice since then and plan to afterwards. Excellent, excellent advice. Hannah, Kay, you want to either, what do you want to go next? Um, yeah, you know, I think one thing that really helped me out, especially on those times where you're like really tired, probably want to go home more than be at the hospital, is really just being grateful for being there and being like, okay, I'm taking care of people at the hospital, but I'm not in the hospital. And especially when you have different emotional situations, like people are upset, their family are upset, maybe something about the care is just having like a snag in it. Taking a step back and realizing these people are probably operating from a state of fear right now. Like, I don't know if you've ever had to like get surgery or anything or like literally put your life in another person's hands. So when you really step back and look at the situation and really practice gratitude for what you're learning and the fact that whatever the small percentage of people in the world are actually gaining these skills, it really helps you open up your mind to taking in the experience of being an intern. The first three months, definitely the hardest. You're definitely going to learn a lot about yourself, about your support system, about life in general. But I would just say enjoy the process, enjoy the ride. And then when you get to the end of it, it's like, wow, I did a lot of cool stuff this year. Like, med school me would never, you know, have been in this situation. So it's a fun ride and enjoy it. That's my best advice. Also, just absolute spot on advice. I think both of these give really good perspective on different intern years a lot. It can be very overwhelming and there's a lot of ways to break down the intense moments, but also like take that 10,000 foot view back. So that's awesome. Hannah, I get any wisdom from your end before I start rambling. Yeah, mine is to still take every rotation that you're on as a learning opportunity and like really value it. I just, in the last couple of weeks, I've crossed paths with an attending that I worked with during intern year on a rotation that I didn't think they would remember me at all. And they are, they not only remembered me, they recommended me for a position. And to me, it was one of those things like we have imposter syndrome so much, especially as an intern. But what you can do is show up every day, take care of your patients, do the best that you can do. Always try to learn. Even if you think you're only there for one month, you're never going to be on this service again. You might see those patients again. You might see those attendings, those residents again. The other thing is also to get to know all the residents that you're working with, because again, later you might be crossing paths with them where your upper level on internal medicine is now a cardiology fellow. And it's really helpful if you have a good relationship and you can just shoot them a text. It makes calling that consult a little less intimidating. So kind of like a practical component of intern year is to kind of foster all of those relationships, because I think they're going to be really important in the future. I think that's also just like such good sage advice there. You cannot, you'd never want to burn bridges. You never know who knows who, and you never know where these relationships are going to tie back. This medicine is a a small world in a lot of ways, and it seems like it's a big, big world, but you'd be amazed who knows who. So for me, I think the perspective advice is great. The take a step, deep breath is great. I think Hannah's stuff is absolutely fantastic. For me, I'm very like intrinsically like hard on myself, and I think a lot of us just inherently are. It's that's kind of what, one of the things that drives a lot of us to keep being successful and ultimately what God has done in medicine, and to give us the opportunity to have that internal drive to achieve these things. But give yourself the grace of being okay with not knowing things. I think it's more important in certain ways to not necessarily expect yourself to know things, but to know where the information is, and like start finding a couple of things that like, for me, off the date, it's just busy. It overwhelms my mind, but there's a lot of good information in there. Some people get really good at sifting through up to date and create little like tabs in their Google Chrome or something that like help them with their favorite things. DynaMed's a source that I was introduced to by a resident that my hospital had. This year where I'm doing my PM&R, we have DynaMed membership too. It's a little bit more of a SparkNotes thing. I find it really helpful. The other thing is like, know your support system early on. My first shift as an intern, I was on a one-to-one admit cross-cover shift on the floors, and the team had like an admission roll-in. The senior kind of helped me with the admission. Her pressures weren't so great. They're like, ICU was kind of not sick enough for the ICU, but it was like one of those like, eh, kind of cases. Five o'clock rolls around, the pager officially goes to me for 15 patients. I was like, oh no, 15 people are like I'm in charge of. 515 hits, and the patient's got pressures of like 70 over 40. So I'm like, water sounds like a good idea. So I started fluids, and I'm like, all I can remember was like, who's my singer? And I called her, and she was awesome. She kind of helped step in and walk me through stuff, and they were already trying midadrine, and she got her transferred to the ICU. And like, it worked out there, and then she coded and died, and that sucked. But like, the bottom line is like, I knew my support network, and like, be okay with using that, and don't expect yourself to try to like, know everything, and like, don't consider yourself a bother to your senior. Like, it's okay to ask people questions. It's okay to confide in people that like, I'm struggling with this, and give yourself the grace to like, learn. But as you go along the process, every month try to think like, how have I changed in this month? And you'd be amazed, especially that like, first three months that was kind of mentioned earlier, like, first three months of intern year, really, you just look back, you're like, wow. And if you break it into quarters, every quarter, I think I grew a ton. And then like, today, it's funny, it's the end of PGY2 year for me. It's actually the first time I have a senior all year, just the way our floors work. And it's kind of funny, because I started PGY2 year with no senior. I just had an attending here and there. And I look back, and I'm like, I remember being nervous that, in fact, I didn't have a senior. And now I'm like, I don't know what to do with this guy. I don't really need him. Like, it's great to have him there. But like, that moment of reflection was like, okay, like, I have developed, I have learned some things. But when you're in autopilot, you don't. So keep giving yourself the grace for that, too. That's my wisdom there. Anyone from the group of participants have any thoughts, concerns, things they want to bring up before we go to topic number two? Feel free to drop in the chat or just go ahead and ask. So, Christian, any other resources people really liked at POC? What do you mean by POC? Does anyone understand though that abbreviation is sorry, I might be naive, point of care. I'll let some other people jump. I like Dynamed. That's kind of my go-to. Depending on what it was, I used up-to-date quite a bit and then Ortho Bullets was helpful as well for some of the like Ortho MSK related stuff. Those are the main ones that come to mind. Yeah, I know M-Boss has something that they're trying to promote for like you can use on the floors in residency. I didn't use it. I personally use like up-to-date mostly. Lexicomp for meds has some nice stuff too. Like if you're writing up, if you have Epic, Lexicomp always pops up and there's a lot of good just like quick dosing and all that jazz and a little black box warning. It's nice. Just when you're not familiar with the med, type in the dose you think and then click the Lexicomp app. Yeah, I used the little orange book. I'm going to put it in the chat. It's like an internal medicine book. It fits in your pocket, gives you like, I can't actually put it in the chat. Oh, that's okay. It's an orange book. It's like pocket medicine, I think is what it's called. It gives you like general kind of values for different things, like for labs and stuff. And it gives you a general idea of how to work up like heart failure or somebody who's coming in with, you know, issues with diabetes, stuff like that. So if you're really nervous and you can't think about like what to do next, which over time you will, like as you're on the wards and you have the same patients coming in and out and in and out, you'll get into the habit, okay, what do we do if somebody comes out with, you know, COPD exacerbation or something like that? You'll get that down. But just when you're starting out, just to have something like in your pocket. I know a lot of people just can look up on their phone, these kinds of things. But if you want to have just like a book, the pocket medicine book is really helpful. Something I use late, I wish I use more is my local intubiogram. I was like, what is this thing? It is one of those like foreign concepts to me. I just kind of ignored as a med student because medicine was scary. But like I really thought the local intubiogram was really nice. And I use it a ton this year because Michigan Med's got its own weird stuff because it's just a big institution. So when I'm on call and I have someone I'm concerned for CAP, HAP, whatever, UTI, I look at that and I go off the intubiogram for my medications and dosing. And it saves you some pharmacy. Usually pharma or someone is messaging you saying, well, per our intubiogram. So for anything like antibiotics related, save it like on your personal computer. I have it in like a little Google Chrome folder. That way every computer I log into, I can like log into my Chrome and it's there. Have it on your phone, whatever is convenient for you. But that's a really nice little resource to have. And you said that other resource you use, buddy, was DynaMed. I think it's D-Y-N-A. Yeah. I'll put it in the chat. Sorry about that. It's DynaMed. Yeah. This one, not talked about a lot. I really enjoy it because it's more to the point. Up to date is really good for like really digging into things or like if I need to do hyponatremia workup that's really in the weeds, I'll go to that route. But if I just need to start something, like I had a patient who was a little hyponatremic that I wanted to start a workup for, I usually go DynaMed for initial stuff. And then if I need to go beyond first or second tier, that's why I switched up to date. Any other questions people want to drop in the chat or voice before we go to number two on the list? Cool. All right, who from FIT wants to kick off number two? Which number was that? If you could give yourself a piece of advice as an intern, what would it be? We kind of did, I guess we did blend one and two together, didn't we? That's fine. Talk about the challenge transitioning. Yeah, let's do it. I think the biggest challenge transitioning was financial for me. I'm a single person moving across two and a half states, so that was definitely a challenge. I didn't work after I finished my med school requirements because no, that was not how I was about to spend my 16 months off. So that was a challenge, but things that helped picking, I mean you guys are past that point, but picking a place where you can sustain yourself financially without having a partner. So like if you get one, you're still okay, that was good. And then just things like, hey, I want a new car, but do I need a new car? Kind of making decisions like that. And it was also helpful for me as I was moving to pick which things to spend money on. And one thing I spent money on was getting a moving company. That was super helpful for me and worth the investment. And then when I started intern year, something that was helpful for the transition was the, just like actually going grocery shopping as opposed to like door dash. And I just didn't like the meal kit boxes, but you can definitely get into a cycle where you're door dashing every day and you're like, oh wow, where'd my money go? The door dash. So those are just like some pieces of advice for the transition. But if you don't have a gym where you live, make sure you get a gym membership because you need that. So yeah. I would say in general, a challenge is that imposter syndrome. But honestly, for me, personally, for all of residency, the trickiest part has not been the medicine or the residency, which is going to be what it is, but it has truly been balancing family and figuring out how I can be present in both places and do a good job both at work and at home. And the first couple months of intern year, it was like a steep learning curve and trying to figure out how can I tend to my own wellness while also caring for others, and again, taking a step back and checking in with yourself and realizing what do you need in a moment. And guys, if you have sick days, use your sick days. If you need a sick day, use it. Even if you're not having a fever, if you're feeling like you just need a break for whatever reason, you have those sick days. So many people, you're so scared to spend your sick days, but they're just going to go away. So if you feel like you need the time, take the time. I think that was the hardest part. Yeah. Going off of that, I had an attending little tell me a story, it was the classic back in my day, and they went off about how they would round that this individual was so sick that they came in not having slept because they puked the whole night, had someone, one of their co-interns put an IV in him, run an IV, and then once the IV bowl is finished, then round it. And I was just like, cool. They get, Tana's point, like take sick days. I've had some days that she arrives at school. I just felt like crap. I was tired. I was exhausted. I had a lot of call that stacked up. My body was done and I took a sick day and like the ACG and me has like a 30 day of residency thing that I think applies to all interning or at least for PM&R does where you have X amount of days vacation, but if you can't, you got to keep it under 30 days miss. So do you get 10 sick days? So like mental health is also something you need to take care of and that is taking care of your health. If you take a mental health day, so be cognizant of it, but don't abuse it. Obviously too. There's a balance there. Let's see. The biggest challenge for me, I think also was balancing life and family. I don't have kids, but I was newly married, so I had trying to, and my wife and I had mentioned her high school sweetheart to me, that's like 13 years before we got married because we were high school sweethearts, college athletes. She got her PhD onto med school. So different schools for pretty much all of that. So it was a challenge, it was worth it, but we finally got married and then two weeks later we did our honeymoon. Two weeks later we graduated, two weeks later we moved, four weeks later we started my residency. So we kind of life moved forward and it was very important for me to like try to, when I get home because in med school I got in the cycle of coming home and just doing whatever I was focused on me, taking that mental step to like sit in the car, check out of work, try to check into my marriage a little bit better. And it's something I still have to continually do because medicine can mentally consume you. And off of that too, like try to, because you're the doctor, you're going to get even more emotionally invested in your patients. Try to find outlets, whether it's going to the gym or going outside for walks, whatever it is that like allows you to mentally disconnect because that will actually, in my opinion, allow you to better reconnect with your patients and be more present. So that make sure you're taking those things and kind of overcoming those challenges. I think there's kind of two challenges and everyone else has covered some great challenges. So not to add more challenges and obviously these don't apply for everybody. So pick and choose your challenges, I guess. I would say one of the biggest ones is realizing that your time is not always under your control. And that kind of goes along with saying with like some things are outside of your control, whether that's how well your patient does or how your day goes. Some of those things are not within your control. So maybe the best advice is to try to identify those things you can control and those things you can't. Sometimes you're going to have to be on a shift for 12 hours and you can't control that. Maybe you can try to switch off of that with one of your co-interns. So definitely make friends and be nice and play nice, especially as you go through residency because I feel like, you know, your co-residents will try to help you get to those things you need to get to, whether that's a family wedding or God forbid, a family funeral, like they will make sure you get there. But also recognize that you're getting paid a job. It's not like medical school where you can be like, okay, well, is there anything else you need me to help you with? And then take off like you're the one who needs to do all the work at the end of the day. Right. So just keep that in mind. It's tough to, I think, understand at first, but then as you get through residency, you start to realize, oh, yeah, it is a job, right? They are paying me to be here to take care of these patients. And hopefully you realize it's a real privilege to do what we do. But then once you graduate residency, and if you decide to do fellowship, you've got to delay it a little bit more. But once you become an attending, then you can finally dictate your hours, your schedule a little bit better. So if you're not used to delay gratification by now, I don't know what to tell you. But it'll happen someday that you'll be able to kind of control your schedule. So I think that's the biggest thing is, you know, medical school, they're like, you're on this rotation. But you can always say, oh, I gotta go to this lecture, I gotta go to this teaching or whatever, and, and leave. But as a resident, it's a lot tougher to get off time for certain things. Not saying it's impossible. I'm just saying it is tougher. And there's more responsibilities, right? If you're going to get off, you need to have somebody that's covering you. So I'd say that's probably one of the biggest challenges to as going into the intern year. And the other one is also, especially if you stay in an intern position where you're at, kind of also, and you have some medical students who are kind of below you that you've been friends with, like, you know, making sure that you're like, hey, I'm also the your intern now. So I have to kind of, I'm your friend, but I'm also kind of above you. So there's some interesting kind of interplay there, too. So it, there are challenges with everything. But I think the biggest thing is knowing that the challenges are can be temporary. And it gets better every year, it really does, I mean, not to kind of, I feel like that's such a cliched thing to say, oh, it just gets better, it gets better, it really does get better. Like, by the time you're ready to graduate residency and go into fellowship or attending hood, you'll have that control back, I can assure you. I think those are all just, again, just so many sage wisdom bombs being dropped left and right. It's incredible. I wish I had this session before I went into all this, I'm actually learning stuff right now, too. So thanks, guys. Starting off with that. Anyone have any questions? Again, feel free to speak up or drop your thoughts in the chat. If I could just say, add one other thing about my point about it being a job that cuts both ways. So with the job, you have lots of benefits. So please look into that. Whether that's during your intern year, during your residency, there can be lots of benefits for you health wise, and also for your family. So please start to kind of consider those things as well. 401k, things like that. Yeah, I was curious. Did everybody do the intern year? I've heard of a few programs now being offered that just let you jump right into PM&R. Thanks for that question. I did do an intern year, I did an advanced position. So I did my intern year one place, and then I went to my home institution and I advanced position my second year, I've been there the last three years. I think there are some programs that may be new programs that might be starting up and so looking for people to join, you know, throughout the three years of PM&R residency. So that's what it may appear to be. But I think technically, you need to have done an intern year in either medicine or surgery to matriculate into a PM&R residency, but I could be wrong, I welcome anybody to change that. Yeah. So if you're... Hi, everybody. My name is Alpha. I'm the AAPM&R fit council president. President too. It is categorical. So we do our intern year as part of our four year process at LSU. And there's other categorical programs out there. Their intern years look all different shapes and sizes. Some of them are more medicine heavy. Some of them are more outpatient heavy. Some have more elective time. So definitely something to be looking into if you're have different values or priorities, whether you want to go straight into your next residency as an intern, or if you potentially want to explore the advanced option with the intern year that's separate. Building off what Alpha said, yeah, there's the, you're going to hear phrases categorical and advanced. What that really means is like, for generality's sake, an intern is a first year resident, just from a vernacular standpoint. You have interns in surgery, you have interns in family medicine, you have interns in medicine. It's just your first year resident. The categorical and advanced is probably what you heard of, Nathan. Functionally, a categorical program is a program where all four years are affiliated with the same institution. And like, it's kind of in the same department. But as Alpha kind of got at, every program is different. My intern year was what's called a transition year. I had a little bit more electives than others, where I had about four or five months of elective time. Some intern years that are labeled transition or prelim, they'll have more or less elective time. Some of these categorical years also have more or less elective time. It's kind of a, for formality's sake, you have to do a first year of like, first year residency. Some people will fade a little bit into PM&R during that first year, but it's a four year process. Unless I'm unaware of a kind of a different ACGME standard, I'm pretty sure you have to figure, you have to complete some form of general first year before you start specializing into PM&R. All right, any more questions before we go to number eight. All right. Um, number eight is I'm thinking I want to do a fellowship. When do I need to start preparing my application. Again, um, I'll let her season best speak to that a little bit more because I'm the most junior one here and then we'll go from there. So I am not planning on doing a fellowship, but just a way to consider that is just always make sure that as you are going through your professional development you always update your CV or your resume. Even if you're not doing like a detailed description of everything if you could have like something to remind you so that when you do have the time to go back and make it detailed it's all updated and it's there. That'll be really helpful and that's a way of preparing and it also helps with that imposter syndrome because when you see everything in writing, it helps ground you and realize everything that you're doing and how awesome you really are. And then the other thing is is again like saying professional keeping all those relationships open the timeline for fellowship will vary depending on what fellowship you might be pursuing. So if you're thinking, like one of the pain programs, those you apply and interview during your PGI three year and sports medicine is also earlier versus the other ones are a little bit later so it just depends on what kind of fellowship you're thinking about doing. But beyond that I'm planning on staying general so I can't speak to anything specific. Eric, Kay, are you guys doing a fellowship? I'm not. You're general. That's right, you two are in general. Yeah, not doing a fellowship. All good. Yeah, no, I'm not sure about my fellowship. I started saying PEDS, but now I'm like, oh, I kind of like to see neuromuscular disorders past age 21. Either way it goes, I think that you're always preparing another application. So I think a way to approach this question is really deciding, I'm not going to say early, but deciding if you want to be in an academic route or not. Because that's a major deciding point for a lot of people, and that's going to drive some of your activities. If you're interested in more academic medicine, I'm interested in more academic medicine. Then you're looking for opportunities for research, you're looking for different ways to get involved with the department, and other things to build up that academic resume, versus if you're going into private or general or other things, you might more so focus on your niche. And that might not be translated into a research project. It might be a community engagement effort or something else. So really deciding how you want five years, 10 years from now to look is really going to guide your activities. And therefore, if you're doing it that way, then the fellowship application should write itself, if that makes sense. Yeah, that's great. That's great advice. I think one thing to figure out is, obviously, if you want to do a fellowship, then knowing sooner rather than later can be helpful. But that doesn't mean you can't apply later into your third year. I think somebody asked, what's the timeline? And I think Hannah said that eloquently, pain and sports medicine earlier. And some of them, like brain injury, spinal cord injury, are more towards the latter half of third year, and interviewing at the beginning of fourth year. So you can have time, maybe, if for whatever reason you decide pain, sports medicine isn't for you, or unfortunately you don't match. Those may have time enough to apply for the other fellowships. And just to clarify, most fellowships, except for PEDS, are one year. PEDS is the only one that I know is two years. So just to give you a time frame for when you're thinking about how long a fellowship is. Kind of building off of that, too, it's OK to not know. And it's OK to know. But if you do, like, I'm dead set on this, that's cool. But keep your eyes open. PM&R is such a cool field. Something that was very impactful for me, last year, I was lucky to be as an intern part of FIT. And I remember sitting there in the room, and they pulled up the slide. And it showed how many subspecialties there are in PM&R. And it blew my mind. I thought, like, OK, like you have sports pain slash spine. You have brain, PEDS, like cord. Like, that's kind of your general. And it's like 12 plus different subspecialties they actually identify as part of PM&R. Because really, anyone that has something that impacts your functionality and quality of life, we can impact. I actually have a co-resident right now who's matched into neurocritical care at University of Washington. And then last year, we also matched one in neurocritical care at Harvard. And they're both, they're actually the first two physiatrists to match the neurocrit. And our program, they came in, both of them were like, one's a PGY-4 now. One's a PGY-5 fellow at Harvard right now. They both were part of that COVID era. And like for them, they fell in love with critical care. But they wanted to stay true to who they were at PM&R and like talk to the department for it. And now they're both doing some really cool like RM, all the big research scholar things, funding them. And they're doing some really cool like early initiation of PM&R in these neurocrit patients. And it's awesome stuff. So don't underestimate what physiatry can impact. And it's OK to not know. And it's OK to keep your eyes open and be evolving. And I think Kay's advice too about like break your career into five years is a great point. Like if you kind of think of it like 20 years, 15, 10, and 5, like don't forget the NRO that you're kind of envisioning. But it's going to be an evolution. And what you say you're definitely doing versus not doing is going to change. If someone told me five years ago, I'd be wanting to do pain, I'd tell them like NFW. And now I literally am like both feet in with pain. I felt I did a PM&R pain rotation as a med student. And I was like, I don't want to be known as a pain doc. I'm not writing opioids for everyone. And then I fell in love with using a physiatrist. And he used his pain fellowship as an extension of his physiatry and offered these people some really dynamic, like he'd be literally doing procedures while he's telling his patients like this is to help get you through therapy and like re-educating them on their therapy while he's still doing an epidural. I was like, this is so cool. And like that, I just like fell in love with like that dynamic way he could treat people. So yeah, keep your eyes open. I'm glad I did. It helped me kind of like start my path, my direction. And then if you want to go one route, you don't match, that's okay. It doesn't mean you can't reapply. And honestly, if you graduate and you work a couple years and you want to go back into fellowship, that's fine too. So it's your career. If you worked really hard to get here, might as well do something that makes you happy. And buddy, you made a good point that there's a lot of different fellowships out there and not just the typical ones we think of with PM&R. Like I knew some people who went into an informatics fellowship at UW. And then I've had some friends go into palliative medicine, which has a lot of overlap with PM&R as well too. You know, the sky's the limit for a lot of these different fellowships when it comes to your interest in them. So don't feel like you're limited by the typical PM&R fellowships. And I mean, I'm a little biased, but if you don't decide to do a fellowship, it's okay too. There's plenty of need for physiatrists in general out there, and I will assure you because of ACGME guidelines, whatever program you go to has to teach you the same things as every other program. So you should feel confident and competent once you graduate to do whatever type of care within physiatry, maybe not epidurals. I won't be doing those, but other things that a general physiatrist should be able to do, everybody should be able to do. So spinal cord injury, brain injury, stroke, amputees, those classic Medicare diagnoses that are admitted to inpatient rehabilitation facilities. They're kind of quickly going off that too. I think Eric brought up a really good point. Like, if you go in a general, it's so cool what you can do with general PM&R. I actually know, and like the market you go to that Kay brought into, like, do you want to go to academia? Dare your own community. Like, if there's a huge need, and this is the thing that's really something that's not emphasized a ton. If you can get, if someone can say, like, you're okay and they credential you to do it at a hospital or take care of a patient, like, as long as it's under your license scope, like, that's fine. Now, don't abuse that. Make sure what you should be, stay in your lane what you should be appropriately doing. But like, I know of a resident from a different program and she signed a, she's from rural Indiana, signed a contract. She did a ton of spine pain time as a resident. And they were really looking for a provider and they hired her on as like a generalist that has some foundational floor time. And then, let's see, what was the other one I was going to bring? I brought up the neurocritical care one. And it's just, keep your eyes open. Being a journalist is totally fine. You could always evolve your career. So, yeah. Any other pieces of advice from the group or questions people might have building off this? Oh, we got a question in the chat. Thank you. What opportunities are there to be involved in fit as an intern. You could always apply. I did. I didn't think I get in. I got a spot in fit so that was super cool. Let's see other things that you can do within, not just fit, but I think, different societies so if you have Kobe if you have interest in sports pain pediatrics neuromuscular medicine start looking into these societies, there's always like almost some sort of resident community and that was the advice I was given as a, as a fourth year. Oh, fit ambassadors, alpha. Yes. You're when you're in PM and are you become a fit ambassador, you're basically the a team and our rep for your within your institution, you kind of work in the scheme of things you have like the fit board council, that's us. And then you have the fit ambassadors that's like the next thing in the pyramid and they're kind of like our reps for each residency program in the country. And then below that if you're a PM and our resident, you're going to fit council so welcome. You kind of made the team, that's pretty cool. Thank you, Christina for putting that in the chat so that's just a great opportunity to get directly involved in the PM and are but not as involved as obviously we are with our respective roles, but also like I said look at the other societies that are there as a recipient society of resident section community a PM has one. Pretty much, I think as you, if you're interested in it, they're love to have a resident involved and if there isn't something just almost all these societies have like a contact us how can you get involved thing and say hey, I'm a doctor, I'm employable human being. I'd love to, I'm interested in what you guys do. Can I do something that'd be pretty cool through society you seem cool. We'd love to have a volunteer that's very educated. So, as long as you're a nice person educated I think it's a reasonable thing. And then Christina also dropped in the chat to, if you're part of a handful of programs that aren't represented right now the ambassadors, you can quickly become an ambassador, so that's pretty cool. And that looks cool on a CV, and it gets you really involved in a PM and are so an a PM and are also has a lot of sub committees and stuff too and then there's the special interest group so if you're like really into. I mean there's, there's a billion of them I when I first registered a PM and are just click a whole bunch of buttons and now every night I get like a giant email thing for that account. Like, it's your, I don't know like there's cool ones like there's like people are interested in, like pediatric this and the other adaptive sports, different minorities in medicine like it's just like find your people, and like get involved with your people and like if that's your vibe like that's great. So yeah, membership committee committee communities right there. Christina is just dropping dimes left and right she's just shooting threes and drain them I love this Christina great background, chipping in with this. Yeah, I mean there's within a PM there's a lot of stuff there's other societies there's a lot of stuff. If you want to be involved, do it. It's pretty fun. And I think one of the great pieces of advice I got was the things that you do outside of your residency and your career, or within it should fulfill you and fill you up. If you're doing a lot of things that drain you got to balance that with things that fill you up and like for me, leadership and volunteering kind of fills me up and gets me excited and working with people that are junior in the career meeting med students pre med is something that gets me excited and keeps me refreshed so find that thing that keeps that spark going, because there's going to be days where you're just like the lights are dim, and it's emotionally challenging day and you're questioning why you've made this life decision, and then you do stuff like this for me, and it brings it all back together as the why behind it in a lot of ways. That's that anyone else have anything to add. Awesome. Alright, we have a few minutes left. I think we go to like 915 930. We have other questions that we already have up one through 12 here. If you want us to address another question, feel free to write that number in the chat, we'll start talking about that. Or if you have any specific questions that are on the mind that you really want us to address, feel free to drop in the chat we'll give you guys a couple minutes as things pop up we'll just start answering. The old step three, another test. Good one, Riley. I talk a lot. I'll let someone else go first. Have you ever heard, was it two months for step one, two weeks for step two, and two pencils for step three? I don't know if that is, maybe that's an older thing. I heard it's two days, two pencils even. Two pencils is what I heard last, but it's all on the computer, so that doesn't really make a lot of sense. So I took step three March of my intern year, and something to consider is that is like a two-day test. So that can be kind of tricky to swing taking that time or getting that time to take it. I actually can't remember if my program gave it to me or if I had to take it on vacation. So kind of look and figure that out. Hopefully they give you it off and it's not during a vacation, like they'll put you on elective or something during that time. I think I went back to the OLU world and got the question bank from that. I can't honestly say I did all the questions because it's like probably 2000 questions, but I maybe did like a couple dozen questions a night, maybe two or three weeks leading up to it. And one thing I really did was look at how to do the cases because there's kind of a section, I think it's on the second day, that's a little different than the first two tests where it's not just like multiple choice, but it's like you gotta like type things in and like type in a differential and stuff like that. I don't think you guys had to take step two CS, right? So it's kind of a little bit more similar to that. So it's something to think about how do you take that test? And that's kind of part of studying for the test is like practicing how to do that second day part. And I think there's some free resources on probably the USMLE website that kind of show you how to go through some of those cases just so you know, like what does this button do or how do I advance to the next part of the case? So you're not like freaked out not only about all the anxiety of taking this huge test, but also like you can do the questions and just have to focus on actually remembering and understanding and applying the knowledge that you have. So that's kind of how I studied. Honestly, I remember studying for step one, step two, putting in a lot of hours. You just can't do that as an intern. You're just so burnt sometimes by the end of the day, just depending on the day can be tough and long. And so just give yourself grace and know that those eight hour days of studying are well behind you and just know have the confidence that you have enough information to pass. And honestly, P equals MD at that point, just get the pass and move on after step three into the PM&R future. Beautifully said. The only thing I would add is just know yourself. If you know that it takes you a long time to get through questions, maybe you want to start doing 10 questions a day, like for six months or something sustainable. I know some people like who knocked out the entire URL question bank in like three weeks before and took the test. For me personally, that's too much pressure. I'm not doing 80 URL questions a day. The time is behind me in life. So really just know yourself and like honestly reflect on what worked well for you for the first two times that you took step. And if something was bad, don't do that. The other thing that's helpful is I'm not saying you have to like Anki for hours a day, but if you know, hey, I learned farm when I do my Anki, take 10 minutes a day and do Anki. Don't be like, oh my God, I didn't get through 600 views, but just get in the point of like actively adult learning. And that's something that's gonna help you throughout residency. Like that's not just a step three thing. That's all. No, I totally agree with both of them. The best piece of advice I was given, stick to what worked for you the most because that's the only thing you have time for. Don't try to be doing all these different things. I'm an Anki guy. I liked Uworld. I'm a DO. I did Uworld and I'd always do a few from the DO bank and specific things to osteopathy but I learned better from Uworld. I found a small Anki deck and it was super helpful. And I just kind of did a couple of cards a day. If I had a break in between rounds or something like that, or I was waiting for something with the patient, I'd just sit in front of the room and bang out my cards on my phone. As it got closer, I made a schedule to make a pass through Uworld. And then I did some cases and there's like a DO case bank. I can't remember the name of it, but there's a website that has like the DO and MD cases that's not Uworld. And I did a handful of those two days before the test just to get an idea of them. I did my test in like, I think late winter, early spring after I had a few months of floors under my belt too. I think that helped with the cases and kind of thinking through things too. Cause it just like familiarizes yourself with the patient and how those things are presented. So yeah. I know we have a few minutes left. So I want to make sure we get to some of these awesome questions here. Nathan, you had a question about doing sports medicine. I'll just go ahead and hop on and answer this one because I have a friend who does sports and he has a very dynamic practice. Ultimately what you do in medicine is based off of fellowship, get you in a direction, but you can also do additional credentialing through different companies, through additional CME training, GME, whatever it is, like to add things to your tool belt because for you like procedures, so tenonomy, so these ultrasound guided procedures that help clean up tendons, for instance, there are plenty of people that never learned this in fellowship. And then these procedures came out, someone had to learn how to do them. So it's more about like with sports specifically, if you do a procedure heavy fellowship, a lot of them are the PM&R based one cause it's non-surgical sports. You have family, you have PM&R. The ones that are PM&R based had to be more procedural. They'll have some foundational fluoroscopic procedures. So more of your lumbar SI joint stuff. They'll have a lot of them have orthobiologics, your PRP in there, and they'll have a lot of ultrasound guided procedures. One of them being tenonomy is kind of like a global thing, but ultimately like there are pain docs that do ultrasound stuff. There are generalists that do ultrasound stuff. There are generalists to do fluoro. So I know a doc who did a sports spine combo, non-ACGME thing. She can do stimulators. She can do tenonomy, she can do it all. So it's kind of on you to kind of develop your career and evolve it. And even if you graduate and don't do a fellowship, you can still keep doing these things as long as you keep your training and get credentialed and do the right stuff to kind of add into your practice. So that's that. Hopefully answers your question. If not, feel free to add more to the chat. Samantha, did you review any material or any prep before starting in July? I haven't had a rotation over a month. That's amazing. I didn't see him after February of my fourth year of med school and I was really happy I did that. So, but I feel like I'm getting dumber by the minute. No, your brain's recovering from the abuse it took in med school. That's my opinion. I'll let the other people jump into that. Yeah, I would have just reviewed my itinerary for my European vacation if COVID hadn't happened. That's all I have to say about that. But I wouldn't sweat it too much. You'll learn a lot as you go through. And like Kay said, like a lot of it is just learning how to access information and put in orders and sign notes and all that stuff. Everything else will come with time. Give yourself some grace. Kay, you had some great advice here too. You want to kind of speak to that a little bit more? Yeah, honestly, I think part of it, we talked about the learning curve. It's really, sounds silly. Knowing where you're going, knowing how much time it takes you to get there. What if traffic is unexpected? How early do you need to leave the house? Like, do you need one cup of coffee or two? Like these are all the things that you're gonna learn as you progress. And I think once you start getting down your routine, the job part gets easier. So I wouldn't worry about reviewing. I would just say what I did do before I started residency, I went to the hospital very like incognito. I just walked around, just like I made myself get lost so I could find out where I was going. And that was really helpful. And I was just there for like 30 minutes. And it was like top tier for me in terms of actually knowing where to navigate because my internal GPS is not the best. So, you know, going back to knowing yourself, know your specific challenges and then create a plan to not have it be a challenge for you. So, yeah. I watched all the Marvel movies in order. I just want to throw that out there. That's a great, if you're looking for something to fill your time, watching them in the proper order is supposed to be wise. If you don't know about that, Google it. It's pretty amazing. So yeah, it's a great way to fill time. You get sucked in three movies later, your day's over with anyway. So, and then you don't feel bad about yourself because you did something productive, which is working on a task. So highly recommend those things. Should we be the good physiatrist and recommend that you at least do that while on the treadmill or on the elliptical or doing something, some exercise? Yeah, you have to do it while exercising or you're not a physiatrist. Although I was at some point talked about exercise, just want to throw it out there. Like that's the most physiatry thing. So welcome to the team. Buddy, there's a question for you in the chat. Awesome, thank you so much for the DO stuff. So yeah, Nathan, do I use OMM in my practice? Actually, yes. Do I plan to long-term? Sure, it just depends on the setting. Like I think the physical therapy, so osteopathy and those that are allopathy here, I'm sorry for my tangent here. Osteopathy has really cool roots and our roots kind of like that foundation from AT still, if you don't know about him, Google about him. Cool dude. He made birds fly that were crippled. I don't know, he was like a miracle worker. But this guy did some cool stuff and was an MD that started osteopathy. And I think it's really useful for me as a physiatrist because I use so much biomechanical kinase type stuff that we learned from osteopathy in my just analyzing a patient. So like organically, and I even do stuff like, I had ankle pain in the VA and I did some muscle energy on this patient's ankle because I thought that the interior talus and it actually improved, which was my physical exam. And then I had some patient teaching on how to do it like with their family member. So they can kind of help with their ankle pain. Some of my exam stuff like fibular head motions and stuff I use all the time. And then I teach my patients that has brought my patient education. Do I plan on booking patients specifically for OMM? I think physical therapy and some, depending on the chiropractor, I think chiropractor is fantastic, but I think HVLA or our big adjustment stuff is only a piece to the osteopathy. Those that utilize some of these hands-on modalities are fantastic and it's a great use of their time. And they kind of, they do it day in and day out. So I would rather let them do something I'm very knowledgeable and I could do, but this is their bread and butter and then allow me to kind of utilize my knowledge in other ways too, because they might not be able to do stimulators or epidurals and those kinds of things that I might be able to do. So if it blends great in my practice, fantastic. Again, I use it for my physical exam skills stuff. And I also utilize it for just basic patient education for some of the safer stuff they can do at home. Eric, you would be amazed how many times I put the stethoscope on the wrong way for a while. I hear you. That's actually good advice. Or I don't hear you, rather. Exactly. Remember where the little dots should be lined up and stuff. If you listen to more than, you know, two different or three different, four different lung posts, you're doing a lot better than any surgeon I know. Looks good from door, limbs present or limbs not present, depending if they removed them. Yeah. Or you do the single spot of auscultation, which is like right in the middle of the chest, and you get the heart, lungs, and abdomen all in one. Well, epigastric starts. It all counts. Sometimes they don't even have, you know, the stethoscope in their ears when they do that, too. That's always fun to watch. But that's why you're in physiatry, right? Yeah. Don't be afraid to utilize some of your patients as, like, options for physiatry. Meaning, like, if you're on a service that's general floors, but you have a stroke coming in, can I take this patient? And then, like, be aware of, like, other things that I got out of my intern year since I'm on this tangent. I had a buddy tell me this. He's like, know that you're going to be, as when you go into your PGY-2, you're doing a lot of floors, like most programs. You need to have some foundational medicine, meaning UTIs, insulin management, basic opioid stuff, pneumonia. Like, just, like, recognize what your scope is and what you should be getting out of your intern year. Don't be afraid to bring in a specialist when it is appropriate to. Like, don't be the person that tries to work up this 13th-tier hyponatremia unless you really love it and you're confident in it. I'm not. I'll do some urine and blood stuff. I'll see what cooks up. I'll go down my ladder. If it doesn't go bing-bing right away, I consult medicine. If I have 12-plus patients on my list right now as a PGY-2, and four of them need their insulin adjusted, it's going to take more than 10 minutes for each one, I'm going to consult medicine about the complex ones. Like, it's important to kind of just kind of be aware and think about, too, like, I have a heart failure patient. I'm on heart failure floors. I'm going to admit a patient with heart failure when I'm at PGY-2. They might feel more stable then. What do I need to be aware of? What do I need to, like, ask? Like, should they still be on aspirin after this stroke? How long are they going to be on aspirin after this stuff? Like, when you're doing those admissions from the other services to IPR as a two, you got to, that's what you take. It's like those, you kind of take those key protocol questions so you know, because your job is this person who had this big functional decline to get them home, and that means you have to tie up a lot of conversations. So, it's important to take some of your foundation intern year stuff that you know, and then make sure the meds are continued and keep an idea of who needs to be seeing them after they're done with the hospital. All right, any last minute questions? Cool. All right. Would like a plug for Monday's session on leadership? Oh, yes. Go to it. All right, buddy. Um, so sorry, I actually have my camera on my other TV. So that's why I keep looking up. Um, next Monday, May 20th at 715 central time, the FIT Council will have another session about leadership titled how we got here where we're going. A lot of folks had asked about fellowship and preparation. So there's gonna be folks that are already mashing the fellowship completing fellowship planning to do fellowship talking about the things they did as medical students, as residents within AAP Menar and outside of AAP Menar that helped them prepare for their future pathways. So for those of y'all looking further downfield, be a great opportunity to get some ideas on what to do over the next few years as your residents, for anybody that has any further medical school left ahead of them as medical students to prepare for success. Thanks. No problem. Do it. I'll for you're gonna be running this thing. Yeah, um, I apologize in advance, but uh, hope y'all can make it. Alpha is been a wonderful part of our team. And I think there's gonna be a lot of good knowledge bombs there. So if you just listen to the background, you're gonna get some stuff out of it. On that note, we are three minutes out for my clock. That's my email. If any of you on here have questions, feel free to email me. I'm happy to help. We can go from there. I would like to say thank you to my fellow fit board members for just some awesome advice and feedback, discussions, thoughts. Thank you everyone also for taking the time to be here. It's and we've got some more emails in the chat if you have specific questions for them. Thank you for the time for being here. I know this is all everyone's volunteering their time and hopefully everyone got out of it. I know I did. So I appreciate you all. And have a wonderful evening. Can we I want to thank buddy for leading us in this. And of course, I want to thank the magician behind it all behind. Yeah, she's so subtle. Lovely a PM and our staff member. Thank you so much, Christina. Thank you so much. Yes. Best and great. Thank you. Everyone have a good night. And welcome. Oh, PM and R. That's the dog. It's nine different breeds. Just so everyone knows. Plus nine plus breeds. All right. Have a wonderful night, everyone. Everyone

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