So, again, I just wanted to make sure that everybody who's on, everybody has gotten the Google poll for the virtual fellowship fair, so our trainee leaders from the pediatric group are coordinating that, and they'll be running it. So, please do respond to them with your available dates or preferred dates. I guess they've sent us the available dates, but your preferred dates to make sure that we all participate. When was that poll sent out? I don't remember. Did it come today? I don't know. I think it was last week. It's not a poll, actually, Josh. It's a note from Dinesh saying that these are the three days that this will happen, and one is a date for potential fellows to talk to current or finishing fellows, and the other two dates are the speed dating, get your information about the programs. So, it's not an option to say when you're available, really. I got the impression that we were supposed to go to both of them, because we might not have the same group of attendees at both, but can somebody tell me if it's supposed to be the other way, that we only show up for one? So, there was a link to a Google form where you could mark your availability. Did you not have that link? Well, the Google form doesn't have, actually, option to sign up for. There is no question about availability. There is no even indication of the time for the presentation. One of those days is totally fall on our children's graduation, so we won't be able to attend. So, I'm not sure how we respond to that either. I actually wasn't even able to log into the form. I just sent him an email saying when I could go. Yeah. So, I can reach out to Dinesh again. I had sent him the link to this, but hadn't heard back from him whether he was going to be able to attend or not. So, I'll ask him to maybe send something out that's more clearly a poll. Yeah, and honestly, that link, for example, I was not able even to open. Mira, our APD, was able to open because you have to either sign in or sign in the account or something. It's a little bit cumbersome to me, so if they can make it a little bit clear and easy, so you click on the link and you have all the information, that would be great. Yeah, I can ask him to send it out as a doodle poll or a survey monkey instead, so we can make sure everybody has access to send them what he needs. That's not a problem. So, about the only other thing I had on my agenda was to talk about recruitment and interviewing. So, Dave, you would correct me if I'm wrong, but I think AA, what is it, the Pediatric Program Directors Group, yeah, they've put out another statement saying that virtual-only interviewing is preferred, and as has pretty much every other group that I've read a statement from, and the Physical Medicine Program Directors are planning for virtual-only interviews again as well. I think the whole world has switched to virtual-only interviews. Yeah, and I think, you know, I think for me, the biggest argument is the equity argument that, you know, for those trainees with lesser resources, that it really keeps them on an even field with everybody else when it comes to not having travel funds. So, I would like to issue the same statement that we've issued in the past. Yeah, I think, Jason, I think optional follow-ups per institutional policies. I think that's what we've said in the past. Everybody is here in agreement? Hopefully, I just want to hear if there's any dissent or other thoughts. Yes, yes, yes. Yes, yes, yes. So, I think the other thing that I would like to talk about is the workforce issues and the exploratory stuff that the ADPM&R is doing. So, Dave, I think I'm scheduled for a meeting. Maybe that's actually on the 29th. Might be that it's actually on the 29th that I'm supposed to meet. That meeting's on the 29th, I think. Because both of those things kind of came to me at the same time. So, it might be that I just flip-flopped one for the other. So, anyway, I don't know if anybody else has been asked to participate. But if you are asked to participate, I would urge you to ask to participate to your full abilities and provide your insights. Because I think the insights from this group is really important in terms of moving forward. As I've said in this group before, I think all options have to be on the table. And we need to talk to them. We need to talk about them all. And I'm pretty sure there is not one right answer. So, Dave, I don't know if you have, from the board perspective, any other updates that you can share. Yeah, I think it's helpful to give some insight about what we've been working on. So, right now, on the board, we have four pediatric rehab medicine physicians, which I think is pretty unique over the years. So, Sue Apcon, myself, Kevin Murphy, and Sherry Driscoll are sitting on the board. And we have just raised the issue, I think, that as a group we've talked about for many years, which is we are not seeing a growth in the number of residents from PM&R who are choosing to pursue pediatric rehab medicine fellowships. And if you look at the trends, you know, especially over the last three years, it's gone down to where we have 12 or 13 persons going into fellowship, which isn't necessarily a problem. But I think when we think about the bigger issue is how do we serve the public and how do we serve children with disabilities, you know, 10, 15, 20 years down the road, it's concerning to think that we're not having a growth or an increased number of people choosing to pursue certification in pediatric rehab medicine. And so, there is an initiative through the American Board of Medical Specialties called the Quality Agenda, where they ask the board to work collaboratively with member organizations. So, in our situation, it's the American Academy of Physical Medicine Rehab and also the Association of Academic Physiatrists to problem solve an issue that impacts the care of patients and issues related to certification and, you know, optimizing the care of patients within your field. And we decided that pediatric rehab medicine would be a good area in which the board could pursue an initiative in terms of quality agenda where we use the collective minds of individuals from the board, individuals from the academy, and individuals from the association to really dissect this issue. As you said, Carl, there have been lots of ideas thrown out over the years and I'll throw out a number of those that have been proposed. So, one is the duration of the fellowship being two years versus one year and perhaps being the only PM&R fellowship that is currently two years, perhaps that's something that dissuades residents and PM&R from pursuing pediatric rehab medicine. There's the opportunity of thinking about perhaps creating a fellowship for or creating a track within the fellowship, let's say, for individuals other than PM&R trained individuals to do pediatric rehab medicine and specifically the pediatric trained individuals if there was a large number or a number of those who wanted to pursue this field. I'm just throwing out ideas. I'm not sharing that we're going one way or the other. And part of that decision is going to be a board decision about which way to pursue down the road. But over the last six months, we have had the opportunity to work and have really good discussion with a lot of different focus groups on this topic. So, those focus groups have included some fellowship directors and combined program directors of PEDS rehab programs. It's involved specialty representatives from pediatrics, so different fellowships within pediatrics like rheumatology and developmental and behavioral pediatrics, sports medicine. We've engaged some leaders and some organizations that PM&R deals closely with in terms of PEDS rehab medicine. So, we have had a representation from the AACPDM. We've had a representation from the American Academy of Pediatrics Child with Special Needs curriculum who have met with us to talk about these issues. Not sure if any of you are aware about, and I'm happy to share this link with you because I think it's really important for us as a PEDS rehab group to be aware of, but the National Academy of Science and Engineering and Medicine, the NASM, had a group this time last year that really worked hard to develop a consensus report or paper about pediatric-based fellowships. So, not pediatric rehab medicine, but our American Board of Pediatrics Fellowships. And the concerns that they have in all of their specialties about the decrease in interest and in recruitment within all of their fields and potential options to think about ways in which that can be curbed. So, similarly, they have a lot of the same issues in terms of salary, eventual salary of pediatric practitioners, but they also have the downside of having a three-year fellowship, the majority of them, instead of a shorter-duration fellowship and a very significant research component to their fellowship, especially for those who are not pursuing a career in fellowship training or in research down the road. We talked with some of the pioneers of creating the Pediatric Rehab Fellowship to begin with as well. So, Peggy Turk came and spoke with us, as well as some of the other creators of the fellowship, to talk a little bit about the decisions at that time in terms of limiting the fellowship to PM&R residents, only the duration of fellowship. There was a lot of discussion about the creation of the fellowship as is being two years, with the emphasis to make one year being mostly research and then one year being primarily clinical and how that has not evolved to create the researchers. And as I think everybody who's on this call knows, nobody does a fellowship because of the program requirements the way they are and which they are as a one-year clinical, one-year research. And having had a fellowship for almost 15 years now or over 15 years now, we've never had a fellowship that was half and half research and clinical. I think there's been a lot of discussion about the duration of the fellowship being two years and whether that two years is necessary. And some of the discussion points have been, you know, back in the day, you know, in my year of training or around my year of training, we had six months in a combined residency of pediatric rehab training. And, you know, we're requiring two years right now. I did bring up the point, and hopefully I wasn't wrong in this, that I think this group as a whole probably has differing thoughts about that. I think that there are, for those of us who have trained a lot of people over the years, I think that there's a handful of people who you think definitely need the two years experience because they didn't have much pediatric rehab during their residency and or their skill level isn't where you think independent practice at the end of one year is where it needs to be to practice safe, cohesive, diligent medicine for pediatric rehab patients. There's a significant number of people who feel that there's a large number of residents who choose not to pursue fellowship training in pediatric rehab because it's two years in duration. I don't know that we have data behind that, but that's come up as a topic for discussion as well. There's also been some discussion about, a little bit of discussion anyways, about pediatric trained physicians going into the PM&R fellowship and developing a curriculum. And I know Jason and a group has been working really cohesively and diligently about thinking about through that process about how you might develop a curriculum for those individuals. But there's a fair number of people who say, that's great, but really to be a peds rehab medicine practitioner, you really need to be certified by PM&R by taking your part one and your part two certification exams and have those skills of practicing. Don't get me started on part two, Dave. Yeah, well, I, so I'm unbiased in this, I'm trying to be unbiased in this situation. I'm just sharing with you, you know, that there are some, I think, heavy opinions on both sides of the fence and in terms of the pediatric residents who go in. And I think when we look at the issues that pediatrics is having in terms of recruiting pediatricians to feel the pediatrics to begin with, but even into subspecialty pediatrics, you know, would that lend itself to an increased number of people, a significant number of increased people who choose pediatric rehab medicine as a career goal from pediatrics. Those of us who have combined residents, I think one of the graphs that I'm happy to show you guys is the number of applicants that are out there annually for combined residents. So if you look at NRMP data, there are about 40 applicants who submit an application annually for a combined residency training program. Now, not all of those 40 applicants are destined to become pediatric rehab medicine physicians, right? I mean, some of those are people who are applying to everything they can apply to, you know, to see where they might get a position from a residency standpoint. But I'll share with you that number has, the number of really qualified individuals who are applying to combined programs has grown substantially over the years. Every year we interview, and we're a little bit restricted on a number of people we can interview with both sides of the street. But at our program, we will offer anywhere between 10 or 15 residency interview slots a year, but that's still cutting out, you know, five, maybe more than five applicants who you just don't have a slot to interview for. Those are people who have identified pediatric rehab medicine during medical school as an interest that they have, but they may not fit the mold or they may not have, they may not interview, who knows why, but they don't match into currently one of the four spots. I was going to say, David, it's a supply side, right? There are more applicants, more qualified applicants than the current number of combined. Oh, right. So currently, that's where I was just going. We have three or four spots. Sally's going to have a few slots that are available next year. And I've heard of a few other programs that are thinking about it. Sally has been really, really the only successful people over the last 10 years to develop a combined program from the ground up that hasn't existed for 20 years, which congratulations and thank you, Sally, for doing that hard work. But the challenge is that's still just going to be six-ish slots that are available for 15 people who have identified pediatric rehab medicine as an interest during medical school or before medical school. So 10 or more people won't match into a combined program that interviewed for a combined program who may choose PM&R. And this past year, the large majority of those who didn't match into combined program matched into PM&R and might still pursue pediatric rehab medicine down the road. But in the past, it was split where people chose pediatrics and some chose PM&R. And those people who choose pediatrics only have the option of doing an entire residency in PM&R and finding a residency that will take a second residency and the funding issues associated with that. And that will give them six months of pediatric rehab medicine as part of that three-year process, which is challenging. So a lot of- As I, with our experience at Ohio State, that number this year of people who were completing a pediatric residency, seeking a PM&R, there was one. Yeah. Well, the other challenge to that, Carl, is that not many residency programs have the funding capability to take a resident as a second resident who've already done one residency because they're not gonna get funding, governmental funding for a second residency for a resident who's done a previous residency. So it's challenging. I know Seattle has done it and Colorado has done it. I don't know a lot of other places in this day and age. I know Josh did it in the years back where it may have been different, but it's- I pushed hard for our candidates this year. Yeah, yeah. Because fortunately, I am sitting on that committee. The only reason I got it done was because RIC had self-funded spots, but it was very hard. Yeah. So, I mean, all of these have been discussion points for us and we're gonna try our hardest to think about and to put forth an effort to say, how do we move to the next step, which is going down one of these pathways, potentially in terms of fellowship duration and or looking at pediatric residents, having a pathway to do the fellowship or a fellowship curriculum in pediatric remedicine and or another pathway, which I think is challenging, but is thinking about, is there a way to think about reducing a fellowship length for somebody who's able to incorporate a lot of pediatric training during their core PM&R residency that they have? There's just not a lot of wiggle room to do that because the program requirements the way they are through the ACGME, but- But the upside of that is that they're really emphasizing competency-based training. I mean, that's- Well, we're very- I'm afraid that- Yeah. That's what we're all about these days. So, if we're truly in competency-based training, then somebody who is in that position could potentially complete a competency-based training in a year. I think we're in the very early phases of CBME. So, I don't think we're at a place where we have the tool set, right, to use competency-based medical education to say somebody can finish their residency or do different parts of their- I think we're going to get there. And I'm pro- I think that's the goal that neither you or I are going to see completed, Dave. I hope we do. So, I don't- So, the one thing that I did- I'm going to put myself in front of you because I'm talking too much. Well, the one thing I didn't hear you mention, Dave, is- So, I know some specialties through ABMS have lesser- I don't want to- Lesser is a pejorative term, so I don't want to say that. But they have less rigorous quali- Some- I don't know if they call them special qualifications or- But kind of certification programs rather than true board certifications. And because- I mean, we all know that there are pediatric rehabilitation deserts out there, right? There's lots of parts of the country where none of us are practicing. And somebody is caring for the kids there. They're doing what has to be done for the kids there in terms of all the things that we do functionally. They may not be doing it as well, but they're doing it. So- So, my question is, would that be a route to go for the board to give those people who are doing it, who have clinical experience doing it, to give them a special qualification or whatever? I don't remember what the terminology is that the ABMS uses, but would that be something to think about? Yeah, I think I can't say- I can't speak for the board, right, on that issue. I think that- I think you have to think a little bit about the energy, the effort, and where you direct that energy and effort into getting the most out of what you're investing, right? So, I think part of the question- We've also had discussion, right, about perhaps there's an opportunity to think about certification for cerebral palsy, you know, as a diagnostic group in which to work in. I'm not sure that solves the question that we go into this whole process of asking, which is how do we increase the number of practitioners who provide care for patients with disability or patients with pediatric rehab needs, right? If you have a separate certification for CP or a separate certification that people can get if they choose not to do a pediatric rehab medicine, but years down the road want to care for kids with CP, does that really solve the solution of having more expertise in pediatric rehab medicine? Yeah, I don't- It's just- I'm not saying- Again, I don't think there's one answer. I think that they're all options to be tossed out there. Yeah. But so, you and I have both been doing this for a long time. There are people on the call that have not been doing it nearly as long as us. I would be interested to hear what some of the younger people have to say. Jason has his hand up just to let you know, Carl. All right, Jason. Dave, question for you. So I put in the chat, I'm in a situation where we could do a combined program. We've just got some people on the inside that are, I think, maybe one or two barriers to making it happen. Is there anything, if you guys look at anything centrally from that can be done with the organizations to have a push to support that? Maybe if there's some leverage that might open some doors or some paths? No, I think that's a great question. And I think that's something that should be on the agenda. And I would encourage when we have our meeting in a couple of weeks that we bring that point up because I do think that that would be nice. I think the challenge, right? And Sally, I'd love to hear your thoughts on this too, having just gone through this at CHOP. I think the challenge that programs find in pursuing combined programs is many fold. I think one of the issues is, sharing that FTE between programs and whether that impacts having to cut one side or cut an FTE from PM&R or cut an FTE from pediatrics and the challenges that they have that. Amy brings up a good point too in the chat, which is the ACGME has now gone down the pathway of accrediting combined programs. And so they put a moratorium on the initiation of combined training programs until they come out with program requirements for, I should say common program requirements for combined programs, which is also a little bit of a challenge. And I think the ABMS may have some input into that decision-making down the road. I think it's gonna make things a little bit more cumbersome for combined programs. It's a little bit hard to navigate two sides of the street to be on the same page sometimes with a lot of sharing of data and input of your program information form and your annual data evaluation and all of those types of things. I do think your point is, it's heard by me. And I think that we should echo this when we have a discussion in a couple of weeks, which is, it would be a nice positive because I think we are all supportive of combined training programs that we have a statement encouraging the use of combined programs and the support of those at institutions. But I'd like to open this up to Sally, if that's okay, so she can speak about her experience in creating the combined program. I'm happy to tell you what's happening with us. We're actually stuck in the limbo of the ACGME new thought that it's a good idea to have these programs be certified through them. You asked about stumbling blocks. Our biggest stumbling block was not in terms of collaboration with the residency program at Penn or with trying to sort out any of those things. We had good support from both sides for that, but it's the new PEETS requirements for the residency that shifts things so that the inpatient time has been cut for the residents who were in that program. Now, there's something that I don't totally understand that would make at least the interns who were in the combined program, not necessarily subject to some of the same rules from the Board of Pediatrics, but the change in the Board of Pediatrics with the increased requirement on the outpatient side and the increased requirement for time spent in clinic has been very difficult to be met at Penn because the requirements are all that the clinic time has to be spent in what's considered general pediatrics. And they're actually pretty particular about that so that some of the things that had been done in the past where someone could spend time in a CP clinic and call it a continuity clinic is no longer possible unless that's run by a general pediatrician. And run separate from specialty clinics. So at CHOP, the clinic that happens to have the label of the CP clinic is housed in rehab medicine and therefore not eligible as a clinic. And it's been really tough to find clinics that can qualify for that. And the leadership, even for the PEETS residencies are running into trouble with that for their basic run-of-the-mill pediatric residents. No one in CHOP is considered run-of-the-mill. In your clinic and they're working with the DBP or general pediatrician who's in your clinic, whoever you have in that role, that doesn't meet their requirements? It doesn't by the letter of the law. Is it possible that you could go and not get caught? Yes, but in trying to set things up so that it would be approved, no. So the fact that we have people in our group who are board certified in pediatrics doesn't make one bit of difference because they're not practicing in primary care. And we actually have a member of our group who was practicing halftime in primary care and halftime in PEETS rehab until, and even it's Chris Keenan for those of you who know him. And even knowing Chris's career and what he's done, there are no clinics that he has that could qualify for a continuity clinic. Sorry, I was expressing my disgust offline. That's, I mean, I understand that kind of the ABP has a dual responsibility to provide, to turn out both primary care pediatricians and subspecialty pediatricians at the same time. And I understand their valuing of primary care pediatrics, but in someone in a combined program who is, I mean, what, I mean, they have, I assume, for the PEDs, are there still PED combined programs? And for those, they're making the same requirements? Yes, and it's actually, it's interesting to see the coincidence in the year of, it came out obviously a year before, but with the changes in the requirements from the Board of Pediatrics, and then the plummet of the number of medical students who ended up applying to pediatric programs this year, and the numbers that, the number of programs that didn't match, the number of open positions on match day for pediatric residents, not all of which ended up filling. So hard to know if that is more of a, I don't want to be forced into primary care sort of thing, or if it's just a coincidence. Yeah. Those program requirements went, I mean, the amount of revision that those had through their process. So they posted their revisions this time last year, and they got somewhere between 1,500 and 2,000 responses about the program requirements. And as I understand it, they kind of stuck to their guns in terms of the changes that they made, and they did not make a lot of amendments to their initial draft of program requirements. We actually had our institutional pediatric fellowship directors meeting this morning, and that was one of the topics of discussion in terms of the impacts on clinical rotations and the need to hire physician extenders to fill in for the work that the residents do clinically in the subspecialty clinics, and how do you mitigate the impact on the fellows in terms of trying to keep them at a fellow level rather than a resident level in those clinics. They're struggling. They're not sure how they're going to handle it. So thank you, Sally. It's one of the things that I have discussed with some of the people at Nationwide Children's, the possibility, because once upon a time, Nationwide and Ohio State, well, before it was Nationwide, but Columbus Children's and Ohio State had a combined program. But I think Denise Carpenter was the last resident who went through it, and she was a resident when I was a medical student. I just want to take this opportunity to say PM&R is currently going through their program requirements through the ACGME, and it's important for this group, in my opinion, having been on the ACGME review committee in the past, it's important for us to pay attention to those revisions when they're done, because we currently sit with two months requirement of pediatric rehab for residents in PM&R training. In the past, that was more. That was three months prior to two months. So it got cut the last time in 2012 or prior to 2012. We need to make sure that that doesn't get cut out, right? We need to make sure. I mean... And I'm not sure we have a pediatric voice on that committee. Yeah, I don't have any inside information, but I worry about that requirement a lot, you know, and I worry about edits to that program requirement. To be honest with you, that requirement, and I understand the historical value of the requirement as it's written, but that requirement does not require pediatric rehab. That requirement requires exposure to pediatric rehab diagnoses. So you can spend time with an orthopod. You can spend time with a developmental behavioral pediatrician and meet that requirement and never, you know, touch a pediatric rehab doctor. But the challenge... I mean, because that requirement has had to exist because there weren't enough of us to go around, right, to be at every program. I think we've grown over the years, and our presence is more than it was 10 years ago, 20 years ago in programs. I don't know that it's out of place yet to require or to edit that program requirement to say that it has to be a pediatric rehab medicine person, but if we're not a voice, and I mean as a group, but also individually. I think multiple people giving input into those requirements when they come out, if they change, if they're edited, is really going to be important because if residents aren't getting exposure to pediatric rehab medicine during PM&R residency, our numbers are going to drop even more significantly than they are right now. So Dave, I have not heard the timeline, but I assume those will be released in the next academic year with the goal of implementing them in the following academic year. Yeah, so they just did scenario planning in March, which is the first step in this process. I think the writing group is going to work over the summertime to draft those program requirements. So it may be fall or winter before we get, you know, even probably winter is probably the earliest that we would get it of 2025, and I'll be happy to be somebody to be reminders to us, but if we can all keep our ears up about those program requirements when they come, because again, I think this is really critical for us. As program directors, you should all be getting the ATGME emails, so please pay attention to those, and when the PM&R requirements come up, please be sure to comment. But yes, between Dave and I, we'll make sure that we send out reminders. And Amy Rapiton, in answer to your question, right now, and Sally, correct me if I'm wrong, but there is a temporary moratorium on combined programs for new programs. So you can't create a new program until they come out with program requirements, and they made this moratorium like in January and said their goal was to have program requirements by April for comment, but I still haven't seen any preliminary ones to comment on. That'll be another thing that we need to engage this group on when those come out. Now, just to be clear, they are creating common program requirements for all combined programs, so not for pediatric rehab medicine, right? They are still leaving some of those program requirements at the board level in terms of what the curriculum requirements are and so forth. They're creating common program, like we have common program requirements for our fellowship, which are the BOLD program requirements and our list of program requirements and our specialty specific. That's what they're doing right now for combined programs. It may evolve over time to where they have specialty specific program requirements as a part of that, but right now it's just the common program requirements that they're working on for combined training programs. Did you think they'll leave it up to the board, the ABPM&R, the AAP, the AIM, for whatever two boards want to combine for a combined residency? Let me know if I'm answering your question correctly. The ABPM&R and the AAP collectively look at the requirements for the combined training program every five or ten years and edit those. As Sally mentioned, since the PEDS, their program requirements will go into effect next July for revision. Because PM&R is getting revised and isn't finished yet, we'll have to figure out our timeline in which we get together and edit the program requirements that were put together. Most recently, I think 2017 was the most recently edited version of the combined training program requirements. But ABP has their requirements. The ABPM&R has their requirements in terms of what is necessary for board certification within their specialties. And there's that shared amount of time between them that counts for PEDS rehab. Right now you can do up to 12 months in a combined program that is devoted to pediatric rehab medicine in a combined training program. Which is also challenging or not challenging, which also challenges the discussion that I had before, which is the duration of fellowship training being one year versus two years. Your combined trainees are getting a maximum of one year plus some PEDS neuro and plus some PEDS specialties that are akin to PEDS rehab. But our fellows who graduate from the PM&R residency do two years of PEDS rehab medicine training. And so I'm just curious, and I'd like to open it up to this, but you tried to tell earlier, but I'll try myself to hear from some of our younger members or anybody who really wants to comment about that question about duration of fellowship. Do people feel that two years is the right amount of time in terms of training competent physicians in pediatric rehab medicine? I think it really depends on the program. And I think we have created a lot of fellowship programs, and some places have different volumes than others. And I think that is where you can become, where things become problematic between a one year and a two year program. Like, for example, we never set a limit on, there's no program requirement, really how many patient beds that you have to have. So if you have a smaller program that has a smaller inpatient unit, it would be much harder for them to train somebody appropriately with a five bed unit. And I think if we're going to move to a one year program, we need to kind of set some, there needs to be some volume requirements in order to make sure that we're training competent people. And I think a lot of the problem that we're going to have is we're nice people, and some people's feelings are going to get hurt. And we need to be able to sit down and say, hey, this is what we have. And if we want to move to a one year program, either you can come up with this or you can't. So, I mean, Josh, you know as well as I do that in the past when we revised the program requirements, we have agreed to be purposefully vague in terms of numbers, in terms of requirements for, you know, what does, what does appropriate back within pump training look like? Do they need to do, you know, we've never put a number on they need to do 20 refills or 300. You can have the terminology back within our program requirements because there's so much variability of who does back health and pumps, right? I mean. And I think that's one of the things that allows our trainees to choose a program that fits their expectations and needs the best. That's always, that's always been the case, but as a program director who's been doing this for a while now, I will say that I think it depends on the program, but it depends on the trainee. I have trainees that I struggle to teach in the second year, some, many that I struggled to teach in the second half of the second year, but some that I struggled to teach in the entire second year. So, and there are others who I feel a little squirrely about letting them go out and practice independently after two years. So, yeah, it's, I think it, I think it's, it's way more complicated than just saying it's one thing or another thing. No, I mean, it's, it shouldn't always be a numbers game, but if we're, but, you know, in addition to the research, there was some concern because I was like the fellow during all this one year versus two year time and concern. And should it, should someone who did two programs have to take the fellowship and they hadn't even made the decision when I did the fellowship, there was still some debate on whether or not the people that skipped that year would be able to be eligible for the boards. And Jay was a good advocate for making sure that his, his combined person was able to sit for the boards where, but it still hadn't been decided at that point. Regardless, one of being able, being sitting down at that time, I think some of the concern was, do we have our, our trainees getting enough volume to be able to go out and have enough knowledge. And again, it is person dependent, whether or not you could teach someone in one year versus two years. But I think if you're going to advocate for a one year program, you need to be able to set some standards of can we provide this amount of training, just as you have to do in a general PM&R program, they have to have X amount of EMGs, they have to have X amount of botulinum toxin, they have to have X amount. It can always be a number game. But if you, if we are compressing the education into one year, then we need to at least create some standards that we can measure and say this is, you know, that they have enough to be competent. If somebody's 700 botoxes and they still may not be competent, but we at least have to create a standard to say that we're, that we feel that we sent them out with adequate training. I just wanted to make a quick comment as someone who's just done the application from the ground up and the amount of time that you need to spend on things that you've probably already done in your residency, like dedicated quality training and administrative training and the research part of it. If you have to still do all of those things and do the training in general, that you won't have time to do any P3 have, if you're going to try to compress it into one year. So I think some of these other things, especially when they've already been done in the first four years, and it could be the, our sponsoring institution was extremely rigid in the amount of training that they needed for those kind of things. Not that they're not important at all but to repeat them when you're also trying to get the P3 have knowledge in there. That was kind of limiting. I agree, Susan, I think the challenge is, is that those are common program requirements to the ACG and me so you the quality improvement, for example, right, I mean, we have quality improvement requirements for residents to do that, but those same requirements in bold are there for fellowship, and, you know, because they're a requirement. You're right, you have to find time amongst everything else to devote towards quality improvement, perhaps in a different way. So that they're not doing the exact same thing they did in residency in terms of doing a QI project from the ground up and thinking about how you can teach quality improvement, you know, in a different method. But you're right, it's it's hard it's challenging with all those things, incorporating the valuable pediatric rehab exposure that you need to teach, plus the quality improvement, the leadership, everything else. Dave, I think that's part of what makes your argument about, or the comparison of one full year of pediatric rehab in the combined program, which for some people, it wasn't even that many, as many as 12 months of pediatric rehab. But I think because it's part of a larger program, it's a little bit comparing apples and oranges, because the fellowships and the residencies, for the most part, are freestanding from each other, right? So, part of what's incorporated, at least into our fellowship, and I think this is true for everybody, are months of time that are spent doing things that are relevant, but are not pediatric rehab per se, whereas the months of pediatric rehab that you did in your combined training program were probably all pediatric rehab. And so, I don't think that you can say because you got it in 12 months that the rest of us are dumber, but also that because you got it in 12 months, that necessarily we would be able to put together an adequate training program in one year, because of the need for some of the trainees to just get the exposure that we almost take for granted to other relevant things that are happening in pediatrics, but that they've never seen. And I think putting in the child development, putting in the general piece, just all of those things are really difficult if you actually wanna get 12 months of pediatric rehab in there. And I think that's sort of the same argument if you turn it around the other way, although I think that because of the fact that in a combined program, you could do it in a shorter time, I think that looking at what if you came at it from the opposite direction of you did a pediatric residency and now you're gonna do a two-year fellowship that would have to be designed quite differently, but a two-year fellowship to learn pediatric rehab from the perspective of pediatric residency training, I think could be very different, maybe would take longer, so that in the end it was the same number of years, but I think you could put together a fellowship for pediatricians that included the relevant part of rehab medicine or physical medicine and rehab, but wouldn't take the whole three years at the residency that somebody has already done. Yeah. I just wanna be clear that I was not saying that a one-year training from a combined training is better than... No, I just wanna make sure that you guys have an awareness of kind of the discussions that are going on and some of the input that's receiving. And more importantly, to reflect on that, I think that the point that you just brought up, Sally, in terms of the pediatric residence and potentially creating a fellowship that's different than exists now, is certainly a hot topic, right? And it's been a hot topic for 15 or 20 years, right? Every program director's meeting that I can remember since back in the early 2000s, that was a topic that came up. Why don't we think about pediatricians and they're available? I do think it's helpful though, for me at least, to get some feedback from you guys and some thoughts from you guys about, is that, do we feel that that is a pathway worth pursuing or do you share feelings? And it's okay if we have people on both sides of the fence here on this, that you really need PM&R and part one and part two to be a bona fide pediatric rehab physician. But I'm personally on both sides of the fence at the same time, Dave. So I see both arguments. Sue put in the chat and getting back to her point about the common program requirements. I imagine many places that are like ours the common program requirements are addressed commonly for the entire institution. But since it's a pediatric institution and pediatric fellowships are generally three years, it's on a three-year cycle. So my fellows have to take one and a half times as much time away from clinical experience to do those common, we call them fellows colleges, but to do those sessions, they're doing one and a half times as much time away from clinical experience to be at those educational experiences, to meet those common program requirements because that's how the institution does them. And if we condense to a year, then they're gonna be three times as much away or we're gonna have to decide which of those things we're just gonna let slide. I think the biggest thing about the one year that's most difficult is the didactics. Getting all the didactics in a year is the one thing that every time we talk about it, I just grown realizing, the one and a half hours a week we have is now gonna have to be like much more. And so I think that's probably, I think that's probably the bigger barrier than everything else. May I just steer the gears a little bit? I think it's a very important discussion and we've been talking about it at each and every meeting when we meet. And obviously we're running out of the time, but I wanted to bring out the recruitment process that we are just facing in a couple of months. So for this year, so not just to kind of, I'm not saying that what we were talked about it was very important, but since we just entering the recruitment process, can we go back to that topic for a little bit? Because we only have a few minutes left besides the fellowship fair that is going to be organized. In our division, in our hospital, we kind of were wondering if we can come up with, I know it's most likely not possible to organize, but I still want to bring it up. If there is a way to kind of make, I don't want to say calendar, but maybe some type of agreement, or I don't know, in terms of the interview dates. What we've experienced in the past that a lot of times the interview dates and all the programs are kind of overlap. And because we had several instances when the applicants had to say, well, we have to choose one over another because they're on the same day and the same time. Since we're still a little, like, you know, a small group within the ground, can we come up with some type of, if you feel that it would be helpful considering our very small pool still, and I don't know how many applicants will be this year, but maybe have some type of internal between the programs agreement in terms of who is doing interviews when. I don't know. I just want to bring it up. I can imagine that it will be close to impossible to organize and all that, but still I think it will be helpful to the applicants to have different options to attend different interviews. Olga, I think that's a wonderful idea. I think we should have thought about that earlier. I think it's a wonderful idea. I think it's gonna be hard operationally to make it happen. Oh, Carl, you've never hung around with a bunch of kids trying to get their bar mitzvahs. You know, they have the big bar mitzvah list. Everyone's got the same time. The families get together and figure out whose bar mitzvah's gonna be on one weekend. The problem is we don't have enough Jewish grandmothers in this group, Josh, because they're the ones that really make it happen. I'll get my wife on it. No, I think that's a great idea. And we should, I mean, I think that we all are interested in making sure that what is in the best interest of the applicants is what we all keep first in mind. I mean, we can't deny the fact that we're competing against each other for a limited resource. That's the economist in me coming out. But I think that we all, at the end of the day, we all are, we're all friends and we wanna make sure that we are being as cooperative as we can be and certainly more cooperative than virtually anybody else we know. So Olga, I think that's a great idea. And we can maybe talk offline to figure out how that's gonna happen. I mean, I think just thinking off, if there are certain days of the week that certain people have to have their interviews, maybe you start that way. What day of the week does your program need to do an interview? And then we can- I know that ours always have to be on Monday morning because that's the only way I cannot reduce anybody's RVUs because it's when we schedule all our meetings and we just cancel all the other meetings to have interviews on those Monday mornings. You see, exactly. It works. One of the other things that plays into this though is that I think there are some of our programs that interview in blocks and some of us that interview one applicant on a day. And so there's not a lot of, when you have that type of variability amongst your programs, it just makes that process a little bit more challenging. Yeah. Well, I mean, if you have to agree to do virtual interviews and I think there can be some agreement that's saying, we're gonna offer a block. And if people that offer block interviews, we're gonna offer those. And then those who interview individually can work around the blocks. This thing, I mean, I think that's, like I said, I think it's a very reasonable idea. I mean, you're figuring how many interviews you do, maybe two or three a week, you knock them out in two months. Everybody's happy. And then you get it way done before the AAPMNR, when you have your last minute stragglers and then you have a bit of a block period. You start in like end of August or September and then you knock it out. So to this day, I'm a little jealous of the pre-COVID spinal cord injury who all got together and decided they were gonna just do all the interviews at the Academy meeting and then everybody's on the same footing. But we'll figure out some way to be more cooperative and coordinate better. Okay, thank you so much for asking that. We'd certainly like to try to cooperate as long as we get our first choice. I'm happy to make this work as long as it fits my schedule. Yeah, and I'm not sure how many applicants. I mean, I don't know if you guys have any idea. We'll look at this, whatever Google spreadsheet that is. I don't know how accurate it is, but it's very small. Yeah, I mean, there were some years that we had to do two days because obviously there were so many people that were applying, but at the same time, if you have to do two days and we all can kind of agree, like, you know, okay, A through, we have X amount of applicants, A through M is your block one day and M through Z is your block two day or whatever it is. I think we're relatively intelligent enough that we can figure this out amongst ourselves. I mean, at least Jason can. So in the chat, I'm seeing that some people are much better planners than I am and already have clinics blocked and dates chosen. In my dotage, I'm not planning that far ahead. But yes, we will get together with that to plan ahead. In the interim, action items are gonna be, I'm gonna talk, I will send Dinesh an email tonight asking him to resend his polling material in a more accessible format than the Google document that he used. And we will get the finality on that. One last thing that I did not mention is that AAP is gonna be again had this year having a fellowship introduction kind of fellowship nights to introduce people to what pediatric rehabilitation is and the other subspecialties are. I have committed us to participating in that. I am again this year going to, in my own bias, I'm gonna reach out to people who not matched fellows in the last couple of years and ask those who are in that position to participate in that to give them a little more exposure because I think it's the right thing to do. Including to the point that this year I will not be personally participating in that experience because I have been overly blessed. So just look for invitations to that to be coming in the not too distant future. All right, anything else? I think we are, we got two minutes. Anybody else have anything to share? Great news, I wanna hear great news. Anybody have great news? I just wanted to thank Amy and Jason who volunteered to coordinate this interview process. Jason, should I do it? Jason, you just can't stop yourself from volunteering. It's exactly the way I trained you, isn't it? It's my training that did that to you. I had him for one year and I influenced him. I can't stop myself from volunteering either. I can't stop myself from volunteering other people. All right, well, thank you all for showing up. This has been recorded. Oh, Amy is just saying that she's not sure she can change her date this year. That's all right, we will just do our best. To coordinate, we'll figure out how that's gonna work. I think I maybe was a little bit unclear on my text. I was saying, I've been trying to coordinate with everyone. I have a hard time getting my own folks in place to get there on the same date. Yeah, I took that from you, Jason, but I'm happy still to volunteer you at any chance I get. All right, well, everyone, it was great to see you. Thanks for showing up and thanks for your input. Jason, I'll be more than happy to help you if you need a hand. I will volunteer myself since you've been volunteering for so many things lately. We'll figure something out. Bye, everybody. It's easier to volunteer than be voluntold. Indeed, have a great evening.

interview schedules

fellowship training

pediatric rehab medicine

didactics

quality improvement training

clinical experience

recruitment processes

cooperation among programs

fellowship fair

AAP fellowship introduction event