Good afternoon, everyone. Thank you so much for joining our presentation for you today. My name is Brandi Waite, and we have a rock star group of experts who are going to be helping you navigate and create pathways for leadership and career advancement. Our team today includes myself, Dr. Kathleen Bell, Dr. Catherine Deck, Dr. Joanne Borgstein, and Dr. Gregory Worsowitz. So a few quick housekeeping things that we need to discuss today. Please do enter any questions that you have in the chat box. We will save all the question and answers until the end of the presentation, but I want people to get their questions out so that we can be sure to address them if there's time. Also, we have a lot of information to share today, and you may need to refer back to the slides, so pay attention to what's on the slides, even if everything isn't addressed verbally. You can move on forward and get the information on the slides on the back end. So my specific presentation today, let's see, I'm going to try to advance the slides here. It doesn't seem that they want to advance. There we go. Thank you. I'm talking specifically about academic merits and promotions, and I myself am a full professor at UC Davis, and I have a PhD in business administration. Again, trying to advance. There we go. My only disclosure is that I am on the scientific advisory board for an AI company, which will not be discussed today. So let's get a poll for the audience. I want to see who's here. What is your primary practice setting? So if you can just click the primary location where you practice, and then hit the submission, we'll see who's here in our group. We do have a little something for everyone as you're answering there, as we've got discussions about academic practice, private practice, and also people who will want to take on leadership positions in national organizations. So we're going to cover a lot of it. All right. Looks like we're slowing down there. So a lot of academics and still in training. Great. I love to see the residents and the fellows in here to learn about it, but our private practice folks, we've got something for you as well, something for everyone here. We've got another question that I'll move on to next. How many years have you been in practice? So still in training, right? That light at the end of the tunnel better not be a pen light, right? So we've got the newbies in full swing. Just put the number of years that you've been in practice here so we can try and tailor our information for you. That's great. Across the board, about a quarter of our audience is still in training, another quarter, roughly quarter to a fifth are brand new into practice, and a good number of representation from our mid-career and senior physicians in the room. That's great. We've got one more question that we want to have you answer, and that is, do you self-identify as belonging to a group that's underrepresented in medicine based on gender, race, or sexual orientation, or country of origin? So we'll get that information as well. Oh, this is good. We've got a broad representation. So we will be dropping some pearls of wisdom here specifically for people who are in underrepresented groups. But we've also got a straightforward standard pathway that applies to everyone. So I'm happy that everyone will be able to get a little something out of this. Excellent. So I'm going to move forward here and just describe our course learning objectives are there for you. That's overall, so you can refer back to that. And then my specific learning objectives for the academic merit and promotions portion should be coming up on screen soon here. There we go. Three key things. If I don't get through anything else, I want you to understand the timelines and tracks that are very important for your merit promotion pathway, identify resources in your office of academic personnel, and create a dossier preparation strategy that is well aligned with your department and institutional promotion tenets. So this is going to be focused on faculty. So these are if you're working at an academic medical center and you also have a position within the School of Medicine, most people start off as an instructor or assistant professor and then move up through the ranks to associate and then full professor. My own personal journey, it took me about 13 years to go from assistant professor to full professor. And at UC Davis and the University of California system where I am, we have interim evaluations where you actually have to turn in a packet every two to three years for reevaluation. So this lets you know. It's almost like a midterm grade and lets you know, are you making the proper steps that will put you in good stead to actually make those big barrier step jumps from assistant to associate and associate to full. So I highly recommend that if your institution does not have a formalized process for this, that you find out ways that you can get some interim information through your office of academic personnel or the faculty development office. Just helps to keep you on track. You should also know if there's a specific timeline for your university. At some places, if you don't promote from assistant level to associate level within seven years or 10 years, you might actually not be able to continue in your position in the School of Medicine. So find out if that is a timeline that you need to adhere to and make sure that you're making a proper step so that you don't have to give up your job in academic medicine because you weren't prepared to know that that timeline was really tight for you. The timeline from associate to full professor is pretty loose, and not everyone actually makes that step up to full professor. Let's see here. So the additional thing is there are different pathways or tracks to promotion. And so the key thing here is to make sure that you are in a track that really values the things that you enjoy doing as part of your promotion pathway. So if you love getting grants and writing papers, then you should be in a track that's a clinician researcher or a ladder rank track, where the number of your promotions really counts towards your promotional step up the ladder. If that's not your thing, then you should really be more of a clinician educator track, where your teaching and teaching evaluations, contributions to education are more of what you're judged on as you put your packet forward to get promoted. Moving on here to the next. There are resources that are out there for you. So don't think you have to figure this all out on your own. Specifically here, I want to highlight the Office for Academic Personnel, which is an office that oversees the merit promotions process at almost every institution. It might have a slightly different name, but that office is there. And it's very important for you to know the people who are in that office, particularly the leadership. I personally knew the people in that office, though we have this stepwise plan. And I can tell you that when your packet goes in for promotion, there is a review committee that reviews it. And sometimes that committee has people who are not physicians on it. And so the leadership in the Office of Academic Personnel can actually guide and even override the review committee. And I actually had that happen to me once in one of my promotions, where I was specifically requesting what is the equivalent of maybe a double-step promotion. And the committee came back suggesting that I have just a regular promotion. And our vice chancellor of academic personnel actually overrode them, having more information and understanding more about what a clinician educator does, and actually provided me the double promotion. So it's really important to get to know those people in the office. Your department chair, your section chief are also great resources. Moving on to my next slide here. Let's see. There we go. Also, the Office for Faculty Development, they offer coursework on leadership skills, educational skills training. And this is kind of a win-win situation. So you get to put that you took those courses on your CV, but you also learn how to be a better clinician educator and more leadership skills when you have this. So those things are really important things to include. We could talk for hours on mentorship and sponsors. I'm not going to delve into that today, but make sure you're leaning on those people to help guide your process. And you should make sure that you search for a really diverse group of people to advise you. We saw that a good number here of our attendees are in an underrepresented minority group based on race or gender or cultural identification. And so you need to have information from other people who have a lens for diversity that might be able to advise you on specific areas within the promotion process that are a struggle or have been traditionally difficult for people from an underrepresented background. So seek allies who are really involved in that promotion process and actively combat inequity by preparing both your offense and your defense with your packet. Moving on to my next slide here. There we go. Create your dream dossier. So the important thing is to know what goes into your packet. Usually it's a chair's letter, your CV, your teaching evaluations maybe, and letters of support if it's a barrier step. Now, a key thing here for the curriculum vitae, you need to update it quarterly at a minimum and include everything you do on behalf of the hospital. So I keep a little sticky note next to my desk that every time I get an email and I agree to be on a new project or serve on a committee, I write it down on that sticky note. And when the sticky note is filled up, then it's time for me to update my CV because the last thing you want to do is spend time on a project and then forget to add it to your CV two years later when you update it so that you don't get credit for it. You want to be able to control the narrative. So your chair has to write a lot of these letters, so help your chair out by giving them a template for the things that you've done and organize that template based on the tenets of promotion, research and publications, clinical contributions, education, university service. I highlighted that because in my last promotion packet, I had a sentence that said, in the past two years, I've made 15 media appearances on behalf of the hospital, engaging the community and uplifting brand recognition for this institution. Now, that's something that's unique, and it's also something that should be valued and accredited. So anything that you're doing in service to your university should be added into there. And quantify the hours and the numbers. Make it easy for the people on the committee to understand what your contribution has been. Let's see. But there will be some roadblocks potentially, and we'll jump really quickly here to how to hurdle some of those roadblocks in your promotion pathway. So if there are weaknesses, attack those weaknesses. You should strategically and graciously accept or decline opportunities to strengthen your dossier in the areas that need strength. And if you feel that your contributions are being overlooked or undervalued, then tally up those hours per week to make it easy for the people on the review committee to really understand how much work you've put in. If you still think that your contributions are being overlooked, then you need to start saying no. It's very hard, but you can work on this. You've got to decline work that's undervalued. Or if it really means something to you personally, then take it on with caution, knowing that you're doing it for personal satisfaction and not for your promotion pathway. And if you are unsuccessful in a promotion, you need to seek clarity and transparency in the decision-making process and request some concrete feedback on the specific areas of your packet that need to be strengthened or more robust in order to make sure that you have a full successful promotion the next time around. You can collect evidence and get real. Most of us will see the other packets of faculty that are being promoted forward. It's not unreasonable for you to save those packets so you can compare your own work against people that are successfully being promoted in your department to have a little bit of an idea of equity. And if for some reason you suspect bias or inequity in the promotion process, you should seek counsel and alliance with your Office of Faculty Diversity, Equity, and Inclusion. I'm going to go ahead now and drop the mic, pass it really quick. Our introduction took up a little bit more of our time than I suspected, but I'm going to pass the mic to Dr. Wursewitz and have him take over. Okay, thanks, Dr. Waite. Anybody that watched that, Dr. Waite, two things. I'm going to have you come talk to my department because I'm the chair of the Department of PM&R at the University of Missouri. She just gave a great lecture on promotion. One thing I'd add, when you ask for letters, ask for someone if they can write you a strong letter. Just don't ask for a letter because I've seen some slip through there that can be quite damaging. Just so people know, I have no relevant financial disclosures at the present time. And I was asked to give this lecture on navigating your career and while getting an advanced degree or not. I'm going to give this lecture on navigating your career and whether or not you're getting an advanced degree or not. I'm going to give this lecture on navigating your career and after my training, I was at Robert Wood Johnson. And about eight years in, I got kind of like, how do things work? I noticed I was going and a lot of the people that were controlling the budgets were making decisions. So I said, let me get an MBA. Well, kind of out of the blue, I went and did it. A couple things to know. Then after that, I got it and it was like, do I go into private industry or do I work on running a department? Running a department, as Dr. Bell knows and those that are doing it, is basically running a small business. You work with budgets, it's actually harder. You have research budgets, you have other budgets. It gave me a lot of insight into some of the financial issues you gotta be. Afterwards, after becoming chair at University of Missouri, I also ran the 600 physician practice plan for about eight years. Don't always recommend it, but it was a great learning experience. And again, I learned, why didn't I get it? Because people thought, he's got an MBA, he must know something. It took them eight years to learn I didn't know anything. But it actually gave me a little credibility that I might not have had if I didn't have that degree. I asked a couple questions, I wanted to know, does anybody in the audience here have an advanced degree other than their DO or MD? that we have quite a few advanced degrees. If you don't have a degree, are you thinking of pursuing one? So we've got about a 50-50 split so far. So some yes, some no. So again, about a 50-50 split. And if you're thinking about it, those who were thinking about the 50%, what type of degree were you thinking about pursuing? Okay. Interesting. So quite a few were thinking about an MBA. I would ask those thinking about it, explore all these different types of degrees and what do you want it to do for you? Are you thinking about an MHA? Do you have the administrative background? Masters of Public Health might be more towards a research or global health type issue. Interesting to see some of the mix. Part of my evaluation was why for you? Why is it you want to do it? No matter what learning we do, there's going to come an opportunity cost. That opportunity was some time maybe spent with my kids at the time I was doing it and time away from my wife. What is the financial cost? Some of you are going to have to fund your own degree. For me, actually, my work paid for it and it was a degree that was for physicians and I got CME. What was the benefit of that? I learned, well, I didn't have to pay taxes on it. It wasn't considered an extra benefit. So it worked out. Is it necessary? There's a few jobs such as CEO of corporations or other types where it says an MBA or advanced is preferential. Did I need it to be a chair? Now looking back retrospectively, no. I didn't need it and you probably can learn all the things you need on the job. But did it give me some credibility and personal? Did I gain knowledge? Yes. And I had to have my partner buy in because it takes time. Again, just like this lecture, what's the benefit and what's the cost? Most of you could be doing other things right now. And don't get too caught up in, oh, I have an MBA or I don't. My first academy lecture, I showed a balance sheet and started about credits and debits and all that. You know what? You don't need all of that. You have to understand some of the things, but not to the detail of a business administration master's degree. It did do some things for me. I did gain knowledge. I knew what a credit and debit was. Relevant costs, sunk costs, putting a pro forma together. Things that my fellow chairs had not seen before when they first started. But you quickly can catch that on. It gave me credibility within my university. Oh, this guy knows something about business. A lot of academic physicians have never been out in private practice and aren't used to talking about money that way. So it opened some doors. At the time I did it many, many years ago, it was unique. Not many physicians were going for advanced degrees. And when I went to become a chair, it strengthened my application some. This was online. I just was looking up what are some of the things that can an MBA do for you? You got to think about that. My biggest thing is why are you going to do it and why are you going to spend the time? Did it increase my earning potential? Yes. I got an extra payment for running the practice plan. Was it easier to get promotions? No, not in the academic world. Did it give me job security? No. Performance is what gives you job security. No matter what degree you have, it's what the performance you did. It allowed me to perform hopefully a little better. It gave me knowledge. Networking. I never used any of my business networks from my training to that. Could it help me change careers? Maybe in the future, but not much. So why do you want it? Which degree? There's several degrees. Do you have to? Do you need that skillset? What's the cost benefit? And what's going to do help you in your career path? I'm not a researcher. I'm not a heavy writer, but I'm pretty good at administration and setting up programs and setting programs for my department. So it did help me in my career path and the type of practice I run. There are other things that can help you with. I like to learn. So it was beneficial that way. You got to know yourself. This is my philosopher, and each one of you got to know that. I am what I am. So for me, it was the right choice at the time. And with that, thank you. And I'm going to pass the microphone over to Dr. Catherine Deck, who's going to take it away. Thanks, Greg. I appreciate it. I am really excited to be here. I want to thank Dr. Waite for putting me on the program. I have a lot of passion about this subject, and it's really going to be the non-academic trenches. I went from fellowship to private practice, solo practice, and now I'm back to academics. So I want to share no disclosures that have to do with my topic. So probably the two points, if you take anything away, volunteer is service. Those are the two that are the most important. And we all go, well, I'm in private practice. I have a solo practice. How am I going to have any time to volunteer and to serve outside of just trying to manage my time? And that's what I'm going to speak towards. I've had a lot of experience at different roles I've held. I've done a lot of volunteering. I still do it. I enjoy it. And so volunteering and service are the two points I want you to keep with. Leadership, volunteer, and service. So engagement. It's important. It's very important when you're trying to make change, when you're trying to follow a larger vision and really create the outcome for the long term versus putting out a fire. So my family is a big Marvel group. I like Wonder Women. That's DC. But Marvel was what I picked for picking out what are our powers. There are three things, and this is not a poll question, because I want you to think about each of these and reflect on it. And you may need to think about it five or 10 years further in your career. What do you want to do in your career? We're physiatrists. We have so many opportunities. There's so much change, and there's so many things we can influence. But you really need to set a timeline, because you may change those goals. So what is your timeline for who, what, and where? What's your superpower? So superpower is something that you see in yourself. It may be different if you ask someone else. The other thing that I see is there's a lot of people who would say you have a different superpower. Interesting sidebar, our Women in Leadership lead kind of power group at our department looked at that. And we would say the superpower we see, but folks would see something else. And when you ask the leader what they wanted to be, it was 180 degrees in the other direction. So I think that this gives you a great look at your skill set. What are your reasons? What are your passions? Why did you become a physiatrist? Why didn't you go into the field of gastroenterology? What drove you to be a physiatrist and set that as a benchmark of pursuing so long-term goals are there with your short-term? The other thing is volunteering. So I'm currently the residency program director and an assistant fellowship director in the Department of PM&R at VCU. And what I find there is a lot of youth and early career do a lot of volunteering, but they don't do, as Dr. Waite said, looking for those crucial committee visibility positions. They also do a lot of volunteering in private practice to create more patient flow, but a lot of times we want to be paid. An example would be prime high school coverage of sports on the sideline. I'm dual certified in sports and PM&R, so I do a lot of coverage. We don't usually get paid for that. So thinking we're going to volunteer and get paid for it, we should be thinking of what the cost benefit is, and it may not be the dollar amount, but I guarantee you if you find something that matches your passion and you volunteer, that will get you to the point of visibility and then leadership. When we look at things that are resources, I've read lots of books. I'm older, so longer in my career. I think there's a lot of them out there. These are only four that I would mention as my top four. Actually, the bottom one, the magic of thinking big, is something my coach recommended to me in college so many years ago for an athletic goal, but I've pulled that book out off and on. It's old, but it has great resources and it's applicable to a lot of the goals I have in my career. The other thing is mentor and mentees. When you're in private practice or working in the community, not affiliated with academics where you're constantly working directly with a colleague or a person in a higher role than you, you have to seek them out and you have to decide what's important for me. In solo private practice, when I started from the grounds up, I found another mentor besides my usual one in career and really needed to learn more about business. You may get short-term mentors. You may have long-term mentors. Some of your mentors may become sponsors, meaning that they see how you've grown. They see a role for you and they're connected, and so they network you and sponsor you to accept a role. I would also warn you that those young in practice, mentor and mentee is a relationship that's two ways. A lot of times we mentor, but those mentees will also grow in their career and what they can offer back is equally important. The mentor-mentee relationship is dynamic, changes, and it's something that you should really keep and continue to cultivate. Then there's the self-query. We can take our own Myers-Briggs, just an example, our EI test. We can ask feedback from trusted colleagues. People will give us true feedback and not be afraid to tell us what they're seeing and ways we can improve. Those are some of the biggies when I think of doing self-reflection. I'm going to just focus now on private practice in my 10 minutes. Really what I'm looking for here is we're already leaders as physicians. We have to lead our patients. We have to collaborate. We have to inspire them. We need to engage them. They need to change sometimes their behaviors. There's already a leadership skill we're developing as physicians, but I think you have to also define what your core values are. Whether you're in private practice or academics, you have to think of what are core values. For me, trust, transparency, legacy. There are a lot of physicians out there. I'm thinking of Dr. Herring, who is cutting edge in our sports medicine and our future. I'm thinking of Dr. Sifu, who is my chair and a prior president of the AAPMNR. There's really a lot of people that have a long history of work and history repeats itself, and these folks know people. It's helpful to get advice from folks that have been in it for a while also, because we're still living and working and still experiencing the same things that you are. The other point I want to make on this slide in private practice is you're going to put yourself out there into organizations, situations, and committee volunteerism that will stretch you, that will be outside your comfort zone. A lot of people think, well, I'm collaborating with another skill. I'm working in another environment. I'm the physician. I'm bringing them something. Really, collaboration and committee work is about really elevating everybody's positive skill that they bring. Not competing, but collaborating and growing, so we get to that bigger goal. From the standpoints of learning and growing, private practice. You pay for your own membership. If you're solo practice, like I was, you pay for everything. You don't have benefits or a professional account. You have to be wise about your memberships, but please pick a membership that you're going to be involved with. It looks great on your CV, but if you're a private solo practitioner or in a group practice, just being a member doesn't really grow your skills for your long-term goals as a leader. I think that increasing your knowledge by working in committee, developing your team skills, really assisting a larger group, such as the AAPMNR, to get to their next level, what their mission and values speak to. If that matches yours, then go for it. Volunteer. There's a symbiosis happening that's really going to get you to the next level. I never thought I would be the president of AMSSM. I did not set it as my goal. I love the organization. I did a lot of volunteering, a lot of service. I brought in some of the things that I liked, and we developed liaisons, but I never thought I'd be president. I didn't think I'd be the first PMNR president of the organization. We are the number two specialty of the five, but only 9% of the total membership. So there's a lot of places where our visibility is not, and there's a lot of places in the community and other medical organizations where our role as physiatrists, team physiatry, being bold, is important for walking the walk and showing folks who we are. So have the courage, be a voice, and volunteer time. The next part of this is really stretching yourself. It is uncomfortable to have the courage to join an organization that may have nothing to do with what you do. I would say of these here, there's several more I didn't mention, but these are ones that I've been involved with off and on over the years. One of the points I want to make is if you get involved with an organization, for example, AAPMNR, and you have a passion for another organization you're involved with, and you see the relationship, what a beautiful thing to do for PMNR and to speak your specialty, but to become a liaison, to bring that new organization that others may not have heard about, the visibility and the passion of what PMNR is and what we can bring to them. So look at other organizations. I think it will spread your skill set, and it will open your mind and your knowledge base. From the standpoint of private practice, I'm bringing this back. It is really, truly time is money. Time is money if you want to reach a certain salary. So of course, when I'm in solo practice, I have to pay all my bills. I have to pay my employees. I need to pay myself. So I may not be able to volunteer for three organizations or volunteer for a committee, but there's an up and down in your timeline that can happen where you can put more effort in, and you can pull some effort out. And so you have to know those three answers to the three questions I gave at the beginning to really make wise choices on where you volunteer and where you serve. I do want to shout out to my family before I go into the two research studies that I pulled. I've had a blessing of a family and a husband. He was my MBA, is my MBA, so I didn't get an MBA, but I think their ability to share and balance and understand and support me in pursuing things really helped me balance some of the time that it took outside of being a physician and my work hours. So one of the nice studies that was done, because this is something I've noticed as I've been in academics, I now am a professor in primary appointment, PM&R, secondary appointment, orthopedic surgery. And when you, when I've gotten into this role, there's a whole other skill set in academics than there was in private practice or healthcare organizations. But all that work I did before, I'm only six years in, and I came in as a professor when I was hired. So those of you in private practice and healthcare settings, if you have a chair, upper leadership that are professors, they can really help you get into that role and become a professor from all those volunteer and service things that you did in your private practice and your healthcare setting outside of academics. They have the knowledge and so that guidance that Dr. Waite mentioned can make a difference. One of the things I thought was interesting in this study is physicians have great skills and great leadership capability, but we really have less of an inclination to collaborate and to follow another person. So it's important to really work through those skill sets and to see everyone's value on the team or the committee that you serve. Your leadership skills will continue to develop and expand over time. Mine still are. The other part is a physician leader. So a physician leader, typically when I was in private healthcare settings, so we're driving a sports medicine department and trying to get healthcare leadership in the primary care, sports medicine, PM&R, surgical setting to understand the need for certified athletic trainers, for coverage to high schools, for why sports medicine is important in a private practice hospital. And often we're seen as, oh, you're the physicians, you understand the clinical piece, you understand what patients need, but you don't know anything about the business. That's a loss leader. You'll lose money. We can't do that. One of the nice studies that came out looked at that impact of physician led networks. And that study specifically spoke to across the platform. Physician led networks had higher quality ratings from patients, more inpatient days per hospital bed, and no differences in financial performance. So I say, get out there, volunteer, and serve because you need to overcome the implicit bias, need to volunteer in your healthcare organizations if you're in private practice, and we need to make a positive difference. And I close with a slide that's from the Beijing 2008 Paralympics. This is a team of professionals. I have athlete trainers, physical therapists, nurse practitioners, PM&R physicians that are dual boarded, family practice docs that are dual boarded, internal medicine physicians. There are so many pieces to our team. Just as team physiatry has so many skills within our team, we still need to have the courage to go out and be engaged with other organizations and other groups to really walk the walk so everyone can see how great team physiatry and PM&R is. I'm now going to drop the mic and hand it over to Dr. Joanne Borgstein. Thank you very much. Thank you also, Brandy, for pulling us together and inviting me to participate in this symposium. So I'm going to address pathways to fellowship and educational leadership. I have no relevant disclosures. And one of the things I was asked to do is reflect a little bit on your own path, which we don't generally do very often. I'm shy to tell you this was my 1988 graduation picture from residency. And somehow 30 years later, this is where I was at Spalding and Harvard. The path there has been an interesting one. I'm not sure it was as planned out as a modern day path may be because we just didn't have those barriers. But I started at Spalding in 1992 and within one year was able to become medical director at the facility where I am now. Fortunately, I was in a place where they started a new residency three years later, and I was able to be part of that from the ground up. And then this is where I think a little piece of pearl or advice is at the time, sports medicine, musculoskeletal, which ultimately became my specialty, was not really represented well in our department. And so I recognized a need for growing the sports medicine clinical program and was inspired by our first fellow, Kelly McGinnis, to start a fellowship, which did not exist for physiatry anywhere in New England. So part of it is being in the right place and part of it is keeping your eye on the prize or vision of what you'd like to accomplish. And then over the ensuing 10 plus years, our department divided up into subspecialty niches and I was able to become chief of the Department of Sports and Musculoskeletal, the Division of Sports and Musculoskeletal Rehabilitation and then also pass off the directorship of the fellowship to our first fellow, my dear colleague Kelly McGinnis. The other thing that I would tell you when you want to advance yourself along academic leadership is you need to have a clinical area that you are very comfortable in and very expert at. One of the things we are, we're not simply educators but we're educators about specific topics and expertise. So some of these folks have been program directors, fellowship directors, many of them have been, but it really started with a clinical vision and a clinical expertise. The question then becomes, let's just say this is what you envision for yourself, how do I get there? And I called upon Deb Weinstein, who's the vice president for all of Partners, Partners is Mass General Brigham and our whole healthcare system, all of Partners graduate medical education and we reminisced of it, she's about my vintage, that medical education now is a career path. When we started in it, it was really volunteer work and a bit of inspiration. So how do you forge that career path? Number one, I think you have to decide what is going to be your domain in medical education. So do you want to be known and develop leadership as a clinical teacher? Do you want to be a scholar, for instance, doing research on medical education and learning techniques? Or do you want to lead a division or a department? This is just an interesting article that I'm going to refer to, which shows that in a growing number, but yet inadequate to date, there are training opportunities within your residency or fellowships and even now about 94% have direct teaching classroom-based for how to be a clinical educator. In addition, we need to be able to understand what the curriculum needs are and we don't have time to go into all of this, but it's not just about knowing clinical skills and being able to impart them, but as others have spoken about, how to lead the group, how to lead your residents, how to lead your fellows through their educational process. So the other thing I think is interesting, let's just say you're now at the point where you're like, wow, this is what I'd like to do, this is my path. How do you get there and what are the resources? So I started just looking with Harvard as an example, but these exist at many other academic institutions, but give you sort of the lay of the land. Number one, you can decide to get a master's of science or a master's in medical education per se. In our institution, and I assume elsewhere, this is really a path to research in medical education leadership. There's a required thesis, it's a two-year process, and it can be for any type of medical professional, not necessarily just for physician tracks, but it's really meant for those who want to do research in the path of medical education leadership. The next opportunities are usually one-year fellowships in medical education. There's one, again, within our Harvard system, but multiple institutions across the country will offer these. And these are one-year fellowships after you've completed your clinical training and clinical fellowship, and it's specifically in providing you with techniques and expertise to develop your academic career in medical education. The other thing, again, there are multiple different levels, and I think it's important to understand this because not everyone wants to take a two-year fellowship or even a year to do this. Let's say you're embedded in an academic department and you want additional experiential learning. As an example, at our institution is the Harvard Macy Institute, and this is a group cohort model where you may be paired up with people from the business school or the School of Graduate School of Education in other fields, and you work together as a team over the course of many months to learn strategies and teamwork in medical education leadership. This does not require a full year or even two years, and it's experientially based and mostly for people who are already in early academic careers. Also within your respective institutions, there are generally ongoing workshops that you can participate in. So once you've been defined, you're in your role in education for your fellowship or your residency, then where do you go? How do you learn about giving feedback or how to submit your applications for the fellowship or residency? And there's generally robust offerings within an academic institution. Continuing down this pathway as well, there are specific logistic items you need to know if you're going to start a fellowship or start a residency, and those are clearly outlined in the ACGME website, and there's plenty of materials. You'll also need a very skilled program coordinator, and I certainly learned a lot over the years from our program coordinators as well. And then continuing again down this path, all that I've spoken to you about thus far have been leadership paths for medical education in general. Then we went on to the institutional level, and then of course by our specialty. So again, if you decide that educational leadership is what you want, our own academic Physiatry Association has multiple paths, courses, and support for leadership development. To that end, I just want to thank you for giving me this time and opportunity to address you, and I will turn it over now to Dr. Kathy Bell. Thank you. And again, I'm, don't seem to, oh there I am. I'm very happy, Brandy, that you asked me to be here today, and I somehow missed the memo about about having anything about my own career in here. I did not, I did however, get the memo about wearing my t-shirt for Physiatry Day today, so I apologize for not being dressed up, but you know, guys, I'm a physiatrist. Although let me, let me throw a few things in there, because I do think that as you're looking at making career plans and looking at career development, realize that one of the beauties I think about physiatry is that you can have a little bit of a wandering pathway, and it works out pretty well. I was a nurse before I went to medical school, and then got into PM&R, and much like Brandy, I was also in private practice for about five years at one point in my career when I had multiple little children. And the other things that I had to make some decisions on when I was starting off early in my career was basically where I was going to spend my volunteer pennies, because I agree that with with young children and growing family, being in private practice for a period of time, even being in academics, I found that it was impossible for me to do absolutely everything, and that's why I kind of chose to become involved in the Academy as my professional home, and to really work in that in that area rather than some of the other societies that we have. So what I'm going to talk about a little bit today is is some of the opportunities that exist for leadership development in both in physical medicine, rehabilitation, and just kind of generally. And part of this will be for those just for physiatrists, and part will be for academics. So first I'm, whoops, didn't work. First I'm going to talk a little bit about the work we've done in the AAPM&R to develop opportunities to learn leadership. We first of all started the future leaders program, which I'll talk about a little bit. We have coming up in the spring of 2022, our business and administration program, and we have debuting, we hope, in the summer of 2021, our medical directorship program. I had the the great joy of working with Dave Welch and Margaret Keating back in 2012 to develop the future leaders program at the Academy, and this is basically a program that's looking specifically at physiatrists between three and ten years out of their residency training to help them develop leadership skills, particularly aimed at volunteer leadership and physiatric leadership. And one of the things you'll note of all the programs I'm going to talk about, they all are different. They're all leadership programs. They're all different. So you have to look carefully at what you want to accomplish before you sign up for a leadership program. This is a two-year curriculum. There is an introduction to association slash volunteer leadership, which is very, very different from running a department. Strategic planning, media skills, advocacy, and governance of the Academy and volunteer organizations. It's a fabulous program. There are ten candidates that are chosen every year. A lot of effort is put into diversity in this group of ten. We look at geographic diversity, gender, minority, type of practice, area of specialty to try to get a really diverse group of physiatrists to work together. Okay. The other thing that we're working on right now, which we had hoped to initiate this year, but we've made the decision that we're going to delay it by a year because we feel very, very strongly that some of the opportunities for in-person development and networking that we're building into this business and administration program are really the heart and soul of the program. And so it's just going to be put off for a year. But the Academy is partnering with the Kellogg School of Management at Northwestern University to put together a business and administrative program that really is aimed at physiatry. It's designed by physiatrists and it's all of the parts of the courses that are going to be taught are going to be taught with physiatry in mind. And it's looking at physiatric leadership roles in health systems and multidisciplinary or large practices in the community and in national levels and in academics as well. But this is a really broad program. There'll be a mixture of in-person intensives and web-based learning modules, as well as mentoring. Specifically, you can see some of the things that will be...course. We're hoping that everybody will have a published white paper at the end of their tenure in this course and an administrative case study. Bill Adair has been a great partner to work on in terms of leading this development and the folks at the Kellogg School of Business have been terrific as well. So I did want to say, if you're really interested in...one of the things we were going to work on second was the medical directorship program. But we decided that this was something that was really crucial and we were going to pull this out and have it go live before we did the business and administration program. So we have a special course specifically aimed at developing medical directors among physiatrists. And this will be looking at medical directorship in intensive inpatient rehab units, in SNFs, LTACs, or in home healthcare agencies. So in all those areas where we practice. We've been helped by a wonderful group of providers who work in all of these fields, including Charlotte Smith and Jean Deleon and Dominique Vaughn, as well as Bill. And we're looking at really looking at things like legal issues, team building, regulatory problems, giving people all the tools they need to go and be a really successful medical director. I think we're seeing a lot of people kind of wander into medical directorships these days. And frankly, you kind of get pushed around by the organization if you don't know what you're doing and you don't have a goal and a plan. I want to talk a few minutes about, I know Joanne mentioned a little bit about the AAP program for academic leadership or the PAL program. Again, this is a different focus as opposed to looking at a volunteer community organization. This is looking specifically at academic leadership. And it's a three year program that looks at academic department administration, teaching and education, and then research. This is a program that you have to be sponsored by your chair and your department actually has to commit to paying for your tuition to go to this program as well. It's a great course, again, for young physiatrists who are interested in an academic track. A lot of program directors go to this course and it does teach you a lot of the, exposes you to a lot of people as well as networking and people sharing their skills in this program. So a lot of fun and a lot of work, but a lot of fun. And you will learn how to look at those profit and loss sheets in this program as well. Now, there are some other organizations that also have opportunities. For instance, the AAMC has a number of opportunities for people who are in academic medicine. If you're looking at, for instance, trying to grow into something maybe not only in your department, but perhaps in your medical school at large. So they have some specific early career programs for leadership and management for specifically early career women faculty. They also have a minority faculty leadership development as well, and a certificate program. So a great thing to look into if you're looking at potentially looking at the bigger world of academic medicine. They have specific mid-career opportunities. I actually attended the mid-career women faculty leadership course, found it very valuable to be able to network with people outside of my field to really get an idea of what was happening in the larger world of academic medicine. And there's an executive level as well. When you get to the point where you're an advanced, looking at advanced opportunities, department chairs, associate deans, even deans of medical schools, there's some great training programs again. And I'm hoping that some people are going to look at delving into this in the future. We don't have too many people to go into this. I know Larry Robinson was an associate dean at University of Washington. Jim McDevitt has gone into a health systems position down in Houston. So I know some people get into this, and I'd love to see more of us doing this. Also, you should know about, if you're a woman academic, you should know about the executive leadership and academic medicine or ELAM program. This is a program that's been around for probably 20 years now, which is a really intensive fellowship training with coaching, networking, and mentoring that's really aimed at improving the national footprint for qualified women candidates to achieve leadership. Looking for people who are primarily at the advanced associate or full professor level, very competitive to get into this, have to be nominated by your dean or your CEO. But it's a great program, and again, very national in scope. Lots of other executive training programs exist. There's certainly the Harvard program for women's leadership run by Julie Silver. All the big name universities have leadership programs at one type or another. Again, as others have said, you could look at other programs like a master's of health administration. There are a number of MBAs now with healthcare focus. Also, certificate programs and things like healthcare administration. So thinking about why you want to get these kind of leadership skills will hopefully help you choose the right program. Thank you. And I think I get to toss the baton or the mic back to Brandy. Wow, what a fantastic smorgasbord of information everyone just got to dine on. So thanks so much for all of our panelists for providing those fantastic pearls of wisdom and guidance. I tried to answer some questions along the way, but Dr. Bell, there was two questions that came through, which were more specific for you. And they're both from Dr. Querubin. One is the Kellogg program recommended for individuals that already have an MBA? That's a really interesting question. And I don't think anybody's brought that up. But it's not in and of itself an MBA program, although some of the courses involved can be applied to an MBA at Kellogg if you want to pursue that. But it really was looking at the physiatric slant on business and administration as opposed to kind of a general MBA or even a healthcare MBA. So it will be different. And the other question he had was, is the medical directorship open to senior residents like a PGY-3 or a PGY-4, or only for those who have already completed residency? Boy, that's a really great question. And I honestly don't even know if we discussed that. But I don't really see any reason that it wouldn't be open to a senior resident. The whole idea is to get physiatrists to be well-trained. We're moving into the post-acute area and areas outside of the IPR. And it's really important for people to understand those areas and understand how to work with things like for-profit companies and chains and that sort of thing. You don't really learn that in residency. And so I don't see that there would be any problem. It's some work. There's some work involved. That's my only issue, I think, with having probably residents participate is that there is a bit of a challenge in being a resident and trying to do a program like that as well. But what the heck, if you got the energy, go for it. That's great. And I think the medical directorship program you discussed would be appropriate for new medical directors, whether they're in academics or private practice. Is that correct? That's absolutely correct. It's not meant for academics. It's meant for medical directorships across the board for physiatrists. Wonderful. And I'll also say thank you, Dr. Deck. If those of you are following along the Q&A, Dr. Deck has very graciously put her email address there in the Q&A. If people have additional questions, I know we're running low on time. But I also wanted to include from the Academy for all of you, I'm checking my phone here for my updates. CME is very important and we want you to get the CME that you've earned for attending this presentation. And they've had a little bit of a slowdown in how the CME is being delivered. The CME questionnaire is being delivered to everyone. So there's very high volume and we want to make sure that you get it. But rest assured that all of your sessions are being counted and recorded. And once they've figured out the glitch to get that out to everyone, you will get the information so that you can get credit for this. And we're running right up to our one o'clock. We're at 101, according to my timer here. So thank you to everyone. If you have additional questions, you can reach out to us through our connections on the AAPM and our website. Or you can look to Dr. Deck's email address there. So thanks. And we are really excited about this next generation and continuing generations of leaders that we have here in physiatry. So take care, everyone. Bye.

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