Okay, well, welcome, everyone, to our Wound Community Session today. Basically, we are going to be talking about the need for physiatrists to get involved in training the next generation of wound care physicians. We are very pleased to have you join us today. I hope to see many of you in the actual in-person meeting, which is on October 20th. It's room 311. We have added that to the chat box, and please feel free to put your questions or comments in the chat. We will monitor that, and we'll give everybody ample time to do a discussion or question and answers. So I'll start by giving some background and our objectives today. So I'm Dr. Aslam. I'm the Chief of Physical Medicine and Rehab at Yale School of Medicine. I also have started a Wound Medicine Fellowship, and I'm the Program Director. I'm also Medical Director of Yale New Haven Health Wound Care. So our objectives for today are discuss the measurable impact of complex wound care training on patient outcomes and medical economics, identify the obligation and opportunity for physiatry involvement in advanced training in the care of chronic wounds, discuss present training available or lack thereof, provide direction on the implementation of advanced education in chronic wound care, specifically a wound fellowship under the mantle of physical medicine and rehabilitation. So just to give you an idea of what the magnitude of the burden of chronic wounds is in the U.S., these are some statistics available from 2019, that there were 3.5 million breast cancer cases, so 6 million heart failure cases. In comparison, in an analysis of Medicare beneficiaries in 2018, 8.2 million beneficiaries were with wounds with or without infection. And another analysis that amounts to about 14.5% of Medicare patients, which is very significant. What does it amount to in dollars? So the Medicare cost projection for the treatment of acute and chronic wounds is between $30 to over $90 billion. Management of diabetic foot ulcers costs about $9 to $13 billion in the U.S. And venous ulcer cost is $2.5 billion. Notice these are all billion. And that also accounts for about loss of 4.6 million birthdays per year. In comparison, the spending on breast cancer is $20 billion. The cost and the burden of chronic wounds is expected to increase as we have increase in aging population and increase in the epidemic of obesity and diabetes. We all know, if we take care of wound patients, how complex this patient is as a whole. They have multiple medical problems. They are affected by the chronic wound psychologically. Many of them have chronic pain. In addition to chronic wounds, which is, you can imagine, as I did, the typical chronic pain patient had a chronic wound, it's a double whammy there. They are disabled. And they are always associated most of the time, mainly the patients we see in our wound center, I think about 50% have social determinants of health. That's my observation. In addition to the complexity of the patient in and of itself, the wound environment of a chronic wound is extremely complex. And over the last few decades, the advancement in wound science has brought to us knowledge about transmitters, biological markers, transcription factors, all in the environment of the chronic wound, knowledge about genetics and how that affects wound healing. And we are going deeper and deeper into the complexity of the chronic wound at a nano level. We all know that there are comorbidities that affect wounds. We know about diabetes and vascular insufficiency. However, now what we are learning is that there is a complex interplay of biological systems, multiple sometimes, with the chronic wound environment, and that interplay affects the healing of the wound. As an example of the complexity of this, this was a presentation on neuroinflammation in wounds recently into 2021 by Rivka Iserov, Dr. Rivka Iserov, who's in University of California, Texas, and her lab has been working on this for about past 10 years, where they're looking at the effects of stress hormones on wound healing. Not only have they found that the stress hormones, and see from that pointer you can see, the stress hormones interact with receptors in the skin next to chronic wounds, and that interaction leads to many downstream effects, mainly decrease in keratinocyte migration and re-epithelization, increase in inflammation, decreased collagen synthesis, decreased stem cell differentiation and migration, all leading to non-healing of the wound. In addition, they found that when there is wounding of tissue or trauma to the tissue in the wound environment itself, in the edges, there is an increased level of the stress hormones, or epinephrine, or catecholamine, which adds to this inhibitory effect of the catecholamines on non-healing. This is a work of Ivan Hozik from University of Miami, who presented this at the SAWC in 2021. And they have shown many, at a level of molecular pathways and interactions of receptors and proteins, but mainly has shown how these mechanisms affect wound healing when you address cholesterol. They have shown that there is increase in cholesterol in non-healing wounds, both diabetic foot ulcers and venous ulcers, and in healing ulcers, the cholesterol production is less. So when you use cholesterol depleting agents, you actually improve wound healing. So in order to understand wounds and be able to treat wounds, you have to understand the complex clinical and biochemical pathways underlying the development of chronic wounds. And understanding of these mechanisms is very important to practice evidence-based and outcome-driven wound medicine. Now we know that physiatry is a multidisciplinary field, where we are the gel that brings many fields together in the care of our patient. And we often are leaders in those multidisciplinary teams. It has been shown in many clinical trials that multidisciplinary care affects wound healing in a positive way. It decreases healing times, it decreases amputations, the rate of amputations, as well as decreases cost. I took this from, if you put physiatry.com, if anybody wants to know what a physiatrist does, this is available on this website. And it was interesting how they define physiatry. And it says, physiatrists use their in-depth understanding, how all the body systems are connected, to customize minimally invasive treatments and optimize rehabilitation, often at a lower overall cost. They further describe how we practice, that we have a whole body focus, we have personalized treatment, team approach, we are minimally invasive, and we are outcome oriented. And I think these three are the key that makes us very well positioned to be successful wound physicians. It is in our scope of practice, as in these items I have described here at the website of ABPMNR, that it is in our scope of practice. It also includes that wound care drives quality improvement in physiatric care and inpatient rehabilitation. In member council survey results, wound care was one of the top clinical topic themes. And complex wounds is included in the conditions treated by a physiatrist, according to ABPMNR. In our academy website, with conditions treated, complex wounds is listed, but in addition there is, in this list is venous insufficiency, lymphedema, chronic pain, which we all see in wound patients. We are well positioned to take care of these patients. I think it is a great opportunity for physiatrists. We are also obliged, I think, to take part and contribute to training in wound care. However, we have not done a good job as physiatrists or in our academy to give a proper direction of training in this field. In our medical student roadmap towards PMNR, it says if they want to learn wound, they have to go to dermatology. I don't think that will suffice to learn about the complexity of the wounds. And PMNR residency recommendations are rotation in a wound care center. A rotation in a wound care center, which is a week or maximum four weeks, will not really cover the whole spectrum of knowledge that is needed to be a successful wound care physician. So there is definitely lack of education and there is definitely an opportunity for us. With that, I will turn it on over to Dr. Rosenberg and I will stop sharing. We'll take questions in the end. Dr. Rosenberg, you're still muted. There we go. Okay, are you getting the full slide on this? Yes. Okay. So you're not getting, you're getting the full slideshow right now. Okay, good. No, you're not in slideshow mode. You can click the slideshow icon down at the bottom. At the bottom? Right here, right here, under the M. Let me, it worked before. Is that, I'm sorry, I'm gonna need some assistance here because it is not working on my screen. Yeah, yeah, I'm just wondering. Yeah, I wonder if it's showing presentation mode on a different screen. I think it's doing it on the wrong screen. Let me stop sharing and try a different one. I'm sorry, I apologize. Okay. Are you seeing the full screen? Yes. Now it's working. You're good now. What? Yeah. You're good, you're good. Okay, I'm good to go. And I apologize for that. I am technologically incompetent, so I can't, that's one of my themes. But anyway, I wanna thank Dr. Oslem for coordinating this. This has been a passion of mine and I know it's a passion of hers. I'm Dr. Sandra Rosenberg. I am a founding diplomat of the American Board of Wound Medicine and Surgery, which I will talk about a little bit what that is. I've been doing wound care and swelling for about 30 years now. I'm an assistant professor in front rehab medicine, adjunct professor in the Department of Family Practice and the Family Medicine Community Health at the University of Minnesota, and also the Medical Director of the Wound Fellowship Program. So I'm gonna talk about why, again, PM&R is so important in looking at wounds. First of all, we are trained in attention to detail with a multimodal patient. As Dr. Oslem so aptly put, these are extremely complex patients. And that's what we do. We do chronic care with extremely complex patients. We are proficient in understanding the neuromuscular skeletal system, which has become very important in treating wounds. In fact, I, right now I'm lecturing, actually I'm at the American Association of, the American Venous Lymphatic Association. I'm lecturing here in New Orleans right now. And it is fascinating because they're really realizing how the neuromuscular system is part of wound care. Getting movement, getting range of motion, stopping perpetual recurrent injury. We're also specialists in chronic condition, and we look at maximization of function and quality of life. Again, as Dr. Oslem stated, we are expected to understand these complex wounds. It's part of our scope of practice, but we don't do well in instructing on how we're supposed to do this. There is a growing population in our world with severe complex needs, which is only getting more complex. The science is getting far more complex. And we are the experts in the multidisciplinary team approach that these patients so, so much need. Now that's very personal to me. I am, this is very personal to me because I have my, there's a woman that helped actually start the medical team approach, and it was started in rehabilitation. It was started actually at Albert Einstein Institute. It was started with Dr. Abramson was the main doctor. He's one of, if you know the history of PM&R, he's one of our gurus and godfathers. But the first multiple specialty medical team and working as a team to treat patients started here as a, on rehabilitation where they took one floor and did the team approach and another floor and did the regular doctor does the orders and everybody does it. And what they found as time went on is that the patients who had been in the multiple multi-specialty team group who had been treated that way did much better in function as time went on. Again, this is very personal to me because the mother, the person who started this and actually did the research and had the idea for it was my mother, and that is her. I'd always think it's interesting to look at these original papers because she's third listed on it. But 1963, she was the only woman on the team. So what is our present status in wound care training? Well, our present status isn't very good. We all think plastic surgery. Oh, they're the ones that do it. Well, I went and looked through all these different fellowships and residencies. This is not a big scientific study, but I just looked through fellowship after fellowship and residency said, what do these different specialties do? How do we train wound care? In plastic surgery, I could find that they do about six weeks in wound care and it's surgery. It's the flaps, et cetera. Family practice, none, nothing specific. They may have some electives and we do have some family practice residents coming through our program and rotating with us. Dermatology, they have wounds, they're the skin. Two weeks, that's the most I could find. In general surgery, they really don't get anything, maybe two weeks, depending on. PM&R, oh, we're the ones because that's part of our specialty. Yeah, we're not very good. In fact, again, as Dr. Oslem stated, we really don't have any specific requirements and very few people even have electives in their programs. Medical school, we're pretty lousy too. Less than 9.2 hours on average in four years. Again, just to say it in another way, in 2014, Yim did a study looking at how many medical schools train. Out of 55 medical schools, only seven had any elective in wound care. Again, the training, he was the one who looked at it. The average was 9.2 hours of training in four years of medical school. In 1997, Khmira did a study looking at, and it was a survey in family practice because everybody, you know, that's where they come. 99% of the family practitioners surveyed felt responsible for pressure injuries. Yet over 70% felt inadequately trained. That's really scary. And if you look at any injury of the other alterations or injuries to the skin, again, it's the same problem. And we talked about plastic surgery. Now in rehab, we have looked at this. Again, this is part of our scope of practice. And it has been found that about 5% of patients on inpatient unit have pressure injuries. 25 to 66% of spinal cord injuries will end up having pressure injuries. And even in the traumatic brain injury group, anywhere from 7 to 16%, depending on how long they've been there. What was really interesting me at looking at this literature, we're responsible for pressure ulcers and wounds, lymphedema, venous insufficiency. Yet I could find no literature out on these rehab units in these patient populations that we treat with traumatic brain injury, spinal cord injury, general rehab, et cetera. Many of them with many complicated comorbidities. I could not find anything on any other type of wound. Yet in the outpatient clinics, when we see wound patients, 70 to 80% of them are lower extremity venal lymphatic wounds. Now you cannot tell me that this guy who fell on his head and with his arm like that, probably doesn't have some other traumatic wounds which may be having problems healing. Same thing with the spinal cord injuries, et cetera. So again, this is a big piece that we're missing. In 2018, the American Academy of PM&R, we asked them if as the American Board of Wound Medicine Surgery, which Dr. Aslam and I are both on the board of directors, and I'll tell you more about that, but we wanted to find out in physical medicine rehab, how many people were even interested in this? I will say that we actually are a large community as the wound care community is. But we did a survey. Now this survey only went on, on our site for one week. And that was it. We did get 120 responses, which actually was good. And obviously this is somewhat jaded because people might've seen surveys, seen wounds, and said, oh, I'm interested in that. So I'll answer the survey. But out of the people that answered, out of the 121, when we asked them to describe their interest in wound care, 53% said they were very or extremely interested. What was the percentage of the patients that required wound care? 36% of the survey, people who answered the survey, said over 25% of their patients were in wound care. But you know what, 72% of people said over 10%. Now, when we asked if they were interested in further training, 45% of the respondents said they were very or extremely interested. 57% said they were at least somewhat interested, if not more. Now, would PM&R be enhanced by offering subspecialty in wound care? Yep, 74% said yes. But we've dropped the bomb. And in fact, what has happened is a lot of other areas of medicine and providers of healthcare have tried to pick up the pieces. And they've done something, because we haven't done it. We've really neglected this area. And so if you look at a lot of wound care program stuff and a lot of training, it's done PTs, OTAs, RNs, everybody says WOCNs, they can be very, very helpful adjuvants and part of our wound care team. But again, as I said, as Dr. Aslam also said, with the technical and the scientific complexity of these patients, with all the biochemical and clinical complexities involved, it really needs the highest level of training possible to be able and detailed, to be able to have the chance of these very complex wounds to heal. If you look at these people on this list, in fact, only three of them can even get an ankle brachial indices. Only three of them can ever get a hemoglobin A1C. We know for instance, in the wound, if diabetes is not controlled, the hemoglobin takes up the glucose and can take up the oxygen and give oxygen to these wounds. So they don't heal on top of the microvascular disease. There are so many other pieces. So when you don't do those and you're not looking at that, your healing is not gonna be as good. And it's not as good for our patients. Now there are a number of different certifications in wound care that are available. And a lot of people, and I will tell you nothing is truly recognized, except for, and I will say the wound care nurses, and they are recognized. But let's look at what the education is of these. Cause everybody says they're certified. And I often say, well, I don't know what that means. The Wound Care Education Institute, which is right here, is an online course for eligible professionals. It's all the same, whether you're an RN, LPN, PA, PTA, PT, OT, OTA, MDD, or DPM. And it's 25 hours of online course in CME credits, 25 hours. I will say the fellows that we are training after being board certified in their main specialty is close to 2000 hours of wound care training. VORA, which is really a surgeon's group, that's 22 hours of online training to be certified. WOCNs have a number of different levels of training, but they probably do more. They do have 60, but they only are required for the WTA program, 16 hours of training and under clinical supervision. The National Alliance of Wound Care and Osteomy has a number of different things, but it's mainly any licensed healthcare professional. It's online and they are supposed to do active wound care management education or research while actively licensed for two years full-time or four years part-time within the past five years. But we don't know what that means. The American Board of Wound Medicine has, a wound management has tried to do different levels of specialty training. Their highest level is MDDODPM, requiring three years of clinical wound care experience and taking a 75 question test. Now, another one has come along with is the lymphedema, International Lymphedema and Wound Training Institute, which has been going on for about two years. And now that's to get lymphedema therapists so they can do wound care and trained in wound care and even run programs. That is 30 hours of online pre-course work and 20 hours of onsite or remote live training. I don't know what that means. So that's a total of 50 hours. And they will license, or I will not say licensure, it's not a licensure, it's a certify, PTs, PTAs, OT, OTA, MD, DO, DPM, PA, NB or RN, same test. That is why the American Board of Wound Medicine Surgery has started. And we started, it was started by Richard Simons who's a plastic surgeon. And it was to say, wait a second, doctors have to get much more training in this. And we have to show which doctors know what the heck they're doing so we can really get the most advanced level of care for these patients and coordinate this team and get these wounds healed better because we're not doing a good job. And what he has been working for, and again, Dr. Aslam and I am on the board of directors. This is a multidisciplinary group. There's vascular surgery, plastic surgery, emergency medicine, hyperbaric oxygen specialists, et cetera, lots, infectious disease, we've had it all. And it is really to get what do we really need to know to coordinate really good and give excellent wound care at the highest level. And it's only, it is a test that is only for MDs and DOs. Why? Because we wanna get recognized as a subspecialty by the American Board of Medical Specialties and or the American Osteopathic Association. That makes a huge difference in recognition. It makes a huge difference in billing. It makes a huge difference in running programs. And it says, yes, these people know what they're doing. People ask why not DPMs? Because podiatrists, if you have a podiatrist that you're certifying also, the American Board of Medical Specialties and AOA will not allow you to become a subspecialty. It can be MDs and DOs only, which makes sense as podiatrists are, and we have wonderful podiatrists at our wound center, really just fantastic, and I love them, but they can't heal anything in any state, I believe, above the knee. Well, we see wounds, a lot of them above the knee. So when we looked at this need for wound care, the M Health Fairview System, University of Minnesota Medical School, we got together and said, okay, what do we need to do to get these doctors educated so we can give the highest quality of care for our patients because we're gonna have to start educating these people because the education isn't there. And we wanted a seamless system of the organization through real nice continuum health care. We wanted it multidisciplinary, multi-specialty because we know we needed that providing the highest standard of clinical patient care. These patients take the whole community. It takes a village. We wanted to expand research and academic clinical opportunities and hopefully eventually become a national international center for wound care. So how did we do this? Well, it's getting this wound care fellowship started with a physician-directed advanced training. Department of Rehabilitation Medicine. Again, we're the team experts, and I went to Dr. Morse, who is the chair of Rehabilitation Medicine, and she'll be speaking after me, and she has been a godsend. She has been a supporter. She has kept me on track, and I will say sometimes I'm not. So she does a great job of that. So we worked with her and she helped me get this started. She's been awesome. We have to work within our whole system. We are a combined system of M Health Fairview and the University of Minnesota Medical School. We had to work. We wanted to, through the Minnesota Medical School, we had to go through ACGME guidelines, even though this is not a ACGME accredited fellowship. Why? Because it's not recognized as a subspecialty yet. But we wanted those guidelines because the University of Minnesota also requires, and I think that is good, that once we do get accredited, if and when we do, we will be able to be officially ACGME. We looked at the AOA-ABMS guidelines and requirements for fellowships, and I worked definitely with the American Board of Wound Medicine Surgery, which is that board I was talking about. That board has developed a commission on wound care fellowships. And this has been awesome because what it does is allows the program directors of people who want to start these fellowships and get these going to meet together. We meet and we wanna have a standard that it's not just people start a fellowship and somebody follows one doctor around for a year and oh, they're a fellow. No, we want a very high quality fellowship where there's multidisciplinary and we get together and we talk about it and we're trying to get some standards, et cetera. And this is multidisciplinary. This is not just within rehab. But that has been awesome and you're welcome. We welcome anybody who wants to join us. Again, it was working very, very coordinated with a multidisciplinary, multispecial advanced wound care with multiple, multiple different departments. That's what it takes. And these are all the different departments I had to coordinate with and I'm still coordinating to develop the fellowship. And we got the fellowship started. And what we had to do is really look at, what I had to do is look at sustainability and adaptability. And when we talk about that, because our fellows come from all different departments, all different specialties. In fact, the fellow Dr. Amy Kaufman, who will be talking here, is internal medicine and vascular medicine boarded. I had to be able to be flexible about the schedule on what her needs were. And she will talk about that also. Her schedule, this is what it looks like. She's doing a lot of the wound kit. She's doing the wound care clinics regularly. She's also being with PMNR, because again, this is a PMNR focus and learning about neuromuscular skeletal disease and how the teams work, et cetera. We have her and she's been going through plastic surgery, podiatry. She's spending right now on hyperbaric medicine. Again, sometime on podiatry, infectious disease, vascular medicine, podiatry. If you notice the vascular medicine is very minimal. Why? Because that's not what her needs are. She can teach it. Hyperbaric medicine, again, dermatology. We're going to be working, she's going to be working with one of the experts in Bullock's disease, emergency medicine and burns. In addition, she's been doing work with, I have her at times with the orthotics and prosthetics to learn offloading, how you get people walking better as some of the orthotics, et cetera. Lymphedema treatments, knowing what the therapists do and also just therapy itself, how to get people moving, how to work on range of motion, how to lessen spasticity, how to decrease trauma to the legs and to the feet, et cetera. She does didactic work. She does, she's working actually on a research project right now. They've got the IRB they're working on. And I think that's almost, almost through. And again, personal study. So we're doing, she's doing a lot with that. We're also coordinating and coordinating working with this that she will get nutritional work also. Nutrition is a part of wound care that often is dismissed. It is extremely important in wound healing. We've learned more and more about this and there'll be some in the spring, she'll hopefully be working with one of our professors in nutrition with wound care. I'm also working on didactic time for her with pharmacology. A lot of medications can make wounds worse. Some of them can make it better. You need to understand them. Some of these you can change, some of them you can't. What's the most important requirements? Support, and again, I say thank you to Dr. Morse. Patience, which I don't have a lot of, so she has to redirect me a lot. Adaptability, flexibility and coordination. And believe me, you're gonna hit a lot of bumps and turns, but that's okay, they will happen. And I really have to thank Dr. Coffin because she, with her experience, she is able to also tell us this is working, this isn't. She understands she is our first fellow. So that's where we are. And now I'm going to hand it off to Dr. Leslie Morse. Thank you, Sandy. Let me share my screen. Okay, and do you see, do you see the full, do you see the full slide? Yes. All right, wonderful. Okay, so I am Leslie Morris. I'm head of the Department of Rehabilitation Medicine at the University of Minnesota in Minneapolis, and Drs. Rosenberg and Aslam asked me to, inviting me to participate in this, in this course, and to provide a department head perspective on the key elements that are required from a systems level to develop and implement a wound fellowship. So I'm going to give you some of the insights and some of the key issues and barriers that we've been addressing in this full first year of the fellowship, and I'm actually going to speak very briefly and then introduce Dr. Kaufman and then leave a bit more time for hopefully a robust panel discussion to answer and address any questions that the group on the call now may have. So, so establishing a wound fellowship at the systems level, M Health Fairview has a service line structure, and so for those that are familiar with this, we are a collaboration between an academic health care system and a community-based health care system, and we migrated to the service line structure about three and a half to four years ago, so it really had been in place for just over a year before the pandemic struck. And as you can imagine, wound impacts really all service lines, all medical specialties, all clinical programs, both inpatient and ambulatory, and in my opinion it's much like PM&R. Really, I often say that there are very few medical issues that do not in some way intersect or could be improved by the addition of a physiatrist, and similarly, you know, I think wound has a similar representation, and I think it makes tremendous sense to have wound care training, education, and clinical program development housed in PM&R because of many of the issues that have already been raised in terms of expertise, multidisciplinary approach, and presence across the system. Well, we also know that pressure injury prevention is a care quality measure. Many hospitals, all of our hospital systems are judged and ranked, and the ability to prevent pressure injury is one of the key measures, and so from a system's perspective, it's really important that we have additional resources, focus, time, and training opportunities dedicated to this if we want to improve and advance the quality of care. And then, you know, I think it goes without saying that long-term outcomes are improved with high quality wound care, from limb preservation to improved survival and reduced health care costs. So many, many reasons to increase focus, attention, and support of wound care nationally, really. But it's not so easy to establish a new fellowship, and it does require clinical collaborations are absolutely essential. The ability to navigate service line structure and clinical programmatic structure with some ease, it requires leadership collaboration and direction. In this first year, we've really drawn heavily on Dr. Rosenberg's networking ability and the relationships that she has built within the wound care community, and it requires a champion, and so Dr. Rosenberg is very passionate about this, has worked tirelessly on the national level, and really is invested. Without that level of investment and passion, it's really difficult to bring all of the key players together to sit around the table and decide how to bring key resources into play to be able to support this. In this service line, academic community center environment, I think having a departmental home or homes, so it could be a collaboration across one or more departments supporting this, but it is absolutely imperative. I think that there is some departmental direction and investment and investment leading this effort. How is this funded? Continuity Clinic with the ability to bill independently for the fellow, as this is not ACGME accredited currently, is one benefit, one way of supporting this. Dr. Rosenberg and I have also taken this program in this long-term vision to the dean to request medical school support, but ultimately, in the absence of clinical revenue that's generated or medical school support, it really falls to departmental support, which we are currently doing. We do that via academic transfer, so revenue, clinical revenue that's generated to support our academic mission is how we're supporting this currently. I talked about financial support, which is a key consideration, but then there is also operational support. In our environment, operational support falls to the service line level. That is everything from identifying clinic space, developing clinical templates for visits, staffing clinics appropriately. That's where the departmental and the service line collaboration is really essential. We discuss salary support for the fellow, but also administrative support in terms of a fellowship coordinator. There are dedicated resources for coordination that have to be in place to make this work long-term. Then, again, system support. It's really critical that key thought leaders and clinicians in the system come together and provide adequate access to patient populations and clinical opportunities to maximize the training experience. In that regard, I think this year or two-year run-in to the beginning of this fellowship has been a little bit like herding cats. Some level of indifference, some level of hostility, some level of agreeability, but it really does take somebody to try to pull all of that together and get everybody moving in the same direction. Again, we are really thrilled that we've had Dr. Rosenberg's vision and expertise and direction in launching this. It is currently housed in the Department of Rehabilitation Medicine. We are currently happy to be training our first fellow. As Dr. Rosenberg mentioned, this is not currently accredited because of the lack of subspecialty designation, but we did design the fellowship with the intention that it meets all of the requirements to move into an accredited state when that is possible. Then, obviously, development of curriculum and other related resources is key. With that, I am very pleased to introduce Dr. Amy Kaufman. She is board-certified in internal medicine and vascular medicine, and she is our first wound care fellow at the University of Minnesota in the Department of Rehabilitation Medicine. I have to say that I cannot think of a better person to step into this role as our first wound care fellow. I'm very pleased to have her in this position and to introduce her now. Hello, everyone. Thank you, Dr. Morse. As Dr. Morse mentioned, my name is Amy Kaufman, and I'm currently a fellow in wound medicine at the University of Minnesota. Dr. Rosenberg is my program director. As previously mentioned, I have a background in internal medicine as well as vascular medicine. During my training in vascular medicine, I learned the management of a wide spectrum of vascular diseases. During this time, I discovered that I especially enjoyed my time in the wound care clinic affiliated with my university, and I found it very rewarding to work with these patients. At the same time, I also realized how much I didn't know and how much I couldn't learn in just a half day a week during my prior training, particularly about non-vascular wound types. During this time, I was given an opportunity to further advance my training through the new Wound Medicine Fellowship at the University of Minnesota. I began this training in August of this year. So far, my training is going well. As Dr. Rosenberg showed you on her slides, my first month was introductory to a variety of services, which included wound care, physical medicine and rehabilitation, plastic surgery, podiatry, certified lymphedema therapy, prosthetics and orthotics. During this time, I've also had continuity clinic at one wound care center every Tuesday under Dr. Mark Moline. I think this is very beneficial for my training because I'm able to see the same patients every week, analyze how their treatment is going and make adjustments and course correct. My mentors at the University of Minnesota take a very thorough multidisciplinary approach in evaluating and managing patients, which is essential because these patients are usually very complex. My mentors also have a strong focus on the management of the associated lymphatic dysfunction that accompanies most wounds and many disease states. During this time, I've also been taught to always think about what is practical, what is doable, and equally important, what is affordable for the patient as this is frequently overlooked. I am currently rotating on hyperbaric medicine at Hennepin County, which has been an important piece of my training as I had minimal exposure to this before. As mentioned by Dr. Rosenberg, she has really factored in my background and my interests as well as my areas of knowledge deficit into my schedule. Accordingly, she's given me more time in hyperbarics, burns, dermatology, and physical medicine and rehabilitation, which are areas that I have minimal exposure to previously, and less time in vascular since I already feel strong in that area. I think this will make me a well-rounded wound care physician. I hope this fellowship will give me broad exposure and expertise in the management of wounds and lymphatic disease. I've been monitoring the chat so far, and so far we don't have any questions yet, but at this time we welcome any questions from the audience. Thank you for attending. Please feel free to ask questions, comments. We have time for a discussion. I will say, so I will ask, and you might want to do this also, Ramana, if anybody is interested in the fellowship, you're more than welcome to go to our website. We are still looking at fellows. So, and again, the University of Minnesota website, Department of Rehab Medicine, just look under fellowships. And how do you do it at Yale? How do you do it at Yale? So, Yale, it's actually still me. So, if anybody's interested, they should reach out to me, and I think I can put my email in the chat. Let me do that. Yep. Yes, I'll do mine too. Yeah, so that's my email. So, anybody who's interested in doing a fellowship or getting any direction of how we develop that, any guidance, please feel free to reach out to me. I will also be at the in-person networking session, and we can have discussions there. My first fellow has graduated. The second fellow had some other commitments to finish, so they'll be joining later this year. The first fellow actually graduated, did start a research project, is going to be finishing it, but has joined a regional wound center as their new director. So, a good, I think he was well-trained for that role, and hopefully will have great evidence-based driven practice and outcomes where he is. Okay. All right. No questions yet, but we thank you all for attending, and I want to thank all the speakers, Dr. Rosenberg, Dr. Morris, and especially Amy for joining the team and contributing to this community session. It has been recorded. Thank you so much for the comment. I received that from Kristen. It is being recorded, so you will be able to see it, and hopefully the other members of the Wound community will have access to it as well. So, everybody, if you're traveling to AAPMNR, safe travels. Hope to see you there, and everybody have a wonderful weekend, and thank you all again. Especially thank you to, hi, you have a question? No, I was just waving because, you know, it's nice for you guys not to just talk to boxes, and I wanted to just thank you. Thank you so much. That is really nice. Thank you so much for staying put and listening to us all, and I also wanted to do a special thanks to Lily. She's hidden behind that AAPMNR logo, who's been very helpful with all the technical difficulties we've had, has been really helpful in getting us all together and making this happen. So, thank you all, and have a wonderful weekend. Bye.

physiatrists

wound care physicians

chronic wounds

comprehensive care

wound healing

wound fellowships

education

patient outcomes

training programs