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PM&R Resident E-Newsletter

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September 2017

From Your Physiatrist in Training Council (PHiT)


Last Chance—Complete the Resident Census

The specialty of PM&R is quite broad. As you progress in your career, there are multiple practice paths you can take post-residency. AAPM&R would like to better understand the future plans of current PM&R residents to gain a sense of what the future might hold for the specialty.

Please click here to take our quick census, which should take no more than 7 minutes. In advance, thank you so much for your time and valuable insights!


The Role of Mesenchymal Stem Cells in Regenerative Medicine

Charles A. Odonkor, MD, MA
PGY4, Johns Hopkins University

Regenerative medicine has the potential to change how physicians treat tissue injury. This article discusses mesenchymal stem cells and the associated regulatory challenges of using them in clinical settings.

Regenerative medicine has been dubbed the vanguard of 21st century health care. This emerging field promises to be the next frontier in medicine with its emphasis on curing rather than treating injured or impaired tissues. It seeks to repair damaged tissues in vivo (in the living body) using techniques that trigger the intrinsic healing ability of tissues or organs. If the body is unable to heal itself, scientists can grow new tissues and organs in the lab using regenerative methods and subsequently implant them safely into the body.

Although previously considered radical, the basic concept of introducing live cells directly from a patient or from an outside source into the tissues or blood stream for a therapeutic outcome relies on old technology dating back to the mid-1950s. Half a century later with more advances in research techniques and tissue engineering, the elusive goal of regenerative tissues on-demand now seems within reach. Enter the mesenchymal stem cell, which has emerged as the sentinel conductor of the regenerative apparatus.

Mesenchymal stem cells (MSCs) are specialized cells within the body, originally named for their unique ability to morph into any other type of cell in the body. They can be found in every tissue and particularly reside adjacent to blood vessels. Here they go by a peculiar name: pericytes. When tissue injury occurs, blood vessels break down and release the pericytes at the site of injury. The detached pericytes, now MSCs, have specialized sensors that allow them to pick up on changes in the microenvironment of the injury site. MSCs then secrete factors, which stimulate injury repair and growth of replacement cells.

This fascinating modus operandi of MSCs is better encapsulated by a real-world analogy. Imagine the scene of a catastrophic event, say a major fire outbreak. Rescue personnel—the fire service, paramedics, and emergency rescue workers—are summoned to the scene. They put out the fire, rescue and stabilize survivors, survey the field, and intervene to mitigate any further damage, as well as clean up residual debris, and create a safe space for survivors, who may then be sent to the emergency room for further care.

The search and rescue system established by our social contract in everyday life is recapitulated beautifully by MSCs at the cellular level. When an injury occurs, MSCs release a protective film that blocks an overly-aggressive immune reaction, but they also make growth factors that promote angiogenesis—formation of new blood supply—block cell death and stimulate tissue specific progenitors to replace dead cells and prevent scar formation. If MSCs sense any bacteria around the injured area, they secrete powerful natural antibiotics, which kill the bacteria on contact. Some MSCs migrate into the wound itself and morph to replace the old cells. Being quintessential multi-taskers, MSCs stabilize the injured tissue, detoxify it, and set up the wound for regenerative repair in a complex process consisting of multiple phases. MSCs also have the unique ability to distinguish among foreign material and are able to sequester cell debris from the site of injury.

According to Arnold Caplan, PhD, a recognized expert in the cellular biology of MSCs and who originally coined the term MSCs, “these cells are so good at what they do. They are like nature’s own repair mechanics, or if you will, natural drug stores.” Caplan has proposed renaming MSCs as medicinal signaling cells. On February 17, 2017, I heard him speak in Broomsfield, Colorado, at the Annual Conference of the Interventional Orthopedics Foundation (IOF) on, “Raising the Bar in Interventional Regenerative Medicine.” The IOF provided grants for residents and trainees to participate in the conference, and I was fortunate to be one of the grant recipients. The meeting highlighted some major regulatory hurdles in creating and using combination stem cell-based tissue and gene therapies.

In the interest of public safety, the Food and Drug Administration (FDA) has a Public Health Safety Act, Section 351, which controls the licensing of biologic products and with strict regulations requiring researchers to submit an investigational new drug application to the FDA before any studies in human subjects can be initiated. They raise questions about the purity, potency, safety, and use of these cell-based therapies, including MSCs, in humans. Currently, products like platelet rich plasma, cord blood, allogenic fibroblasts, and other regenerative products have gained FDA approval for various clinical indications.

However, according to the department of Health & Human Services, one of the biggest challenges is the lack of cohesive government-driven funding for regenerative medicine. Although the industry has a potential $500 billion economic impact in annual revenues, most of the investments have come from the private sector. The disparity in funding could hamper fundamental research that is necessary to advance knowledge in the field. At present, researchers work in isolation and there are few cross-disciplinary research collaborations. While large-scale trials are needed, these are expensive for private companies to conduct and the shifting landscape of regulatory requirements often leads to confusion about expectations and acceptable uses of these products.

From a global perspective, some countries like Britain, Germany, Sweden, Japan, China, and Australia have started their own national initiatives in anticipation of making regenerative medicine a reality for their populations. To achieve the promise of MSCs as well as other cell- and tissue-based therapies in the United States, a more proactive federal initiative is needed. As research in the field continues to evolve, it remains evident that understanding how MSCs interact with each other and connect with blood vessels, which are needed for transporting nutrients and waste through tissues, would be key to mass producing, preserving, and engineering tissue- and organ-based therapies in the future.

Interested in learning more about regenerative medicine? Check out the Academy’s “Regenerative Medicine: Stem Cell Treatment in Osteoarthritis Office-Based Application” Skills Lab, held on October 11 at the 2017 Annual Assembly.


Cancer Rehabilitation—A Cancer Fellow’s Perspective

Megan Clark, MD
Cancer Fellow, the University of Kansas

Physiatrists who subspecialize in cancer rehabilitation are part of a growing group of physicians who work in the evaluation, diagnosis, and treatment of cancer patients. With the ever-evolving oncologic and surgical practices in the field of oncology, we continue to have improved patient survival rates. However, that survivorship does not necessarily come without increased symptom burden and functional deficits for the patient.

Physiatrists are working in a variety of settings and with a diverse patient population throughout their diagnosis, treatment, and beyond to assist in the management of symptoms, side effects, and functional improvement. Cancer rehabilitation is not necessarily a subspecialty that narrows your scope of practice, but rather focuses your patient population.

Physiatrists working with cancer patients can evaluate a head and neck cancer patient in the acute hospital following their >10-hour surgery to evaluation and treat significant deficits. Maybe they are consulted for an inpatient with a history of bone marrow transplant who has developed graft vs. host disease and is severely debilitated. That same doctor could be evaluating a breast cancer patient, prior to initiation of adjuvant chemo or surgical resection with lymph node biopsy to address potential neuromuscular side effect or assess their risk for lymphedema. That doctor could then meet with a patient who is at the end of their treatment options—has failed the chemo and radiation available, and has recurrence of their disease. The physiatrist can help to manage their symptom burden or possibly offer interventional pain options to restore some function and quality to their remaining time. However, these examples are just the beginning.

The opportunities for physiatrists to make meaningful impacts in the cancer population are continuing to grow, and our role in the oncology team is not only being recognized as useful but as a necessary part of the patient’s overall treatment plan.

Cancer rehabilitation fellowship programs can vary in their focus from acute treatment on the inpatient side to outpatient management, but all will further the skills obtained in residency, including diagnostic and treatment skills in neuromuscular medicine, pain management, musculoskeletal injuries, and functional complications associated with a particular cancer or the treatment of that cancer.

For those residents interested in pursuing a career in cancer rehabilitation, there are currently 4 fellowship opportunities available: MD Anderson (2 fellows), Memorial Sloan Kettering (2 fellows), University of Kansas (1 fellow), and Georgetown University (1 fellow). These programs will vary some in their focus (inpatient vs. outpatient) and some in the patient population that they see (MSK, procedural, neuromuscular, pain, etc.).

Another option for those interested in cancer rehabilitation is going on to a different fellowship (i.e., traumatic brain injury, spinal cord injury, pediatrics) and then focusing that practice on an oncologic-based patient group. This alternative fellowship training can still provide the additional knowledge and experience to assist with the management of the cancer population. For example, spinal metastasis in a prostate cancer patient can result in spinal cord injury symptoms and may be best served with a physician who has that additional SCI training. Many cancer patients also suffer from severe pain and the interventional pain management skills obtained in fellowship can still be applied in this population.

Lastly, a majority of the current leaders in the cancer rehab field have learned their practice as they have progressed in their career. No matter what training you receive in residency or fellowship, oncology is an ever-evolving specialty. A cancer rehab physiatrist will need to continue to research, study, and develop a relationship with local oncologists and surgeons to be able to best serve their patients in this ever-changing (but very fulfilling) field.

Learn more about cancer rehabilitation at the 2017 Annual Assembly. The “Cancer Rehabilitation Medicine” theme contains 13 sessions for you to explore.


Discussion on Cancer Rehabilitation Early Career and Fellowship with Dr. Ekta Gupta

KleinDr. Klein is a PGY4 resident physician in the Stanford PM&R program, and is vice president of the AAPM&R PHiT (Physiatrist in Training) Council.

 

 

GuptaDr. Gupta is an assistant professor of PM&R at UT MD Anderson Cancer Center and serves as co-secretary of the Cancer Rehabilitation Community Network. She is also presenting in The Physiatrist’s Role in Cancer Recovery: Helping Patients With Cancer-Distinct Impairments preconference course at the AAPM&R 2017 Annual Assembly.

 

Dr. Klein: Do you have any general comments on starting a career in cancer rehabilitation or the fellowship?

Dr. Gupta: In terms of being a resident, it depends on your exposure as well as interests. I was lucky to have the opportunity to shadow at MD Anderson when I was a resident. MD Anderson has an acute inpatient cancer rehab unit, which is unique, because it's the only one in the country. We get to work with many debilitated patients that may not necessarily fit into the 60% rule and diagnoses required for admission to an acute inpatient rehab unit. For someone who is training, it's important to see the sickest of the sick in terms of management and care, even if you don’t see that on your everyday practice. With this exposure, you understand what could occur, so you know how to help improve the strength, quality of life and function for those patients who have lasting effects from cancer or its treatments, like steroid myopathy, lymphedema, and graft versus host disease. Saying that, it is not necessary to see cancer patients in your current residency to pursue it as a career. Having a desire to treat cancer patients is the most important.

I went straight from residency into my job, and I have a huge advantage of having experienced partners that are always willing to impart advice and share knowledge regarding the management of our cancer patients. The fellowship provides a comprehensive experience in terms of learning about different types of cancer and following impairments and disabilities. During fellowship, you have lectures to learn about prognosis, treatments, and related side effects that are ongoing in all areas of oncology. The oncology field is constantly changing, and it is often different than what we learned in medical school. Most PM&R residents lack real exposure to oncology. If you can devote that year to fellowship, you learn about the impact of treatment on prognosis, and how the disease and side effects play a big part in your patient’s function and quality of life. You learn when it’s appropriate to do an injection that we may not think twice about in a general population. You also learn to predict the level of return of function we expect for these patients from experts in the field. That said, treatments are always changing, there’s always new clinical trials out there, so you’re constantly learning on the job as well.

 

Dr. Klein: What inspired you to work in cancer rehab?

Dr. Gupta: I always had an interest in cancer and its effects. I'm from Houston, and I had the opportunity to do a summer research internship at UT MD Anderson in both college and in medical school. I fell in love with PM&R in my 4th year of medical school at Northwestern. When I returned to Baylor in Houston for residency, one of my co-residents the year above me told me about cancer rehabilitation and fellowship opportunities. When I realized it was an option, I was very intrigued and wanted to pursue it. I was interested to learn about the difference we made in the cancer population. 

 

Dr. Klein: What do you find to be most satisfying about what you’re doing?

Dr. Gupta: I really enjoy working on our acute inpatient rehab unit. As many of you know, the inpatient unit allows us to optimize medications, function, quality of life, and the transition to home in an inpatient environment. An interdisciplinary team with physical, occupational and speech therapists, nurses, psychologists, case managers, and social workers allows us to really make an impact on how patients adjust to their diagnosis, treatment, and side effects of cancer. It’s not always a happy ending; there are some patients who have to transfer back to primary medical teams for acute medical management and some patients who pass away. However, I’ve also had it the other way around. For some, I really wasn’t sure how they would adjust to life outside of the unit, and they come back to my outpatient clinic showing how we helped them reach their functional needs. They have returned to work, or they’re successful in what they want to be or do. It’s very gratifying to see that. In this patient population, society says “oh you have cancer, it’s the end of your life,” but it’s truly not. There’s a lot to live for, adjust to, and be happy with. I’m honored to help these patients achieve this.

 

Dr. Klein: What makes cancer rehab unique and what are some services offered that are unique to the specialty?

Dr. Gupta: Cancer rehab includes every rehab diagnosis we learn about in training, with an added component of dynamic change with cancer. Our goal is to optimize function and quality of life in patients dealing with the effects of the cancer and its treatments including chemotherapy, immunotherapy, and other investigational drugs. Hopefully we can reduce side effects causing physical and mental issues, and increase function and strength. There are some cancers that go into remission or there's no evidence of disease, and others that are always evolving with new metastases or effects. While we see spinal cord injury and deficits from brain tumors such as spastic hemiparesis, our rehabilitation treatment plans can differ compared to traumatic injuries. Through experience, I have realized that the recovery is different in terms of the return of function and spasticity management.

There is a variety of unique services. To name a few, lymphedema management is an integral part of care, and we work very closely with physical and occupational therapy to help diagnose, treat, and manage this. Head and neck cancers and their treatments cause very specific impairments, and we work closely with speech therapy on improving function after these. There is also complexity behind managing rehabilitation of patients with liquid tumors. Cancer-related fatigue is prominent, and rehabilitation has been shown to have a significant impact on improving this side effect. Thrombocytopenia affects the level of resistance and strengthening exercises that therapists are able to perform with patients. As a cancer physiatrist, you have to have a comprehensive view of the patient’s cancer, treatment-related side effects, medical comorbidities, and then come up with an optimal treatment plan.

 

Dr. Klein: Where do you think this subspecialty is going? 

Dr. Gupta: It’s growing and it’s growing quickly. There are many avenues to explore and relationships to build. Certain oncologists and surgeons recognize the impact of cancer rehabilitation more than others, and I’m hoping we will be able to develop relationships with all oncologists and surgeons to truly optimize patient care. Nationally, steps are being taken by prominent members of the field to develop relationships with organizations and communities as well.

By educating the providers, we hope to impact the amount and quality of patient information that's out there. It’s a simultaneous process. A major focus of the AAPM&R Cancer Rehab Community Network is both patient and provider education, focusing on avenues to explain our role in the cancer continuum. 

Research is key. AAPM&R as well as ACRM (American Congress of Rehabilitation Medicine) are doing many projects focusing on research and development in different areas of cancer rehabilitation. There’s work on a Cochrane review looking at head and neck cancers and the physiatrist’s role. Our community network is also doing a survey to see how cancer rehabilitation is practiced, and there is a trial involving centers around the U.S. looking at functional metrics that can hopefully be used to standardize impact of care in the future. In addition, I know that most cancer rehabilitation physiatrists do research daily at their institutions to help advance our field.

 

Dr. Klein: What kinds of settings have people worked in once they’ve gotten training in cancer rehab?

Dr. Gupta: There are several opportunities with both academic and private practice options. MD Anderson’s fellowship often focuses on teaching a comprehensive understanding to developing a cancer rehabilitation practice, and many of our prior fellows have started new programs at academic institutions. There is also a definite need for private practice cancer physiatrists. Some residents with interventional exposure go on to have a procedural practice. Some go into long-term acute care or work in nursing facilities, where a large amount of cancer patients are often sent to for strengthening and return of function with cancer-related fatigue and other impairments. There’s quite a variety of avenues. We need to realize that these patients are there, and we need to figure out how to get them access to care in each setting. 

 

Dr. Klein: What do you think are some character traits in an excellent cancer rehab practitioner?

Dr. Gupta: Patience and integrity are quite important, as well as compassion. You make difficult decisions for patients suffering from cancer and its effects, and sometimes it’s not what a patient wants to hear. A strong knowledge base is key as well. Because of the evolving nature of cancer, we have to remember treatment and functional plans are different than stroke or traumatic spinal cord injury. Sometimes optimizing a patient’s care at a lower level of function but the opportunity to be at home with their family equates to an improved quality of life, rather than staying in the acute inpatient rehabilitation unit despite functional potential.

 

Dr. Klein: For areas that do not have cancer rehab, how do you envision it fitting in and being developed with palliative and oncology services?

Dr. Gupta: In terms of starting a practice in areas that do not yet have formal cancer rehab, there’s a need everywhere. I always tell people that we work as an interdisciplinary team. When oncologists see what we do, they often say they didn’t know there was a physician who worked with such a team that could provide these services for their patients.  We provide components of care to manage symptoms, enhance quality of life, improve function, and optimize strength.

We have patients that are going into hospice, who are DNR/DNI, that still benefit with rehabilitation. Choosing to proceed to comfort measures only doesn’t equate to not having rehabilitation to optimize your care, to be happy during that time period, and be functional and do what you want to do. 

Palliative and rehabilitation have a significant crossover. We have providers that are double boarded in palliative and cancer rehab medicine. They're able to use their skills to improve the quality of life and symptom management. At MD Anderson, our department consists of palliative, rehabilitation, and integrated medicine. Working together, we realize the importance of rehabilitation for palliative patients. The techniques that we learn as rehabilitation physicians can be used to assist at end of life.

 

Dr. Klein: How would a resident who wants to pursue cancer rehab fellowship explore it further and optimize getting into a fellowship or position they want?

Dr. Gupta: Every fellowship wants to see that the resident has an interest in cancer rehabilitation and has a sense of where the field is heading. It’s not always easy to obtain hands-on experience, partially because of diagnoses qualifying for acute rehabilitation, but also due to lack of referrals as not everyone realizes how we impact care. Some residents are reaching out to oncologists on their own during residency and saying, “this patient population has needs that we can assist with,” and are offering to give talks on PM&R and cancer rehab.

If you have the option of doing an away rotation, I would consider this if you really don’t have exposure in residency. Doing other things on your own, like case reports of patients you see, and literature reviews can definitely make an impact. Genuine interest to impact the care provided to the cancer population is what we are all looking for. A great resource to find available fellowship opportunities is the AAPM&R Job and Fellowship Board.

 

Dr. Klein: Any other thoughts on the fellowship, for example, comparing palliative and cancer rehab fellowships?

Dr. Gupta: Our fellows in the program always say they wouldn’t trade the experience for anything. The people that do the fellowship understand how much there is to learn and appreciate the knowledge that they've gained. I know that one goal we are working toward is accreditation of the cancer rehab fellowship.

Between cancer rehabilitation and palliative, there are some differences. With your background of rehabilitation, you can bring the added component of functional improvement to your palliative patients. I do know a few people around the country that are double boarded and have practices that combine this care. However, with only the palliative fellowship, you may see a different patient population. There are the stage 1 or stage 2 cancer patients that are not always seen by palliative, but are seen by cancer rehab specialists. The management, prognosis, and the way you help those patients and their function and quality-of-life is different.

 

Dr. Klein: Any other recommendations for residents who have an interest in cancer rehab that we haven't touched on yet, maybe that I haven’t asked about?

Dr. Gupta: What really helped for me as a resident was having a mentor of whom I could ask questions. From my experience, everyone is willing to mentor and help teach about cancer rehabilitation. As a resident, I would reach out to your residency director or prior residents that may know someone you can then talk to about cancer rehabilitation.

Speaking as co-secretary of the AAPM&R Cancer Rehab Community Network, we have sub-groups where there are a lot of opportunities to become involved. Residents can assist with research as well as development and growth of the field. Be involved with a national organization. This helps create relationships with practicing cancer rehabilitation physicians, helps you learn more about leadership opportunities, and helps make a difference as a resident for patient care.

 

Dr. Klein: What are some good resources?

Dr. Gupta: As above, AAPM&R, ACRM, and AAP have a lot of resources. There’s a lot of research to be done in our field. AAPM&R and ACRM have formal groups and are looking for residents to assist with research projects. There is a new cancer rehabilitation research fund recently launched by the Foundation for PM&R. Fundraising is in process, initiated by Drs. Gail Gamble and Michael Stubblefield. This will be a great venue for young investigators to find funding to work on their research projects.

AAPM&R’s journal, PM&R, also recently released a new cancer supplement, Integrating Rehabilitation Into the Cancer Care Continuum. At the AAPM&R Annual Assembly, there is The Physiatrist’s Role in Cancer Recovery: Helping Patients With Cancer-Distinct Impairments preconference course, which will have practical teaching on how to apply cancer rehab in your everyday practice to improve cancer-distinct impairments. There are also talks that happen every day:

  • The Physiatrist’s Role in Cancer Recovery: Helping Patients With Cancer-Distinct Impairments
    Wednesday, October 11 | 8 am-5 pm
    Course Directors: Jennifer A. Baima, MD, FAAPMR and Mary M. Vargo, MD, FAAPMR; Faculty: Andrea L. Cheville, MD, FAAPMR; Sara A. Christensen Holz, MD; Jack B. Fu, MD, FAAPMR; Theresa Gillis, MD; Ekta Gupta, MD, FAAPMR; Nancy A. Hutchison, MD, FAAPMR; Ashish Khanna, MD; R. Samuel Mayer, MD, FAAPMR; Vishwa S. Raj, MD, FAAPMR; Julie K. Silver, MD, FAAPMR; Michael D. Stubblefield, MD, FAAPMR; Mary M. Vargo, MD, FAAPMR; Yevgeniya Dvorkin Wininger, MD; Eric M. Wisotzky, MD, FAAPMR; Rajesh Yadav, MD, FAAPMR

Thank you, Dr. Gupta!

 


Top Stories You Need to Know 


Last Chance to Join Us in Denver

Don’t miss #AAPMR2017, October 12-15! The Annual Assembly is the largest annual gathering of PM&R residents. Meet with hundreds of other residents who can offer new ideas and fresh perspectives. We have plenty of educational and networking opportunities designed just for you:

Plus, we have a session about PM&R Knowledge NOW® and the PM&R Journal to help you learn more about these member benefits you should be taking advantage of!

See you in Denver!

Resident Quiz Bowl: Sign Up Your Team Before It’s Full

Join us for the second annual Resident Quiz Bowl on October 13. This year, we’re bringing the fun to the PM&R Pavilion floor where PM&R residents from across the country can compete for fun and test their physiatry knowledge. We already have 9 teams signed up! So don't wait—sign up your team now. For questions, email assembly@aapmr.org with the subject line, “2017 AAPM&R Resident Quiz Bowl.”

The Game is On!

There are 10 programs competing in the Foundation for PM&R’s Rehab 5k Residency Program Challenge: Johns Hopkins Residency Network, Medstar GUH/NRH PM&R Residency Program, Northwestern University/Shirley Ryan AbilityLab, Spaulding Rehabilitation Network, Stanford University PM&R Residency Program, UMMSM/JMH PM&R Residency Program, University of Colorado Department of PM&R, University of Pittsburgh Medical Center, University of Texas Southwestern Medical School, and University of Washington.

Will the University of Colorado take the home court advantage and run faster in the thin mountain air? Will the University of Washington hold its current lead in the largest number of participants? And who will raise the most money for physiatric research? Join us at 6:30 am on Friday, October 13 at Sloan’s Lake Park in Denver to find out!

2017-2018 PHiT Leadership Announced

We are proud to announce the 2017-2018 PHiT Executive Committee members:

  • President: Nathaniel V. Zuziak, DO (PGY3—Mercy Medical Center)
  • Past President: G. Sunny Sharma, MD (PGY4—VA Greater Los Angeles/University of California) 
  • Vice President: Rachel Brashears, DO (PGY3—University of Missouri-Columbia) 
  • Secretary: Ann Hulme, MD (PGY3—University of Pennsylvania)

We are proud to announce the 2017-2018 PHiT Committee members and liaisons:

  • Membership Committee: Charles Kenyon, DO (PGY1—Baylor Scott and White Internal Medicine) and Stephanie Tow, MD (Associate Fellow—University of Colorado)
  • Medical Education Committee: Idris Amin, MD (Associate Fellow—NewYork-Presbyterian Columbia-Cornell) and Justin Bishop, MD, MBA, MS (PGY2—Baylor University Medical Center)
  • Quality, Practice, Policy, and Research Committee: Marc Gruner, MD (PGY3—MedStar Georgetown University Hospital/National Rehabilitation Hospital) and Vivian Roy, MD (Associate Fellow—Medical College of Wisconsin)
  • Residency Program Liaison: Julie Witkowski, MD (PGY2—Mayo Clinic)
  • AMA-RFS Delegate: Brittany Bickelhaupt, MD (PGY3—University of Texas Health Science Center of San Antonio)

We are proud to announce the 2017-2018 PHiT Nominating Committee members:

  • Nominating Committee: Matthew Haas, MD (PGY3—Shirley Ryan AbilityLab) and Ashley Wong, DO (PGY3—CWRU/MetroHealth Rehabilitation Institute of Ohio)
Newly-Matched Fellows—Update Your Information

Have you recently matched into a fellowship? Congratulations! The PHiT Board would like to recognize you in this newsletter and website. Please fill out this brief form so we have your updated contact information.

SAE-R Study Tools from Your Academy

The AAPM&R self-assessment examination for residents (SAE-R) takes place January 2018 and consists of 150 multiple-choice questions. Are you prepared?

Your Academy has several online resources to help you study. Many of these resources are available on mē® at a discounted rate for residents.

  • Abridged SAE-Rs: Each abridged SAE-R provides a taste of what to expect with January’s exam by featuring questions covering 10-12 clinical areas of PM&R.
  • Self-Assessment Examinations for Practitioners (SAE-Ps): SAE-Ps are a great way to zone in on 1 clinical area and evaluate your knowledge. Plus, some include review articles.
  • Certification Exam Prep Qbank: This online exam study tool covers the 12 PM&R core topics of the specialty through 800+ questions and provides immediate feedback with comprehensive commentary and references.

Resources for You

What’s Coming Next
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