Abby Cheng, MD
Assistant Professor, Orthopaedic Surgery
BJC/Washington University in St. Louis
As a biomedical engineering major in college, I have always been interested in the musculoskeletal system, but I wasn’t exposed to PM&R until my first year of medical school. Shirley Sahrmann, who is a matriarch in the field of physical therapy, gave a guest lecture in my muscle physiology course. She demonstrated how addressing patients’ movements and daily habits can alleviate pain and dysfunction, and her movement-based, patient-centered approach resonated with me. She suggested I consider physiatry as a specialty, so I applied for T35 funding through my medical school to do summer research with Dr. Heidi Prather. By the end of the experience, I was hooked.
I joined the RMSTP in my second year of residency at the Shirley Ryan AbilityLab. My program supported me to attend the annual RMSTP meetings, and, through those experiences, I learned what a clinical research career looks like and what it would take to make that career possible for myself. I received guidance on how to develop my clinical interests into a research domain, find a good research mentor, advocate for the necessary resources for success, craft an NIH-style biosketch, identify funding opportunities, and write a compelling specific aims page. Perhaps the most valuable aspect of being part of the RMSTP has been the networking opportunities to meet other physiatrists who share my excitement for clinical research and have successfully navigated the challenges I will inevitably face.
Participation in the RMSTP helped me confirm that a career as an independently funded clinician-scientist is my dream job. However, I would also encourage physiatrists who are still “peeking over the research fence” to apply for the program. The RMSTP equips participants with unique insight into the research process and connects people with mutual interests. These tools are valuable to all physiatrists, even those who end up deciding to focus primarily on clinical care and just dabble in research.
I am an assistant professor at Washington University in St. Louis in the Division of Physical Medicine and Rehabilitation under the Department of Orthopaedic Surgery. I currently have 40% of protected time for research, and because my NIH K23 career development application scored well enough to be funded, I will transition to 75% of research time in July 2019. My K23 project will focus on assessing biopsychosocial risk factors in order to predict patient-reported outcomes in the pre-arthritic hip disorder population, and my long-term research goal is to approach all kinds of musculoskeletal pain with a precision medicine, biopsychosocial model in order to identify and address modifiable risk factors to optimize outcomes.
The majority of my research is in the domain of health services research as it applies to musculoskeletal medicine. Recently, I have been using the Patient-Reported Outcomes Measurement Information System (PROMIS) to understand relationships between patient-reported health and demographic characteristics of patients and providers. For example, my collaborators and I found that, among patients who present for elective evaluation of a musculoskeletal condition, patients who present to phyiatrists self-report worse physical and emotional health than patients who present to orthopedic surgeons or other fellowship-trained non-operative providers. I presented these results as an oral presentation at the AAP's Annual Meeting in Puerto Rico, and the study was recently published in PM&R.
Developing a relevant, feasible research question is challenging, but I have learned that two other components to a successful research career are equally as important: grantsmanship and the research environment. Regarding grantsmanship, both my local mentoring team and the RMSTP advisory board reviewed my NIH grant application before I submitted it, and their feedback greatly contributed to the success of my application. In terms of the research environment, the protected time and funding provided by my department and division chairs, in addition to the research training resources and the culture of cross-disciplinary collaboration at Washington University, were absolutely essential to securing my first NIH research grant. I am grateful to Drs. Regis O’Keefe and Heidi Prather for supporting my career aspirations and investing in my potential.
My suggestions to physiatrists who are hoping to expand their research careers and/or increase research funding are: 1.) consider applying for the RMSTP or other research training program; 2.) identify a department with a record of strong research productivity that understands the resources and investment required to successfully develop a clinician scientist; and 3.) find respected research mentors at your institution who can guide you toward appropriate opportunities and advocate on your behalf for the resources you need.
Roger Mignosa, DO
Physiatrist & Clinical Professor, UC San Diego
Director of Rehabilitation, Osteopathic Center San Diego
Founder, Andiamo Health
I knew about PM&R since high school (sports injuries) and entered medical school with the intention to become a PM&R physician. As a first-year medical student, I attended the AAP Annual Meeting and learned about the RREMS program. I was extremely fortunate to be awarded a scholarship to RREMS for the summer after my 1st year of medical school. My osteopathic medical school was in Northern California and I met Stanford PM&R physicians and researchers at the AAP's meeting. I participated in Stanford's PM&R didactics for my RREMS experience, which focused on research and application.
I worked with Stanford and the VA Palo Alto Spine Cord Injury Unit in 2008-2009 on “The use of Push Rim Power Assist Wheels in Spinal Cord Injury.” I served as the project manager of a pilot study, and, in eight weeks, I did a comprehensive data review, formulated a pilot, organized a team, recruited patients, collected data, and wrote up a report which was presented at the AAP's 2009 meeting in Colorado. I also presented a lecture of my own work at the AAP's 2015 meeting in Texas on the integration of exercise science in medicine. RREMS was an amazing experience that helped to shape my life and strengthened my resolve that my gift to the world is the interpretation of complex information into simplistic language and the creation of health programs that address the totality of our human experience. Before participating in RREMS, I already knew that I wanted to do PM&R, but this program helped me to see my gifts and my passion for my role in health care.
Throughout medical school and residency, I have continued my scholarship work through integration, application, and education. What I have learned in all of my projects, posters, presentations, and public outreach is that people appreciate when someone is able to translate and integrate complex information into a user-friendly format. I diligently worked to create programs for knee osteoarthritis and protocols for kinesiology taping while I was in residency and presented this information at integrative and traditional medical conferences. In all of these experiences I had a sizable amount of attention from the medical cohort, who desired to understand my programs so that they could immediately apply this material to their practice.
I continue to lecture at conferences, but the bulk of my scholarship with my peers is direct collaboration in the form of workshops for healthcare providers. In April 2018, I was extremely proud to work with the US Olympic Committee, World Surf League, Hurley, and Nike for a Movement Masterclass to train therapists who work with elite athletes. The participants from these events walked away with skills that they were able to apply to their practice immediately. These events foster the experiential learning process of reflection, hypothesis, testing, and continuous improvement.
My experience in research and scholarship has made it clear that original discovery must be translated into tangible services and products that can be consumed for the benefit of patients. Integrative medicine is dependent upon teamwork between patient and physician. Therefore, the process of integration, application, and education must be converted into a model of medicine that serves the community as a whole in order to financially survive while also serving every socioeconomic population. Focused goals are necessary to advance integrative medicine to a state of inclusion and financial stability. The most challenging obstacle to overcome within integrative medicine is that of communication and standardization. Integrative medicine is often seen as a set of techniques as opposed to a systematic approach to health.
It is my intention to continue my work through publication of the unique programs that I have created for the public, educational work with integrative and traditional health care, and wide collaboration with my extensive network of colleagues in the arenas of medicine and professional sports. It is my belief and the belief of Ernest Boyer that education is equal to research. Education changes culture. If integrative medicine is to succeed, the culture of medicine must move toward a model of education.
I hope to one day get funding for my ideas. In medicine there are three roles: clinician, educator, and researcher. You can only choose two of these if you hope to excel. Otherwise you live out of balance. I choose to be an educator and a clinician.
Adam Tenforde, DO
Assistant Professor, PM&R
Harvard Medical School
My first exposure to the specialty of PM&R was through my experiences as a division one collegiate athlete at Stanford. My team physician was Dr. Michael Fredericson, and this provided me the first opportunity to learn about the specialty. Subsequently, Dr. Fredericson served as my mentor and role model in demonstrating what is possible for our specialty. I was able to gain clinical exposure that confirmed my interest to specialize in PM&R as a medical school student. We also started research together in 2008 on understanding modifiable risk factors for stress fractures in young runners. This project had great meaning as I had a number of teammates who suffered from consequences of this injury.
The first successful grant application for funding I received was from the RREMS program. The grant helped support my initial research project identifying modifiable risk factors for stress fractures in high school runners. The purpose of this study was to identify whether ball sports, nutrition and other factors could modify risk for injury in young athletes. I served the role of overseeing enrollment of the 748 athletes from 28 high schools in Northern California and collecting 136 bone density scans.
The funding was critical to support initial work on this study including pilot data that allowed for obtaining a subsequent grant that was able to fund the full study. Findings from our study did confirm that prior participation in basketball was protective for male runners and that the Female Athlete Triad risk factors predicted injury in female runners. The results of the study resulted in three published manuscripts including in PM&R Journal and 2 top sports journals of Medicine & Science in Sports & Exercise and the American Journal of Sports Medicine.
In addition to learning how to submit an IRB, write a grant application, recruit and retain study participants, analyze and publish my findings, the RREMS program provided structure in presenting my early findings at the 2009 AAP Annual Meeting. At the meeting, I met talented researchers from other programs and received further support from Dr. Dicianno, including feedback prior to my presentation to improve my speaking skills. While I had some prior research experience, the program was very helpful for me to gain experience performing research within the specialty of PM&R and confirmation this would be the best field to pursue a career in academic sports medicine.
I am currently an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School and director of running medicine for Spaulding Rehabilitation Hospital. My early experience during medical school through the RREMS has served as a catalyst to further research and grants from Foundation for PM&R including the New Investigator Award and ERF Justus Lehmann Biomechanics/ Biophysics Research Grant. Additionally, I have received funding support for my research through the American Medical Society for Sports Medicine, NBA-GE Research Grant, and Pac-12 research funding. The initial work evaluating risk factors for stress fractures in youth runners provided me knowledge and experience I have applied to work on studying these injuries in collegiate runners and other populations. I have also had the privilege to serve in leadership roles including a co-chair for Youth Early Sports Specialization effort through the American Medical Society for Sports Medicine and part of the International Olympic Committee expert group for writing position statement of Relative Energy Deficiency in Sport. My research has also expanded to the NFL Players Association supported study Football Player Health Study.
I spend half time on research and half time on clinical work. Grant support remains challenging to me and can serve as a barrier to others engaging in research. The Foundation for PM&R is a valuable resource to support academic physiatry by providing critical grant opportunities. The foundation awards can serve to perform initial research that can evolve into larger federally-supported grants. For those interested in research in our specialty, the Foundation for PM&R grants can provide an opportunity to complete meaningful research at multiple stages of your career. I also encourage everyone support the efforts of our specialty by donating to the Foundation for PM&R to ensure future availability of these grants.
Richard Wilson, MD, MS
Associate Professor, PM&R
Case Western Reserve University School of Medicine
I learned about the field of rehabilitation in medical school from a friend who was going through a PM&R rotation (Lainie Holman, MD- pediatric physiatrist at the Cleveland Clinic). The field seemed to be the perfect blend of neurology, internal medicine, and orthopedics that I was interested in pursuing, but without the downsides that I saw in each of those specialties. I subsequently went through a medical school rotation and I knew that physiatry was the specialty for me.
I became interested in research late in my third year of residency. One of my attending physicians (John Chae, MD) suggested that I might be suited for research on account that I was skeptical of many of the things being taught in our lectures and consistently requested the evidence to back up clinical practice in rehabilitation. To this day, I’m not sure if he meant it as a compliment or that he said it out of annoyance. Either way, he pointed me in the direction of the RMSTP to learn more about a research career. I’m thankful for the push Dr. Chae provided - it was the right direction for me.
I participated in Phase 1 from 2005-2006 and in Phase 2 from 2006-2009. I entered the RMSTP focused on health services research, focusing on decision analysis and economic evaluation of health care in rehabilitation. The project I had proposed was to determine the association between the resources used by people with spinal cord injury for healthcare and their style of coping, personality traits, health-related behavior, and health attitudes. Unfortunately, I did not recruit a large enough sample to allow analysis and I failed miserably with my primary project. On the other hand, my most cited publication to date is of the results of a side-project from that time regarding the cost and mortality associated with pneumonia for stroke survivors.
I published multiple papers on different topics with the skills that I had gained, which allowed me to work with other researchers while continuing to submit grant applications. In addition to the typical skills (grant proposal writing, IRB applications, transcript writing), I spent a great deal of time learning about trial design, statistical analysis, and large database analysis. Ultimately, those skills are what made me valuable to be offered a position in the research group of which I still belong, though my research focus is much different now.
I don’t think I’d be where I am now if not for the RMSTP. When I applied for the RMSTP, I wasn’t sure where I was going or how to get there. The RMSTP showed me a path to a stimulating research career that I love.
I am now Director, Division of Neurologic Rehabilitation at the MetroHealth Rehabilitation Institute in Cleveland, Ohio. Currently, 60% of my time is devoted to research. I also get to work with residents and medical students on research projects. My research is in clinical trials studying the efficacy of peripheral nerve stimulation in the treatment of chronic pain, particularly chronic shoulder pain.
I currently have 2 R01 grants funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the NIH. I’ve also had industry sponsors, though none currently. The failure of grant applications was difficult at first. Junior investigators are desperate to prove to themselves that they can succeed, and also prove to their chairpersons that they should remain in research. In the beginning, every failure seemed like the end of the road. It takes some time to develop the resilience that allows researchers to continue their line of work without taking a failed grant application personally.
If a person loves research they should remain focused on their goal. Look at failure as an opportunity to learn and to improve. It’s also helpful to be flexible in funding sources – look everywhere for funding. It’s easier to get subsequent grants after getting the first. If all else fails, be willing to change your research focus – it opened many doors for me.