RFC Newsletter Issue #2
Share |

Table of Contents
  • Letter from the RFC Chair: Tips on Health and Wellness in Medical Training
  • New Additions to the Resident and Fellow Council
  • Developing a physiatry podcast series
  • Latest research in Dance Medicine
  • Traumatic Brain Injury Fellow Spotlight
  • PM&R Fairs Spotlight

Letter from the Resident and Fellow Council Chair

Dear Colleagues,

This time of the academic year is always full of exciting transitions. Some trainees graduate from PM&R residency and fellowship programs and move on to the next phase of their careers, and freshly minted medical graduates begin the hallowed rite of passage—the intern year. Apropos of this, I would like to extend a congratulatory note to all recent graduates and a warm welcome to all new interns and categorical trainees to the specialty of physiatry.

As your representatives at the national level, the RFC seeks to foster ideas and initiatives that enhance your training and together with AAP works to provide resources to help you succeed. In view of this, one of our major campaigns this year is to call attention to an important issue that has risen to the national spotlight—physician burn out.

In a recent interview with MedPage, the Surgeon General of the United States, Vivek Murthy, expressed grave concerns about the increasing rates of physician burn out at time when there is higher demand than ever to train more physicians. He identified cultivation of emotional well-being as a top priority that is critical to the health of physicians and trainees. A first step, however, to promoting wellness is an understanding of the prohibitive factors for medical trainees.

Barriers to attaining emotional well-being among trainees include: sleep deprivation, overtly aggressive work environments, excessive workloads in a rigidly hierarchical culture, physical and mental exhaustion, disillusionment of working within broken health systems, predominance of a blame rather than a just culture, dealing with non-compliant patients, non-cooperative staff and the hurdles of EHRs.

These stressors lead to high rates of depression and suicide among physicians and trainees each year. According to a recent study in the Journal of Graduate Medical Education, less than 50% of depressed interns and residents seek treatment. Trainees are often pressed for time, fear judgment of peers and supervisors, worry about stigma and confidentiality and accept stress as an expected part of training that should be handled independent of help from others. There is also an erroneous belief perpetuated by the perfectionist culture of medicine that physicians and trainees are immune to depression.

In December 2015, a meta-analysis in JAMA showed that the rate of depression among residents was three times the rate among the general public, a worrisome trend that is on the rise. In response to this problem,theAccreditation Council for Graduate Medical Education (ACGME) currently encourages residency programs to design system-level solutions that integrate health and wellness in the training curricular.

This year, the RFC is committed to helping promote wellness among our peers and fellow trainees. We have identified online resources to aid trainees identify and seek treatment for suicide prevention, depression and burn out as outlined in the links below:







As a 4th year resident in my last year of training, I conclude with some advise from senior physicians and mentors which has been helpful in my own training:

1. Do not let the perfect become the enemy of the good. So while you strive towards perfection and mastery in your training, seek first to maintain your good health.

2. Self-care is the gateway to sound care for others. Not caring for yourself puts you and your patients at risk for errors and potentially fatal medical decisions.

3. Asking for help is a sign of strength and courage and recognition of your own limitations. Take advantage of your institutions free confidential counseling and mental health services program and seek help if you have feelings of helplessness, hopelessness, incompetence, fatigue, lack of joy and fulfillment at work, problems concentrating, inability to think clearly, loss of appetite, lack of energy, anger, frustration, restlessness, and guilt.

4. Find a support network outside work. Whether it is family, friends, social or religious groups, your support network will provide you an outsider’s perspective and solidarity in your vulnerable moments.

5. Maintain your hobbies. This will allow you to do things that bring you sustenance and energizing refreshment away from a stressful work environment.

6. Get a full nights rest and exercise regularly. A well-rested mind is a mind primed for excellence.

7. Go on vacation. Do not sacrifice your vacation time in residency training. Vacation time with family and loved ones is an essential aspect of stress relief and self care.


Residency is a challenging phase of medical training and habits developed during this time are formative for our professional and personal identity. We are excited you have chosen physiatry as your specialty and the RFC and AAP is committed to your continued success. I look forward to your comments, thoughts and suggestions on ways we can better support you.

With kind regards,

Charles A. Odonkor, MD, MA


Johns Hopkins Medicine

Welcoming New Members to the Resident and Fellow Council

After a rigorous selection process, the AAP and the RFC are pleased to announce that the following residents have been chosen from a competitive pool of applicants to join the RFC in various roles:

Ryan Mattie, MD

Role: AAP Resident Liaison to the AAMC Organization of Resident Representatives

Institution: Stanford

Venessa Lee, MD

Role: AAP Resident Liaison to the AAMC Organization of Resident Representatives

Institution: University of Utah

Fun Fact: Venessa grew up in a town of only 400 people! She is very outdoorsy and loves to camp, kayak, hike and ski. 

CJ Plummer II, MD

Role: Social media ambassador

Institution: University of Texas Health Science Center in San Antonio, Texas

Fun Fact: CJ is an "Army Brat" and has lived in Maryland, North Carolina, Georgia, Washington D.C, Alabama, Texas, and even Germany!







Stephanie Van, MD

Role: Social media ambassador

Institution: Johns Hopkins University School of Medicine 

Fun Fact: Proud 'Slytherin,' loves the board game 'Settlers of Catan,' enjoys reading and writing the medical narrative

Please join the RFC in welcoming our new resident leaders to the council!

Developing a Physiatry Podcast Series: A Call for Participants

PM&R residents are always looking for quick and easy ways to enhance their medical knowledge. One exciting new medium is medical podcasts. The use of podcasts in other specialties to enhance medical education has greatly expanded over the past several years. These podcasts can help physicians stay up to date on current literature and knowledge in their field. Unfortunately, a comprehensive podcast regarding PM&R relevant literature is currently unavailable and could be another valuable resource and learning tool for those in the field of PM&R.

Our goal is to develop an educational resource that can be utilized on a weekly basis to keep PM&R residents across the country up to date on current research in our field, have topic reviews and provide a forum for discussion about changes in healthcare impacting physiatry.

A pre-podcast survey was sent to PM&R residents across the country to learn about their comfort with current PM&R literature and the type of resources currently being used to stay up to date. Our results showed that over 50% of responding residents were less than “somewhat” comfortable with current research and over 50% were reviewing less than 2 articles per month.


Ben Abrahamoff and Erin McCarthy working on a PM&R podcast series

Most residents rely on academic journals and residency curriculum as their gateway to review literature. The majority of residents also responded that their literature review rarely led to a change in their medical decision-making. While 74% or responding residents are not currently using podcasts, greater than 50% are likely or very likely to use a podcast for medical learning if a relevant podcast were to become available.

Our discussions with residents and the results of this survey clearly demonstrate the need for an alternative resource to engage residents in new research. The survey also told us that there is interest in a podcast being that resource. With this information in mind, we created the PM&R Blast Podcast.

The goal is to have a weekly podcast that is engaging and informative across the PM&R spectrum from sports to spine. The knowledge base of PM&R continues to expand and like stretching, every little bit you practice counts. Hopefully our podcast can make driving to work, doing the dishes or running on the treadmill a little more educational

This is a podcast by residents and for residents. We are currently looking for more residents to become involved; if you are interested in podcasting or production, please contact us. We look forward to hearing from you.

You can access our current podcasts at pmrblast.podbean.com or on iTunes by searching “PM&R Blast.” You can contact us at PMRBlast@gmail.com.

Erin McCarty, MD

Emory University

Ben Abramoff, MD

Emory University

Mirror Neurons and Rehabilitation for Dancers: Is it Possible to Perform Dance Rehab Without Motion?

As a ballet dancer since the age of two and having multiple injuries along the way, I remember having to sit out of many dance classes and rehearsals. The teachers always made me come and watch the entire class, even though I was not able to dance due to whichever injury I happened to have at that time. And I never understood why I had to go to class if I was not able to physically participate in class. It always seemed silly to me. Recently, while reading the April newsletter of the International Association of Dance Medicine and Science, a particular article related to this strategy caught my attention. It was titled, “Mirror neurons: A tool for dancers’ rehabilitation or learning to move without moving?” and I thought, “I wonder if this could explain why I was forced to sit and watch class? Was I actually rehabbing myself without even knowing it back then?”

The article written by A. Couillandre PhD, PT, EA out of the Centre de Recherche sur le Sport et le Movement, Université Paris Ouest, as summarized below, sheds more light on the matter:

“First of all, dance teachers have long known that when a dancer is injured, they should still come to dance class to observe action. In fact, an injured dancer might be able to maintain their skill despite being temporarily unable to move, simply by watching others dance1. Once recovered, they will find that the new movement they missed out on is not too hard to pick up or learn. Their body already seems to automatically create the movement from the memory traces they have created.

Mirror neurons are a special class of neurons discovered in the 1990's by Rizollati2, identified in humans in Broca’s area, the inferior parietal lobe and ventral premotor cortex as well as in the caudal part of the inferior frontal gyrus, using non-invasive neuro-electrophysiological assessment or functional brain imaging techniques 3. Emotions and empathy seem to operate according to a mirror mechanism. Additionally, mirror neurons respond when we perform an action and also when we see someone else perform that action. Thus, they are involved in execution (as in traditional motor learning), imitation4, observation (as in observational learning)and motor imagery6,7.

(Source: http://news.xinhuanet.com/english/photo/2014-11/17/c_133795732_2.htm)

Action observation is considered as a potential tool in rehabilitation because it is thought to improve motor function through repeated activation of mental motor representations. It is increasingly considered in rehabilitation contexts, specifically in neurology8,9,10. Some authors report that a passive rehabilitation technique, based on stimulation of the mirror-neuron system, has a beneficial effect in the treatment of patients with post-stroke motor deficits. A better understanding of mechanisms underlying action observation is essential for the optimization of functional outcome using this training condition. As a matter of fact, most effective conditions for stimulation of the mirror neurons network have been identified such as for example action observation type (active versus passive)11; subject’s motor experience and competence (expert versus naïve)12,13; posture (absence versus presence of postural congruency)14. In other words, action observation could have a positive impact on rehabilitation of motor deficits in dancers after injury. Practically, do not leave the dancer lonely at home when injured. Make them come to class with the intention to imitate (active action observation) movements and postures they are expert in, and that are quite complex yet close to their own posture. It is believed that this multi-sensory action-observation system should enable individuals to re-learn impaired motor functions, such as walking, staying stable and of course dancing. Studies on dancers are needed in order to know if action observation can improve dancers injury recovery process.”

This is the current cutting edge dance medicine research to date and it is very exciting. As physiatrists, we all know that mirror therapy has been proven to be helpful in a hemiplegic patient after sustaining a stroke. To date, however, this has never been proven in dancers, only speculated. It is wonderful that studies like this are currently being done. It is research that the dance world has needed for years and promises to advance the field. I believe this research will lead to many more studies involving dancers and rehabilitation if it does show that active action observation does significantly change the course of dance rehab after sustaining an injury.


1. Ludden, JA. dance legend who still finds new directions. All Things Considered. 2004.

2. Mathon B. Mirror neurons: from anatomy to pathophysiological and therapeutic implications. Rev Neurol (Paris). 2013 Apr;169(4):285-90.

3. Sale P, Franceschini M. Action observation and mirror neuron network: a tool for motor stroke rehabilitation. Eur J Phys Rehabil Med. 2012;48:313-8.

4. Heiser M, Iacoboni M, Maeda F, Marcus J, Mazziotta JC. The essential role of Broca’s area in imitation. Eur J Neurosci. 2003 Mar;17(5):1123-8.

5. Grèzes J, Decety J. Functional anatomy of execution, mental simulation, observation, and verb generation of actions: a meta-analysis. Hum Brain Mapp. 2001 Jan;12(1):1-19.

6. Jackson PL, Lafleur MF, Malouin F, Richards C, Doyon J. Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehabil. 2001 Aug;82(8):1133-41.

7. Jeannerod M. Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage. 2001 Jul;14(1 Pt 2):S103-9.

8. Buccino G, Solodkin A, Small SL. Functions of the mirror neuron system: implications for neurorehabilitation. Cogn Behav Neurol. 2006 Mar;19(1):55-63.

9. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm (Vienna). 2007;114(10):1265-78. Epub 2007 Jun 20.

10. Pomeroy VM, Clark CA, Miller JS, Baron JC, Markus HS, Tallis RC. The potential for utilizing the “mirror neurone system” to enhance recovery of the severely affected upper limb early after stroke: a review and hypothesis. Neurorehabil Neural Repair. 2005 Mar;19(1):4-13.

11. Roosink M, Zijdewind I. Corticospinal excitability during observation and imagery of simple and complex hand tasks: implications for motor rehabilitation. Behav Brain Res. 2010 Nov 12;213(1):35-41.

12. Calvo-Merino B, Grèzes J, Glaser DE, Passingham RE, Haggard P. Seeing or doing? Influence of visual and motor familiarity in action observation. Curr Biol. 2006 Oct 10;16(19):1905-10. Erratum in: Curr Biol. 2006 Nov 21;16(22):2277.

13. Haslinger B, Erhard P, Altenmüller E, Schroeder U, Boecker H, Ceballos-Baumann AO. Transmodal sensorimotor networks during action observation in professional pianists. J Cogn Neurosci. 2005 Feb;17(2):282-93.

14. Alaerts K, Heremans E, Swinnen SP, Wenderoth N. How are observed actions mapped to the observer’s motor system? Influence of posture and perspective. Neuropsychologia. 2009 Jan;47(2):415-22.

Jovauna Currey

RFC Medical Student Affairs

University of California Irvine

Fellowship Spotlight: Traumatic Brain Injury

Traumatic brain injury (TBI) is one of the sub-specialty areas in physiatry with fellowship training programs offered throughout the United States.

I connected with Dr. Mary Beth Miller-Phillips, who is currently completing her TBI fellowship atthe University of Pittsburgh Medical Center, to discuss her experiences pursuing physiatry as a career and during fellowship.

Dr. Adam Susmarski (AS): What attracted you to pursue a TBI fellowship?

Dr. MaryBeth Miller-Phillips (MM): When I first started residency, I was convinced I would ultimately become a general inpatient/outpatient doctor in a rural setting. However, as I progressed through residency, I found myself being drawn to more neurologically complex patients in the inpatient setting. Brain injury patients come with their own set of specific challenges and medical complications that we as PM&R physicians have specific knowledge about and are trained experts in this unique branch of medicine. Additionally, I wanted to work with patients and families after a life altering event had occurred and do my part to get their lives back on trackand provide them with the tools to be successful while transitioning back into a community setting.


AS:How did you choose which fellowship was the “best fit” for you? What are the aspects of fellowship that applicants should carefully consider when making their rank order list?

MM: I wanted a good balance of exposure to the brain injury spectrum. A program with both inpatient (consults, rehab unit) and outpatient opportunities was high on my list. This would ensure I was comfortable with the spectrum of brain injury (mild-severe), the types of brain injury (traumatic, anoxic, cancer, encephalopathy, etc.) and the stages of brain injury recovery.I also wanted a program with strong leaders in the field of Brain Injury Medicine. Research is something that is different for everyone, but I also think a program that offers opportunities to participate in research in some capacity is also important;particularly because the field of Brain Injury Medicine still has a lot to learn about the pathophysiology of injury and what that means for possible treatments and recovery trajectories. Finally, I think a program that provides you with a good understanding on how to utilize community resources for your patients is important as brain injury is a chronic disease in a lot of cases and options for these patients can be limited depending on where you practice.


AS:What has been your favorite experience as a fellow?

MM:Making the transition from "resident" to "fellow", while challenging at times, has probably been my most favorite experience. Attending physicians have been more comfortable allowing me to lead the rehabilitation team and identify myself as the primary care provider to patients and families. This autonomy has allowed my confidence in my ability to handle challenging situations to grow astronomically.Also, I have had the opportunity for more resident teaching, which will serve me well as my next job will involve teaching.


AS:Now that you are approaching completion of fellowship what is some advice you have for residents applying for fellowship?

MM:I think the most important thing to consider is what are your goals for pursuing a fellowship? It is an extra year of training and a lot of people are able to go straight into practice without it and do aspects of things you would learn in fellowship. However, for areas that are more competitive or more academic, a fellowship might be the thing that makes you the most attractive candidate for the job. Also, try to declare your intent to do fellowship early and structure your residency pursuits towards that intent.While not the most competitive PM&R fellowship, Brain Injury Medicinehas had increasing interest over the past few years. Additionally, make sure you chose a program that will meet your specific needs and set you up to be as successful as possible upon graduation.

Adam Susmarski, DO

RFC Secretary

Academic Chief Resident

University of Pittsburgh

Mary Beth Miller-Phillips, MD
TBI Fellow

University of Pittsburgh

PM&R Fairs Update

PM&R Fairs for Medical Students were held this spring in New York, hosted by Albert Einstein College of Medicine and Hofstra Northwell School of Medicine.

The Hofstra Northwell fair featured 12 stations for the more than 70 students to rotate through during the three-hour event. Stations included a physical exam of the should and knee, Knee and shoulder joint injections, Ultrasound, Acupuncture, Baclofen pump demonstration, EMG.NCS, Botox injections for spasticity and more. The stations were led by residents, faculty physicians, physical therapists, occupational therapists, orthotics and a licensed acupuncturist. Student evaluations were overwhelmingly positive with requests for more time to spent at the stations in the future.

Albert Einstein College of Medicine hosted more than 50 medical students from at least six medical schools at their evening fair. They also offered a number of stations for the students to visit during the event, including Prosthetics and orthotics with a 3D printed prosthetic hand, Virtual reality and telemedicine, EMG, Ultrasound, Research opportunities in PMR. Each stations was run by residents, fellows and attendings. Response to the fair showed that students understanding of the field increased following the event, with 69% indicating they are considering pursuing a career in PM&R following the fair, compared to 49% prior to the fair.  Overall comments from students were that the event was an “amazing educational experience” and “this was super, hands on, information, and engaging! Great Staff!”

Congratulations to both for hosting successful fairs and introducing medical students to the field of Physical Medicine and Rehabilitation. Information on how you can host a Fair can be found on the AAP website or by emailing Member Services Manager Amy Schnappinger at aschnappinger@physiatry.org.


What's Coming Next:

  • Getting involved in PM&R Advocacy

  • Technology in Rehabilitative Care

  • Social Media and Physiatry

Look for these and more in the third issue of Physiatry in Motion in your email inbox on September 25, 2016.

Want more resident-specific content before then? Visit the AAP website, plus check out our new Facebook group and page for the latest Physiatry research and news.