All right. Good morning, everyone. How's everyone doing this morning? Good. Good. Thanks for waking up and starting things off with us. Great NANCE 2025. Really appreciate you all coming out. I know 7 a.m. is early, so thank you so much. Really I just want to start with some opening remarks. Really kind of right off the bat, too, we want this session, we really want to make sure that you get the most out of this session. I know sometimes people come in and it may be information you've heard before or bits and pieces, but we're hoping everyone today can at least take home a couple things that really stick out to you or be able to ask questions, you know, for whatever your personal situation is to really help make sure we can have you get the most out of the session. So again, thank you so much for taking the time to come out. Whether you're a student, resident, fellow, or even educator, just wanting to hear some additional thoughts from this esteemed panel here, we really appreciate you taking the time. So overall, I just kind of want to go through a couple opening remarks. We know pain medicine as a whole, it's been going through a transition lately, particularly as we're coming into fellowships, more and more and more we're experiencing a diversity of thought, a diversity of backgrounds, people who are coming into our specialty. And for me at least, I think it's amazing. I think it's amazing that we're having so many different specialties and groups coming into our field, making our field better, and I think we have a really promising future. And so we want to help you all get to that next step if you're not there already, or give you tips and tricks if you're there already to be really successful as you take the step into fellowship. We're going to be covering three areas today. We'll be going beyond your CV, additionally, we'll be going through a part where we try to bring your application to life, really make it stick out from other applicants. And then finally, we'll be ending with preparing for fellowship training and the different things that you may encounter or do or references for textbooks that you can look at and undergo to be ready for that step. So first I want to dive in with our first speaker. This is Dr. Scott Pritzloff. And I've known Dr. Pritzloff since 2020. I don't know if he remembers where we met exactly, but we met in a cadaver course, actually, way back in 2020, doing peripheral nerve stem. And I think you can tell a lot about someone, especially when, you know, it was my intern year, I was very, very lowly intern, but this man always showed kindness to me and something that I really appreciated as I've gone through, he's been a great mentor for me. Ultimately, you know, or excuse me, initially hailed from MGH, did anesthesia there, did his interventional pain fellowship over at Stanford. That's currently now at UC Davis as a fellowship director. And he's got a lot of great insight into what can really make your application stand down, how to go beyond in terms of the CV. And so I just want to welcome Dr. Pritzloff to the stage. Thanks, Adelaide, that's a very, very generous introduction. I tell fellows and potential fellows that you worry and you build and you try to get that fellowship and it's just a year. And then you're a colleague presenting at a national meeting. And so just keep that in mind, that it's a very short period of time. It's a compressed period of time that you unfortunately invest hundreds of hours of worry into. But the hope is that we can shed a little bit of light on what we're looking for, what is going through Dr. Kohan's head, Dr. Anatuske's head, all of the PDs here as we review applications. Keeping in mind that we are most likely in a lull right now, that's the lowest recruitment that we've seen probably in two decades. I can't say for sure, but applications are down. And so I think more than ever, it's super important to know what program directors are looking for. We had a great paper and Dr. Franzio is not here with us today, led this effort back in 2022. And this had not been done before to this granular degree, really looking at what are PDs looking for, both with regard to selecting candidates for an interview as well as ranking them. And so this was a survey that went out to every program director in the country and 50 percent, about 50 percent replied back. And we were able to look at these data to really break down what PDs think about when they're looking at your application. We broke this down into some characteristics that included medical training. So primary specialty was a big, a big concern. Academics, letters of recommendation, leadership and research. And they were essentially ranked in importance from 1 to 10 for most of these characteristics. And then for specialty preference, 0 to 5, 5 being the most desirable, 10 being the most desirable. Interestingly, back in 2022, this comes as no surprise, anesthesia was at the top of preference among PDs, followed by PM&R. And then when you got into some of the other specialties, keeping in mind that radiology was not listed as one of the specialties here, there was much lower preference. But I would say in 2025, this demographic has shifted dramatically. And so if we did this survey now, I think you would see a very different distribution because anesthesia applicants have largely dropped almost by 50 percent in the past four years. When it came to applicant qualities, big, big things that really mean a lot include interview performance. So the actual interview day really matters. And why do I bring that up? Because little things matter. Show up on time, dress appropriately. Put your dog in the other room. I mean, interview performance matters because most programs are still doing virtual interviews since 2020. And then another big one that isn't listed on this graph, but I'll show you here, by and large, the number one applicant quality that mattered, that was of highest importance, was perceived commitment to the specialty. So does the applicant have longitudinal commitment to pain medicine? I always tell candidates that I'm less impressed with 40 publications that are orthopedic or, say, neurosurgery pubs. And that is nothing to do a knock on orthopedics or neurosurgery, but it's much more impactful to have maybe three or four pain related publications showing up to meetings, having a leadership position, than some of those other things. So when it comes to research, as I just mentioned, peer review publications, very high, highly ranked, highly rated, as well as posters. So if you're a PGY2 and you're just getting interested or even an intern, really seek out those mentors and try to find ways to do a poster at a meeting. That is really a great foray and opportunity. Letters of recommendation. It's very important and was viewed by PDs as very important that letters were from pain faculty, not all of them, but is critical. And I'm sure if you ask the panel up here, that at least one or perhaps even two of your letters are from respected, known pain faculty who can advocate on your behalf. Other things just to mention, I'd mentioned the interview performance, but also having a good rotation in chronic pain medicine. Once again, along that theme of longitudinal interest and involvement in the field. So how do we break down commitment to specialty? We think about participation and rotations, knowledge of the field, understanding the issues facing the specialty, maybe some of the insurance challenges, some of the other battles that we're fighting in our field. And then how do you really get involved and how do you show commitment to the specialty? It's really seeking mentors. You're all here today, which is great because that shows that you're participating in pain societies and that you're doing some sort of leadership activity that really shows that you're interested in this is what you want to do. And I think it was also important to note that you should not sacrifice your duties for your primary specialty, meaning that it's not a good look if you have great pain letters, but the letter from your chair, it's lukewarm or your rotation evaluations or some of those things are lukewarm. So it's really important that you have to do both and do both well. And when we talk about letters of recommendation, PDs were very much interested in this idea of teachability, proactivity, leadership and research, and those should be reflected in your letters. The Association of Pain Program Directors actually has a common letter that many of us use and really drills down on some of these ideas and really can give other PDs a good idea of your performance. So if you're going to get a pain letter from an academic clinician, that form can be very helpful for your letters of recommendation. And then lastly, things like personal traits, teamwork, empathy, rapport with patients. Notice how there isn't a focus on procedures, procedural acumen, how well you can drive a needle. That is not of high concern to PDs and was not reflected in the survey that we did. And I mentioned interview. When you do your interview, these are mostly virtual. Some programs are in person, but really PDs are looking for if you're going to be a good fit for the program and that you're going to be a good fellow. No one wants someone, maybe a fellow who looks good on paper, but no one wants to be a fellow for choice. So we're really looking for that person who wants to be at the program, is really interested in the culture and what you have to offer and looking forward if you're going to do well at that program. So I just want to finish with another survey study. Dr. Wachese, Dr. Imo Wachese at Montefiore led this study with pretty much many of the people up here on this panel was just another look at PDs, more looking at both characteristics of fellows that lead to success, as well as characteristics that prognosticate or dictate long term success well after fellowship. And I think what was really compelling about this survey is that integrity and professionalism were by and large the most important humanistic qualities that were that were at the top of the list. They outweighed technical skills, they outweighed some of the other things that I think fellow and fellow candidates think are more important. And so the two categories, the left being characteristics that PDs look for in a fellow and the right side, value determinants of long term success and professionalism and integrity, both were very high on that list. You can see on the left that procedural technique and acumen were less important. And so these studies really show that commitment to specialty is important. Letters of recommendation from pain faculty are important. Having good publications, pain specific publications matter. Leadership and experiences are important. And really having those humanistic qualities that really dictate that you're going to be a good colleague and a good addition to the program, all these things matter. And so I wish everyone here luck. And I'm going to hand over the microphone to our next speaker. All right, so I'd like to introduce our next two speakers, Dr. Kohan and Dr. Shi. You know, I'm going to start with Dr. Kohan, who's hailing from the University of Virginia as program director as well as division head. And ultimately, you know, she's played a pivotal role in shaping the pain medicine currently and continues for future work, not only through expertise in clinical headache, but for headache, but also, you know, guiding trainees, particularly for myself. You know, I don't know if she remembers as well, but we were over in Paris at ISRA, and it was always nice to have a smiling face in another country before kind of get the jitters out before going up and presenting. So that really sticks out to me and I really appreciate that. I also want to introduce Dr. Shi, who I affectionately call CC. She's the former president of the ASRA resident section committee. She's kept me in line, helped me be productive, and has been a fantastic colleague to have and has always stepped up to the plate. So without further ado, I'll introduce both. Hi, everyone. My name is CC. Hi, I'm Lynn. So we're going to talk about how to ace your interview. So we're going to cover a lot of topics and at the very end, I'll have Dr. Kohan talk about the PD point of view. Okay, perfect. So for the interview prep, actually, I want everyone to take a picture of this QR code. This is a video interview with Dr. Ryan D'Souza. He actually goes into depth into the common questions that's asked during a pain fellowship interview and how to respond to those. So very importantly, you want to get your why down. So in every interview, they're going to ask you why pain? And you want to have rehearsed a 30 second elevator pitch and talk about exactly why you are choosing to go into pain, how you discovered it, and unique details that make the story unique to you. Now, how do you talk about prepare to talk about your CV? One thing I recommend is if you make a list of all your character traits and strengths, and then you make a list of all your CV experiences, and then you figure out which ones ties into which so that when an interviewer asks you like, tell me about time, you're a team player, you would have had five to 10 experiences ready to go because you made that list. Now, every time you respond to an interviewer, you want to use the STAR method. So responses start with S, which talks about the situation. T talks about the task you were assigned to. It talks about the action you took and R for the result. And in the result, that's where you want to tie back to one of your character traits, a strength that experience exemplified, or how this experience showed that you realized you had a passion and pain, or it showed some growth. And then you want to prepare responses to challenging questions like, tell me about a weakness or a mistake that you made. And how you answer those is you always want to tie back to, you know, how you overcame that challenge, or you learned your lesson, or you're working on that weak point. And when it comes to inappropriate questions, just know that you don't have to answer that and just prepare a short response that just, you know, I feel like this is a comfortable question. Can we move on to the next one? That way, when it happens to you during the interview, you are not, you know, taken aback and you're ready to address, like, handle any difficult situations. Now, when it comes to questions to ask the interviewer, this is your time to vet the program as much as it is for the program to vet you. So understand what your values are, what you're looking for in a program, kind of delineate that, whether it's like you care about what procedures they train you in, if you care about, like, what kind of mentorship they provide, how they help you with the job search, things like that. So kind of understand what things you're looking for. So that way, when it comes time for the interviewer to ask you, what questions do you have, you're ready to go. Okay, let's talk about how to look good on Zoom. So when it comes to, you know, a virtual interview, you want to be mindful of how you appear. So specifically with the background, you want to make sure it's very minimal, there's no clutter or distractions, people walking in and out behind you. When it comes to the lighting, you want to make sure the light source is in front of you, not behind you. So like in this picture here, when the light source is behind the woman, there's a shadow that casts over her face. You want to make sure the camera angle is directly in front of you, and you want to minimize any background noise. So put your kids away, put your pets away. And a trick with the camera angle is, if you take your Zoom screen, and then you actually move it up to as close to where the webcam is, so that when you're looking at the, you know, the Zoom window, your eyes are looking as close to the camera as possible. And that actually gives the illusion that you're giving eye contact to the interviewer. And also Zoom has other features if you play around with the settings to, you know, either increase the brightness so that you look brighter or to reduce the background noise. Okay, so practice, practice, practice, right? So do mock interviews with colleagues, with mentors, do it over Zoom. You can actually log into a meeting on Zoom with yourself and record it, so you can play back and see how you can modify. But what's also really helpful is if you go out into the real world and practice, just like how you get the chance to at this conference, go meet strangers and practice talking about yourself, which is something we're not used to doing. Talk about yourself, get out that, work out all your social awkwardness, and just practice what it's like to just connect with a stranger. Okay, so let's talk about mindset. So before an interview is very normal to get nervous, we get performance anxiety, but how can we actually shift into an empower mindset? One thing that's helpful is if you ground into an intention. So something to note is that most of the time people are not going to remember all the words that you say, but they will remember how you left them feeling. So you don't have to be so worked up about like, oh, I want to make sure I say all the right words. What could be helpful is if instead you think about like, you know what, how do I want to leave this person feeling? So you can set an intention that, you know, I want to go into the interview wanting to leave the other person feeling like they just had a fun time connecting with me. And that's one way to take the pressure off of the performance. Something that also is helpful is if you can identify the negative self-talk that's happening right underneath the surface. So for example, if you're getting nervous before an interview and you know, like, you know, the things that you're saying to yourself is, I'm just nervous because I'm worried I'm just not going to perform well. That's a very vague statement. So if you can get more specific about exactly what you're nervous about, for example, I'm nervous. I'm actually nervous that, you know, I wave my hands around a lot. That's actually a behavior you can modify and control. So one thing you can do is practice in front of a mirror, in front of a camera and watch how often you're moving your hands around, right? And then just as you practice, notice how you can decrease your hand movements or just be more intentional with your hand movements. And then when you modify that behavior, that will actually improve your confidence before an interview because you just proved to yourself that you can control your own performance and improve it. Another thing I want to touch on is you can use somatic practices to shift your emotional state. What that means is using your body and to shift how you feel. So it's as simple as practicing some power poses before an interview or during the breaks. If you notice you're feeling anxious, like go in, like take a walk, shake it out, take a little dance break. Another thing you want to keep in mind is, you know, when you are anxious during an interview, your fight or flight is ramped up, right? And you want to have developed some coping skills to regulate your nervous system and bring yourself back down into that parasympathetic state. So one example is I want everyone to take their hand and put it over your belly, okay? And notice if like, as you breathe, if your hand moves at all or not. And if it doesn't, then possibly you're shallow breathing and you're just breathing into your chest. And when that happens, especially when you're in your fight or flight response, it reduces the oxygenation to the brain and it makes it hard to think, right? So then what you want to do is you want to breathe until you feel your belly expand into your hand and then keep doing that until you notice your heart rate start to go down and the calm starts to set in. That is vagus nerve activation, something you can teach your pain patients actually. So we covered a lot of topics, but I want you guys to remember one thing that in an interview, you're just connecting with a human being, something that you do every day. And lastly, again, my name is Cece. If you would like more help with the interview prep or cure coaching, email me, take a picture of my email. I fellowship train at Stanford and I love helping residents of fellows succeed. You guys are the next generation of pain and I want to see you guys do well. Thank you. All right. Dr. Lynn Cohan. Hello. So, um, so Scott already went over some of this and I think, um, he went over, you know, the, some of the selection things that program directors look at when we're kind of trying to decide who to interview. And there's a lot of good applicants. So sometimes it does get hard kind of weeding down these factors to really select, um, the right people. Um, so these are kind of some of the things that he already talked about. So I'm going to skip over some of this, but he did talk about this letter. Um, and I did kind of provide an example of the letter just so you guys can kind of see, um, this is not mandatory that we use it, but I love when other program directors use it. I use it, um, just to give you an idea of kind of what we are kind of, um, not ranking, but the kind of criteria that we're using to kind of offer our opinion of candidates. So I thought that might be helpful for you guys to see. The other thing I wanted to briefly bring up, um, for those of you who are applying now is that this is the first year that we are, um, using the signal system. Um, so signals have been used in residencies and some, and so pain is one of the first fellowships to use signals. And so, you know, we don't know how this is going to come out yet. We don't know strategies or anything yet. Um, but this, you know, you can signal programs that you are most particularly interested in. And so, um, that is a good way potentially for candidates to kind of enhance maybe their chances for interviews, um, depending on the quality of the candidates. So just interview tips. Um, CeCe did a great job already. Um, and Scott has mentioned some of these things too, but you want to talk about yourself. You want to highlight your accomplishments, but you don't want to exaggerate or brag or come off, you know, as conceited or overly confident. You want to be humble, but still highlighting your accomplishments. What sets you apart from other applicants? You know, a lot of applicants have done a lot of great things. You know, this is your chance to shine and to talk about yourself in a, in a good way. Um, we talked about, um, you know, like, uh, I'm sorry, um, being humble, being prepared, you know, making sure you're on time for the interview. We know that things happen on Zoom. Like there always seems to be some, you know, thunderstorm and our electricity goes out, someone's electricity goes out. Those are things you can avoid, but the things you can prepare for, right? You want to be prepared for those things. Um, so just potential interview questions. Um, so, and these are, there was an article that came out from some of the GI societies that's kind of listed here, but I like to think about when we're thinking about interviews, like what are the qualities that we're looking for, um, when we're interviewing people? So Scott did a good job talking about that commitment to pain medicine, but I would say also it's that commitment, but don't like stress out. If like, you didn't know earlier on that you wanted to do pain and that, you know, you didn't do your pain, um, rotation till later. And then you decided, so you don't have that chance, perhaps show that commitment as much as others. Cause it's also, in addition to that commitment, it's an under, it's letting us know that you understand the field of pain medicine and what you're getting into, right? Not just that you're running away from your primary specialty, but that you're actually running towards pain medicine. Like, this is what you want to do. Not that I, you know, I don't want to be in the operating room or, you know, I don't want to do inpatient PMR. And so like, I'm going to do pain because of that. Right. We want to know that you truly have an understanding, right? There are challenges in pain medicine now, right? We want to know that you understand those challenges, you know, at an appropriate level, you're not going to understand all the intricacies, you know, that an attending or seasoned practitioner would, but you at least have an understanding of the landscape of pain medicine and that you're able to kind of communicate that. Other things such as, so that, you know, is the understanding of pain medicine. The other things we're looking for are professionalism. And Scott kind of mentioned some of these things too, but we want to make sure that, you know, how do you interact with others? How do other people describe you, right? How do your colleagues describe you? How would nurses describe you? What are things that people would say about you? How do you describe yourself? These are all things that we're trying to look for when we're kind of thinking about that professionalism issue. Also, how do you deal with challenging situations? So CeCe did, you know, a good job of talking about that. Like we might be asked how, you know, describe a challenging patient encounter, describe a challenging encounter perhaps with ancillary staff and, you know, what did you do? How did you overcome that? And that's going to be probably like a very common question that you might get asked because we want to see how you react to challenging situations. Everyone has challenges and, but, you know, we want to, the most important thing is how do you overcome them? What do you learn from them? Those are important things to gain insight into the applicant. Communication as well. How well do you communicate with patients? Again, how well do you communicate with your colleagues, with staff? These are all important things. And then fit, right? By the time you've gotten the interview, you're qualified, right? You made the cut that you are qualified. And so now what we're also really looking for is a rapport. You know, Scott and CeCe, I think, both mentioned that. We're going to spend a year, right? And, you know, we, an anesthesiologist and anesthesia, you're kind of separate from your colleagues a lot. But in pain, you're working really closely with them. Like we are in the room side by side all day long. We want to work with people who we like, right? Who are fun to be around. So you want that, you know, you want to develop that rapport too. So it's not uncommon also to be asked about, like, would you like to do for fun? You know, what do you like to do outside of work? Other important things is when we're going back to kind of the fit for the, for pain, you're also likely to be asked, you know, why our program? Like why their programs, right? Geographic comes up a lot and that's good, right? Their geographical tie could be a positive. But you also want to study the program, know the program and be able to ask specific questions or answer that question specific to that program, not just location, right? Anyone can live anywhere, but what is drawing you to that program? Because that's a good chance you're also going to be asked that question. Just touching on this briefly, there are rubrics and more and more programs are probably using rubrics or stand and standardized questions. So you're all kind of getting asked the same thing. And then there might be some kind of form of rubric to try to take bias, bias out of the interview, out of the ranking process. And Scott kind of talked about that already. And so in summary, you know, you've also, as you mentioned, do a good job in residency. So that's one of the strongest factors, right? Is that if we see someone perform well in residency, then they're going to perform well in their fellowship. Know why you want to go into pain, highlight your accomplishments, practice. Cece went over that a lot. And then of course be yourself. So, next up, it's my great pleasure to introduce Dr. Magna Anitescu, who's a highly respected leader in pain medicine and our rising president of NANDS. She hails from Chicago. She's at the University of Chicago as the program director and chief of the medicine division there and really brings a ton of experience, wealth of knowledge of how this process goes. I know, you know, personally having interviewed at the University of Chicago, I felt like I left my interview knowing a ton more even about everything in the process and how to kind of go through that than when I even came in. I mean, I think they did a fantastic job of setting up the day. And so, I know she has a wealth of experience that she's going to bring to this. Additionally, I'll be presenting as well, just wanting to go over a couple things in terms of sort of different tips and tricks. Now that you've matched into your fellowship, you know, what can you do to prepare for that fellowship? And what can you do to sort of take the next step, really shine in the very small amount of time we have, just simply one year, as you get ready then to go out and get your first real job? So, you know, I really kind of want to talk about sort of that situation as we're going into why this is important. You know, I mean, I think at least when I was finishing up my residency, there isn't sort of a specific track or different ways that we go into fellowship to know, okay, if I check all these boxes, I'm going to do very well. And so, that's sort of in part why I wanted to bring this up. There's really not a lot of guidance in this area. And so, the goal of this discussion is to hopefully provide a couple resources and a couple questions of different things to think about as you get ready for fellowship. So, basically, we're going to look at kind of the gaps initially of just what are some of the things that at times we see missing as residents come into fellowship. Specifically, we'll be looking at sort of the procedural aspects, surgical aspects, clinical aspect areas to improve. And then we'll provide you a couple of resources, action steps to sort of bridge and facilitate those gaps. So, we'll start here with what those are exactly. I know, at least for me, coming from an anesthesia background, you know, I didn't have clinic regularly and it's definitely an area that's a hard shift as we go and start fellowship. Being able to stay efficient, extract a great history from patients while also being able to do it in a confined period of time is important. And so, sort of understanding some of those things and thinking about that as you transition is going to be important. Additionally, procedural skills, you know, the classic epidural, if you haven't done that before in your training and coming in, it's a hard thing to get experience with as you go in if that's not from your residency program. And so, there are a couple of resources, books, different things that you can do to really improve that and sort of fluoroscopic guidance too. And then the surgical skills, you know, our specialty is we do more advanced procedures, more neuromodulation. It's an important aspect. And I know generally speaking, you know, maybe a couple neurosurgeons or neurosurgeon background, but most of the people who are applying into pain fellowships, going into pain fellowships don't have kind of that direct surgical skill and are kind of coming in naive in that area. So, let's take a look kind of at these particular areas here and starting off with our surgical skills. It's, you know, really important that we get the basics down. Proper draping, sterile technique, those things that sometimes I feel like we skip over or we want to get to the procedure, we want to put the lead up, but it's important that we really take the step to make sure we learn those basic skills well. Because our field's evolving, it's changing. It may be that, you know, one day we're doing leads, another day we're doing another procedure, 10 years, 20 years down the line, you know, it didn't look like it did 20 years ago. But if you're able to appropriately drape a patient, appropriately make sure things are sterile, making sure that your positioning is good, the rest of the procedure, you know, it'll right itself. You'll do very well with that. Additionally, you know, I think it's important as we're coming into the operating room, really not having sort of that clinical operating experience background that fellows really understand the steps that they're getting into and why they're using certain things. You know, what's the difference between a two-layer and three-layer closure? You know, why would I use a certain needle like a PS2 versus CT2? And additionally, too, you know, why would we use absorbable versus non-absorbable sutures? These are all aspects that are very important and are just kind of show the room that you understand where you're going and that you're very competent in the surgery that you're doing. Next, I just kind of wanted to talk a little bit about procedural skills and where you could improve there, too, as you're coming into fellowship. So a lot of this is going to go down to image acquisition, really finding the correct angles with the C-arm, really wanting to make sure that you're placing your needle and driving your needle correctly, trying to use two-handed technique as some people in the audience have taught me over the years, and really making sure that you're getting your reps. If you can get even just seeing, you know, I spent a couple days in private practice before I started just observing, watching someone kind of repeatedly doing medial branch walks and sort of seeing some of those aspects. And I think it really helped to just see how people go through and find different angles. Additionally, you know, NANS has a ton of opportunities for cadaver course. I know some of you were probably there yesterday. But I think these are aspects you really want to seek out, particularly for advanced procedures like hypoplasty. At my institution, we do some, but I had a ton of experience with cadavers that really helped that we really wanted to seek out to get that extra experience during fellowship. And I think, you know, especially if you're in a city or different area, you'll be able to find those courses through industry sponsors or other areas to be able to really learn in a safe environment as well. And then finally, you know, just talking a little bit about some of the clinical aspects, clinical visits, really kind of wanting to learn sort of the typical pain, ways that pain presents, sort of the typical histories that you may get in terms of the types of pain, and then to be able to sort of efficiently go through a physical exam. I think it's important that you understand, you know, really all the aspects of a complete neuro exam, but you won't have time to be able to do that on every patient. And so being able to appropriately pick out the different areas of the physical exam you want to do that are most relevant for this patient is really important. And then finally, I just wanted to touch on a couple of resources, things that I've used during my training in terms of books. I know our panelists up here also have textbooks as well. I looked up and saw they're out on Amazon and different places too. And so, you know, I think these are important to be able to have, be able to refer to, go back to, be able to prepare appropriately the night before as you're going into procedures. And definitely feel free to reach out, you know, if you have any questions, concerns, anything I can do to potentially help you on your journey, you know, I've had a number of mentors who have really helped me and I always want to be able to pay it forward. And with that, I want to bring up Dr. Anna Teskew. So my presentation will be super short because I really want you guys to ask questions and prepare properly for your incoming interview season. So it's going to be pretty much personal advice. So, you know, you start a residency, first year rotating based specialty. Then year two, you start your pain rotation. So the question is, when you're actually rotating your pain rotation, do you like it? It is very important if you want to pursue a career in medicine to really like that. So just doing and just for the sake of the career choice, it doesn't work. So it's going to be, you know, day in and day out pain medicines, you need to like it. And you also have to ask yourself, why do you like it? And do you see yourself doing this for the rest of your life? Then if you really decide that your specialty of pain medicine is for you, you have to network. So you have to go to conferences, you have to find mentors, you have to kind of understand what that means. You have to ask people, you know, you've been a pain physician for 5, 10, 15 years. What does it entail? Is your passion, you know, wanes or, you know, it's just the same as it was day one. Talk to the current when you do go to meetings, ask the fellows, talk to the fellows, talk to the attendings. Ask them what their life is. And then when you actually go and do the interview, do your homework. So if you go and just talk to the interviewers, you have to know a little bit about it. You cannot really go to an interview saying, hey, what did your fellowship? Well, this is public knowledge. Every single program director has their CV on their website. You cannot really do that and expect that you will be a good interview. Do your homework, get something, some ideas to start a discussion about, not necessarily what did you do? Why did you do pain medicine? Asking your interviewer, just like have something meaningful to talk about and just do your elevator pitch as everybody alluded to. How do you improve the CV? There are many ways. Research is not only one way to do it. It's just, you know, you can do case reports, you can do quality insurance programs. You can actually do the teaching for medical students, for your colleagues. A lot of things can go into this area to kind of buff up your CV. Again, when you interview and how do I interview has been covered already. But, you know, I really want to want to see what your questions are about this process. But just like be professional and just go to an interview, prepare for an interview and just like think that you will be, if you like the program, apply to that program. So, you know, do your job and do your homework to kind of join, you know, the interview prepared. Then it comes to how do I choose? So, you know, you have to prepare your list. And then how you prepare your list is personal. You know, you like a program more than others. But just do a benefit analysis. Just like see what you like about the program. If you'll be happier there, how your interview went, how what are your chances to be matching into the interview and so forth and so forth. So after that, you're pretty much ready for your journey. So, you know, really, I would like to entertain a lot of questions as the panel would as well. Thank you. I just want to thank all our panelists for the great talks and really want to give time back to you all. I mean, I know sometimes the moderator comes in with a question, but really want to start off with you. Do you guys have any questions? Anything you want to ask these esteemed lecturers? And I'm going to come out here and give you the mic. Appreciate it. Good morning, everyone. My name is Alejandro. I'm a third year PM&R resident from UT Southwestern, along with my colleague here, Imran. My first question is when you're looking at a program, obviously the first thing that we look at is the location. And there's other kind of intrinsic things that we can look at aside from like the number of palm tree in the city that you're training. But things that we don't really think about that much would be maybe like the program size. If it has a single fellow or six to nine fellows in the program, how important would you say that would be into choosing a program to apply to or to rank highly when it comes time? So interesting question. So whether if I understand correctly, how do you choose between to interview between programs who have one fellow versus 10 fellows, something like that? Well, you shouldn't, because you actually it's all depends on what you do. So that's why we all suggest to talk and just do your homework, talk to the fellows, talk to the attendings, ask people who know that program. So, you know, just you can have nine fellows and we should do nothing. We have one fellow who does everything. So it's just it depends on what your purpose is. It's just it's just you go there for training. You don't go there for, you know, how many fellows there are or for lifestyle. It's one year. Yeah, I think what she's saying is right, the size of the program doesn't reflect the strength of the program. So, you know, just like she said, a small program could be really excellent, you know, and there could be large programs that are that are weaker, maybe or just not as good of a match. So I wouldn't worry about it. I think the big thing I would say, just more broadly, is in the virtual environment, I say candidates collect interviews, you know, like eggs in an Easter egg basket, like, oh, I have 20 interviews and I did 20 interviews. You're only going to match at one. You're only going to match at one program. And so I think once you start doing interviews, you have to do some really solid soul searching to say, what is actually important to me? Is it location? Is it the mixture of procedures? You know, I hear the word advanced probably five times a day during the interview season. Is it the faculty? But you're going to really have to drill down what that is. And then I would say, once you know what that is, what that program is, you know, there's obviously rules about programs asking you, you know, how you want to rank. But if you really are just about a program, let them know, because I guarantee you, Lynn and Magda, everyone, I don't want to be someone's second or third choice. I want to, I want all the people who match at my program and as do they to, I want to be someone's number one. And so that is the hardest thing to do in the current environment, because you don't have to take two days off of work. You don't have to get on an airplane. It's all virtual. So that's just my general guidance for when you're thinking about program. And one hundred percent, but don't like send in even a five program saying that, you know, you love them the most, you know, be honest. I'm just telling you, we all have each other's numbers in our phone. That's not, that's not a threat. But I'm just saying, PDs, it is a painfully small community and network of people, and we all know each other. And so just be genuine, play a good game. I always, Adelaide, if I can tell you, this man played a fabulous game when he applied. He applied at all the programs and he played a great game. And I'm not trying to embarrass you, but how you play the game matters. It really does, because it's just a year and then you're a colleague. And we do it. We'll even recommend like, you know, even a candidate maybe wants to go to one of their programs. We'll say, great, like you rank them higher, right? Like we talk to each other to favor the applicants. Hundred percent. So the main issue, the main message from here is do not lie. We will see when you lie. And, you know, we remember. So do not lie. But showing that interest, genuine interest, like if there's a close candidates and a lot of times it ends up being very, very close, like when someone really wants to come, we might adjust the rank list to that person who wants to come. Hundred percent. Hey, I'm Stephen Lee, third year resident from University of Chicago Schwab Rehab, PNR resident. For you, Dr. Pritzlaff, I think for my question is how do you see the certain, if you're a good fit for that program? I think for a lot of programs like, for example, UC Davis, where you guys are very active on Instagram, there's an open house. You can learn a lot about the program and really kind of see that fit. But for other programs who don't share as much, even on the website, how do you go about finding that out and really getting a good feel for that? I think Dr. Anitescu really hit on a point, which is reach out to former fellows, both current and former fellows. I will tell you, a two-year separated fellow from a program will give you every, you know, they'll give you every detail you want to know, good, bad, and everything in between. So that's for a public who was at different programs, but I would say you can also find that information. I mean, LinkedIn is a great place to find people who are out in practice asking current fellows. But I think fellows are the legacy of a program, and so reaching out to them is a really good way to do it. I don't know if the other panelists have thought of that. A hundred percent. And on the flip side of that, we, you know, I think many of us have, you know, our programs allow access to the current fellows and we get feedback from them. You'll be a good fit for our program. It goes both ways. The fellows are the main source, I think, for you guys to find out about the program, you know, if you fit. But also we do, that is one of the ways we see if you're a good fit for us as well. One of our fellows always interviews the applicants as well. So it's just, you know, we really take it very seriously. Good morning, everyone. Thank you so much for your time. My name is Verena Clark, and I'm a current anesthesia resident at UCLA and thankfully secured a position In the chronic pain fellowship at UCLA for next year, so I'm going back to your points about soul searching I was wondering you know we all know that each program has their strengths But during fellowship were there any things or any things that you guys recommend during your training that you sort of? Sort of had an idea of what the next step would be during fellowship Is there anything that you did any conversations you had early on that you would recommend to you know the future fellow I? Can answer that actually similar to previous response Soul searching it helps if you like go out talk to a lot of people So a lot of people who recently graduated or a few years out and ask them like what their experience has been whether in private practice academics as people especially people who have transitioned between private practice or academics or different types of practice setting and so that they can tell you like What what the pros and cons are and how they determine? What was a good fit for them so talk to a lot of people go to conferences? Go to people outside your region different regions like you know pain is practiced a little differently in different places I think I would just say You'd be surprised if you come to a meeting like this, and you you ask them for help Someone who sometimes you're very intimidated to say oh my gosh. I'm gonna. I'm gonna. I'm gonna walk up to you know Lawrence Perey or you know one of these other people you're like oh my gosh I you would be absolutely shocked right if you walk up to someone who is very well known very well known in the space that How willing they are to help you? That's another way soul search, that's very true I think one of the like things I'd like most about pain medicine. It's just that right we everyone It's just so approachable. It's a small field and I think we're lucky we don't it doesn't seem like there's a huge number of egos in our field and so approach anybody I Don't agree. It's just everybody's very very willing to help and very very nice You know you get a lot of advice from people who've been in the field for many years Any other questions from the audience Hi everybody I'm crystal. I'm a pgy3 anesthesia resident at Beth Israel up in Boston So my question was about Signaling I know it this year's the first year that signaling is you know applied for applications How much do program directors hold value to them? I? Don't know if we know yet We are just you know we haven't I think we all talked about how we haven't really actually started going through the applications quite yet And so I'm not entirely sure I think we will definitely look at it I think if the candidate is strong and they signaled us. I think that will be an advantage to getting an interview, but Yeah, I mean same uses after this I think preliminarily we were comparing notes. I always like to compare the golf You know score a car. You know to see where the over-under is but this year Historically lowest amount of applications. I've seen ever as a PD About 10 to 15 percent of those applications are signaled applications so I Guess the biggest surprise for me is I was expecting more So I think It will play probably some role in interview selection, but probably I think in some ways If you have two equally tiered candidates after an interview, I think it will probably play more of a role, but There's only five which I think you know and a lot of this was under Lynn's leadership with a PPD There's only five signals, so I think it's it's the perfect number frankly, but I discussed it You know we tried to figure out what the right number was Yeah But I think it'll be interesting to see I think time will tell Yes, it's sorry. We don't next year. We can maybe answer that question better Which I know won't be relevant for some of you, but I? Think we have time for one more question Thank you. Hi, my name is Sean. I'm a neurology resident at Mayo Clinic. I know most people come from anesthesia and PM&R, so I'm a little bit, I'm excited to go into pain, but for people like me in a non-traditional kind of residency that want to go into fellowship, what would you say is the things that I should know, things I should read up on, textbooks I should read up on. I know Furman to kind of get prepared before my rotation, and just like a FYI, we have, at least my program, really the possibility to do two months of pain before, you know, getting into fellowship, so kind of limited exposure to practical pain. So it's more and more specialties which are applying for pain fellowships, so we had actually a neurology resident as a fellow. It was great. It's just, you know, number one, you have to have the passion for it, so you have to kind of put the work into it. Number two, you have to prepare, and number three, you know, when you come to any program, it's just, in a year, we make you proficient and a good pain physician, so you shouldn't be very worried about that, but you know, you have to kind of put the work in, just like make sure that you actually like that specialty you go into. I think the only thing I would say is drop the imposter syndrome, you know, no one cares, right? We care, once again, to those attributes. People, I think, neurologists and some of the other specialties are worried about the perception. Guess what? You're probably better than any anesthesia resident at a dirty six letter word. It's called clinic, right? Anesthesiology residents are really good at, you know, the needling, per se, but you're good at clinic, and that's a huge strength, so know that you're gonna bring something slightly different to the table, much like PM&R residents bring amazing clinical kind of being in clinic, but I think having two months of rotations really shows longitudinal interest. You're gonna have some good letters, so, but I would say this is your year. The next couple years are gonna be years for, I think, candidates who were, when we showed that graph, were, you know, quote, non-traditional, but it's wide open now. And it's an advantage to a program, I think, to have diverse background applicants because everyone learns from each other. Yeah, I can attest to that. I had a co-fellow who's a neurology resident, and we were always going to him to ask him about, like, explain the neuro exam again to us, like, talk about headache medications, and he was always a great resource for everyone in the program. Even the faculty will go to him for headache questions, so you'll be a good resource. I mean, personally, I'm excited that we have a lot of different specialties coming into the field. You know, diversity of thought, so important, and I think it really is going to help advance the work that we do in the coming years, so. And that's all we have time for. I want to give time, you know, let's give another round of applause, first off, for our speakers here. And for you guys, I really appreciate you coming out at 7 a.m., getting up early. It shows a lot of hard work, so appreciate that. And with that, thank you.

pain medicine fellowships

application process

diverse backgrounds

interview preparation

networking

mentorship

program directors

clinical skills

virtual interviews