IJMSC Insights: Elizabeth Gromisch, PhD, Is New Associate Editor

At its founding in 1998, the International Journal of Multiple Sclerosis Care (IJMSC) was led by editor in chief Robert M. Herndon, Sr, MD. He passed the torch to Lael Stone, MD, in 2007. In 2014, she passed the torch to Francois Bethoux, MD, who just celebrated 10 years at the helm in 2024. In 2020, Alissa Willis, MD, was brought on board as an associate editor. IJMSC is excited to announce that we have added a new associate editor to the team, Elizabeth Gromisch, PhD. She sat down with us to introduce herself and talk about her career and research interests.

IJMSC: Tell us a little bit about yourself. How did you get into psychology? And how did you choose to specialize in multiple sclerosis (MS)?

Elizabeth S. Gromisch, PhD: I had a strong interest in cognition. I studied neuroscience [as an] undergraduate, and I knew I really wanted to do more of it. For a lot of that, I have to give credit to my mom. She had a rare form of brain cancer, so I saw cognitive changes firsthand. She was also the inspiration to start looking at resiliency because I saw her dealing with 2 primary cancers and bouncing back from all of that. When I applied for my PhD program, it was in clinical psychology with a health emphasis. Each lab [specialized in] a specific condition, and in the first month there, we were able to see [which of] the different labs would be a good fit…. And that’s how I met [Frederick J. Foley, PhD, MA, of Yeshiva University]. I credit him as the reason I [specialize] in MS because he was running the MS lab. I reached out to him, and he was so enthusiastic: “We could absolutely do cognition research; come to my lab meeting. We [can] talk about it more.” During that meeting, in September 2010, he said [he had] had some conversations with colleagues, [and] if we could take these full [neuropsychology] tests and cut them down to 1 or 2 trials for a screening, that could really change how we do screenings. I chose that as my master’s thesis that day, and then I’ve been in MS research ever since.

IJMSC: What were the institutions? Where’d you get your undergraduate degree, and where did you get your following degrees?

Gromisch: I earned my bachelor’s degree at Trinity College in Hartford, Connecticut, and my master’s and PhD degrees were in psychology at Yeshiva University in the Bronx, New York. My doctoral internship and my postdoctoral work in neuropsychology were both at the VA Connecticut Healthcare System in West Haven.

IJMSC: How did you first hear about IJMSC and the Consortium of Multiple Sclerosis Centers (CMSC)? I’m guessing through Dr Foley.

Gromisch: Yes, my first paper was in IJMSC. It was a consensus paper about cognitive screenings. Then a year later, in 2013, I started reviewing for the journal.

IJMSC: Tell us about your research team.

Gromisch: I head up the research group at the [Joyce and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research at Mount Sinai Rehabilitation Hospital, Trinity Health of New England]. We’re a tiny group, but we’re a mighty group… I’ve been lucky that I have a team of collaborators across the US. [I also work] a lot with the team at VA Puget Sound [Health Care System led by Aaron Turner, PhD]. We have a bicoastal research [team]. I met him through a mutual colleague, and [we] started with a mutual interest in treatment adherence research. It’s hard for me to think of a project that he is not on. And I’ve been lucky to continue working with all my mentors throughout the years. I still work with Fred on a number of projects, and one of my current ones, which is continuing my initial research in cognitive screenings, [includes] my undergraduate adviser, my graduate adviser, and my current mentor. They don’t get to escape from me!

IJMSC: It sounds like you have a wonderful team. It’s an advantage to stick with people you know and who know you.

Gromisch: I’m really lucky with that, especially because when I started at the Mandell Center, their focus was more on physical rehabilitation research. I started more of the mental health and cognition research from scratch, so it was helpful to have collaborators across the US I could pull in.

IJMSC: I’ve noticed Dr Turner’s name on your papers, and I never realized you are a bicoastal team. What has that been like? How did the pandemic affect it? Is it easier now?

Gromisch: It’s a lot easier now because telecommunications is much more accepted. We started working together in 2016 and didn’t meet in person for the first time until a CMSC meeting in 2019 when we did a panel discussion together. Early on in my independent career, when I was putting together career development awards, I definitely got knocked [because] my team was not centrally located…. Since the pandemic, I think it’s much more accepted that we have these virtual talks or meetings. It’s second nature at this point…. We have calls every other week to touch base on our projects.

IJMSC: And you’ve kept the VA connection.

Gromisch: I finished [my training at the VA] in 2017. I did a practicum, then another practicum, and a year in between, and then I went back for my internship and postdoctoral work. I’ve been lucky that I’ve been able to stay with a WOC [without compensation] appointment. I don’t get paid, but I’m still able to do research at the VA.

IJMSC: What have you noticed about working with veterans? What does that focus bring to your work?

Gromisch: A lot of the work that I started with veterans was looking at appointment attendance and treatment adherence. Much of the work with treatment adherence in MS has been on medications, but we know that not everything is about medication. Some people choose not to be on DMTs [disease-modifying therapies], or they do infusions, which tend to have a higher adherence rate because they’re getting a lot of follow-up to go to their appointments. Because [the VA is] a more centralized health care system, we were able to look into whether people are coming to their appointments or not and get more insight into who [is a no-show for] their appointments and who cancels at the last minute. That’s all disruption in care. And then we can look at that in the civilian population, which is sometimes more of a challenge because not everyone goes to 1 health care system for all their care…. Currently, I’m trying to take some of the work I’m doing in the civilian world and bring it to the veterans population.

IJMSC: So some crossover. What is your current research project?

Gromisch: I am mainly working with technology. In 2021 I got a Harry Weaver Scholar Award from the National MS Society to develop a fatigue self-management app. I went from having no technology experience to learning all about user-centered design and development of user interfaces and experiences. [My focus] is on developing a program that uses cognitive behavioral therapy and energy conservation strategies, but one that you can do [on a smart device] from the palm of your hand. Patients play a really big role in the development, so they tell us what they want to see in an intervention, what they like, what they don’t like. Because I learned how to do all that technology development, I was able to go back to that original work in developing cognitive screeners and work on making a tablet-based cognitive screener. And again, having patients on our development team helps us make it accessible and, I hope, increases access to services.

I went from having no technology experience to learning all about user-centered design and development of user interfaces and experiences.

IJMSC: You’re learning all about technology, an area I think we all have become more expert in.

Gromisch: And not one I expected I’d get into based on my training. I’m a neuropsychologist by training. I don’t have design experience or know about computer programming, so it was something I had to learn from scratch, but now I absolutely love it.

IJMSC: So what’s the through line? How does this connect to your past paper or your past couple of papers, which were on resilience and psychosocial factors related to walking?

EG: One of the things we found with the goal attainment paper was that several psychosocial factors are associated with whether people reach their rehabilitation goals, and these are potentially modifiable. A challenge is how to assess this. And it really is helpful to have that multidisciplinary approach. One of the things we have on our MSCogScreen battery is that our patients [can] chose [from] 17 different questionnaires. When you’re doing the cognitive testing, there’s a delay, so [we have] questionnaires to fill in the time delay. They include pain interference, depression, and different social support questionnaires that we found were predicting [whether] people were meeting their goals. If everything works and we’re able to bring this cognitive screen to the wider population with MS, it’ll integrate with the EHR [electronic health record]. When people come in for their annual visit, they can do the cognitive screening and fill out these questionnaires, [which will be sent] right to the EHR. If the referral is for physical therapy, the physical therapist gets all that information from the get-go and can say, “Oh, I’m seeing that there is an issue with depression. Let’s make sure I’m talking to the psychologist or social worker to support them so that they can focus and work on their rehabilitation goals with me.”

That ties in to my interest in test development, too. We found that focusing on resilience building and teaching coping skills may be an approach to help people [undertake] physical activity, which could help their functioning. We can improve coping strategies with things like cognitive behavioral therapy and teaching them other ways to manage their energy. That’s where the self-management programs come in handy, teaching those skills. And the resiliency scale that we used in that study is one of our outcome measures we’ll be looking at in a feasibility trial in the next couple of months.

IJMSC: You have a lot of interests. Can you give us a picture of what your work looks like as a whole? What is the goal of this line of research?

Gromisch: The big, overarching goal is really trying to improve access to health care services, particularly mental health services. We know that mental health and cognitive impairment are big issues for people with MS, but there are a lot of barriers to getting care, whether that’s having providers who know about MS and its unique challenges or being able to access them. Maybe somebody lives in an area without a mental health provider or a neuropsychologist. The goal is to create tools that give patients resources in the palm of their hand that can support what they’re doing in clinic and make it easier for them to get treatment without having to travel far or find accessible transportation. [It is also about] helping providers by giving them tools that make these screenings easier so they can get patients the services they need more quickly and facilitate [patient-clinician] communication. If patients know what’s going on and providers know what’s going on, they can come together to make informed decisions.

We know that mental health and cognitive impairment are big issues for people with MS, but there are a lot of barriers to getting care, whether that’s having providers who know about MS and its unique challenges or being able to access them.

IJMSC: After you get these apps and the screenings, what’s the next step in that research?

Gromisch: The next step [is]: Do they work? And then, do patients like them?… I have a CMSC grant to do a pilot evaluation of their psychometric properties. Are we testing what we’re supposed to test, and are they around the same level of difficulty? We recently put in a grant [application] to try to build and test…the [integration of the] EHR with the intervention. We’re finalizing the fatigue app. We’re doing the last bits of usability testing and, I hope, rolling out the initial evaluation of its feasibility and initial efficacy in the next couple of months. If that works and it helps people, the plan is to put it out in the app store…. We’re also looking at expanding into other symptoms. We’ve been working on a depression version and a cognitive version as well. So patients can go into the app store, download it, and have an initial orientation session with somebody who doesn’t necessarily need to be a mental health provider. We’re designing it so it could be someone like a [National Multiple Sclerosis Society] MS Navigator, and they could do that virtually and then get access to those services.

IJMSC: Do you have any trepidation about the reliance on virtual care?

Gromisch: I think we have to. Even though a lot of people use technology, we must also acknowledge that not everyone feels comfortable with it and not everyone has access to high-speed broadband, and those are still barriers. One of the things that we’ve been doing is technology training. We have a one-on-one orientation session [that is] about not only setting goals but also orienting the person to using the program and making sure they feel comfortable with the technology…. [For example], if they don’t know how to make an appointment in their calendar, [we show] them how to do that.

IJMSC: What is your perspective about how clinical care and research come together? What is your ideal view of how these 2 seemingly separate fields interact?

Gromisch: I’m lucky that [at] my center, research and clinical [work] side by side. Our center was formed with research first, and we’re right next to each other, so we share the same waiting room. We share the same hallway for exam rooms. I see research as being the way to find cutting-edge clinical care. We’re that first step. I’m lucky…that I still directly work with patients. I am my own RA [research assistant] at times. The nice thing is I still interact with patients every day and get their thoughts on what they need from their care and what they feel is missing from their current services. And then, how can we work together to develop a better intervention or a better assessment tool to really fit those needs?

IJMSC: Are clinical interactions different from research interactions?

Gromisch: For me, the research [interaction] tends to be shorter because as a neuropsychologist, I’m used to 4-hour evaluations, and I think the longest [research interaction] I’ve ever done is 2½ hours. I always joke that when it comes to research, people want to come see me because they’re agreeing to do this. Either they’re excited about the project, or they want to help move the field forward. If you’re getting referred to a neuropsychologist, it might not be the most fun thing and it might be a little scary. I think sometimes research can be that first introduction to certain specialties. I’m [often] the first person they’re seeing who has an expertise in cognition. Right now, I’m building extra time into my research appointments because people have questions or need some guidance about [questions such as]: What does MS do to my cognition? What do I do next? And I have limitations: I can’t give you a diagnosis, I can’t give you direct feedback on how you do today, but I can educate you on MS, and I can talk to you about what the next steps might look like if you want some additional assessments…. [It’s about] building that confidence that maybe we’re neuropsychologists but we’re not that scary. I haven’t scared people away yet.

IJMSC: I think people [perhaps] have a block on medical research, so helping them through that is probably a good first step.

Gromisch: With our current study with the MSCogScreen, we’ve had many people who’ve never done research before, but they want to know more about cognition and MS, and they signed up for the study. Now they love research, which always makes me happy because we’re getting more people [involved].

IJMSC: We always need more people to participate. What’s something you hadn’t expected, either in a research finding or through a patient encounter, or something along your educational path? What’s been surprising about your career so far?

Gromisch: Definitely the pivot into technology. When I first went to graduate school, when I first started at the Mandell Center…I did not think I was going to be doing technology work at all, and the reason I pivoted was our patients. I decided I wanted to do a self-management program because it tied a lot of my work together. We did a big survey and asked patients, “How would you want this kind of program to be available to you?” And a lot of people liked the technology because then [they] could use it whenever [they] wanted. [They’d say,] “If I need to take a break, I can walk away. You know, I don’t have to try to schedule it around someone else’s availability.” I think the important thing [in] research [is] we really have to honor what people want. I always tell people, “You are the expert on your MS, so I need to know what works for you, what doesn’t work for you.” Otherwise, I’m not making something that’s going to be worthwhile. That definitely shifted my perspective [and my entire career trajectory]. This is something that people want, and this was prepandemic…, 2018, so pretty early on before [technology] became more accepted and needed.

IJMSC: We’ve talked about how the landscape of MS care and research continues to evolve. There are a lot of hot topics right now, a lot of things on the verge, in development. What will you personally be following in the next 10 years? What hot topic are you keeping track of?

Patients want to know what their contributions are to research, and they really need to have a say in what the research looks like.

Gromisch: This past June, the International Progressive MS Alliance had a digital tools workshop. It was focused on where we are going with digital tools for people with MS. I was a speaker on user-centered design. One of the things that became clear from hearing the patient speakers is we’re really [moving toward] highlighting the role of patient advocates in research. Patients want to know what their contributions are to research, and they really need to have a say in what the research looks like. If we’re developing new assessments, interventions, and diagnostic tools, they need to be focused on the patient. And it’s beyond just digital, so it’s really that [research needs to be] more patient focused.