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How to Engage with Content & Colleagues at a Virtual Meeting (And Like It!)

Now that AHA20 is going virtual, you might have some questions: Is it worth it? How can I connect with my council? Will the valuable networking still happen? Will I actually learn anything? So many of our regular touchstones have been canceled in 2020, but you don’t have to give up Scientific Sessions. It won’t be the same, but with a little planning, it will be great in different ways.

I polled the AHA early career bloggers for their best virtual meeting tips, and here’s their rundown on how to make virtual meetings work for you:

  • Use multiple channels. While the meeting may be streaming on a designated platform, you might also find engagement using outside tools or social media platforms.
    • Follow the official hashtag (#AHA20) on twitter. This is a great way to highlight key presentations, engage with other participants, and connect with experts and presenters. (If you haven’t used twitter professionally before, take the time to set up your bio, make sure your existing content is safe for work, and make your avatar a good picture of you. Or consider a dedicated profile for work. Do some legwork ahead of time to follow people and organizations you’re interested in connecting with during the conference).
    • You could create a Slack Channel with others in your institution or research area to share resources and have ongoing conversations.
    • You could make a Strava group to engage in a little healthy competition and give one another kudos— who got their workout in today?
  • Take breaks. At a face-to-face event, you spend time walking between sessions and break for meals. When everything is online, it’s easy to forget to get up, rest your eyes, and move around.  Hydrate. Take bio breaks. Bonus points if you go outside and don’t take your phone.
  • Consider using a standing desk, or even a makeshift setup, to help you be more mobile throughout the day. Changing position frequently is one of the keys to avoiding pain from being sedentary.
  • Take notes! Things start to run together and a good note-taking strategy will help you remember key information. Maybe you use a good, old-fashioned paper notebook, or maybe you prefer a tool like Evernote. Up to you.
  • Use the interactive tools to ask questions. Especially if you haven’t gotten up the gumption to stand up and ask questions at a live session, you might find the online format more accessible.
  • Connect with colleagues before the meeting starts, and schedule times to debrief and share key takeaways. This helps to keep momentum and excitement going.
  • Constant on-screen interaction can be very taxing. If available, try the on-demand option to give yourself more flexibility. Also consider taking a break from being on camera and just listen.
  • Let yourself be immersed. When you travel to a meeting or conference, you may arrange child care, get someone to cover your clinical or teaching duties, and put up your out-of-office message. While it might be tempting to squeeze conference sessions around your regular responsibilities, you’ll miss the value that the immersion experience provides.

And remember, the virtual conference is accessible to all– if you might ordinarily be limited by difficulty traveling or cost, this is could be your year.

Share other tips (@AHAmeetings and #AHAEarlyCareerBlogger on twitter), connect with the Early Career Community, and grow your network!

And register for sessions: https://professional.heart.org/en/meetings/scientific-sessions

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From Race-Based Medicine to Fighting Structural Racism

“Race is the child of racism, not the father.”

-Ta-Nehisi Coates, Between the World and Me.

BiDil, a combination of isosorbide dinitrate and hydralazine, was approved by the FDA in 2005 to treat heart failure in African Americans— the first race-based indication in the U.S. Though some groups lauded this move as a win for the underserved Black community, controversy soon emerged— and rightly so. Why did the researchers come to the conclusion that this combination of drugs worked better for one racial group than another? Why did the FDA take the action to approve it this way? The answers were not reassuring.

Did you know that there is no genetic basis for discrete racial categories? If not, this is likely because of what you were taught in training. It’s time to unlearn some falsehoods! The concept of race is not, in fact, biological, but social. It is not race, but racism that creates and perpetuates inequities.

Race-based medicine is bad medicine. Period. Dorothy Roberts gave a seminal TED talk in 2015 explaining this concept. The persistent myths that characteristics like pain tolerance vary by race are damaging and false. It is up to us, as clinicians and scientists, to dismantle the racist structures and processes within health care and within our larger communities that harm people of color. We cannot allow the fiction of biological racial difference to obscure the reality of racism.

Race can be an important variable to include, analyze, and understand in science and medicine, but not because of biology— because of structural racism. Diagnosis and treatment should not differ by race. Rather, social determinants of health must be part of all the care we provide, and all the research we conduct. We need to fundamentally reexamine the characteristics we use to ensure diversity and external validity. Yes, we need data on race, that that’s not enough.

As we see stark and alarming differences in COVID-19 among racial groups, the realities of racism’s health impacts are writ large. Living and working conditions, rather than biological differences, drive the differential infection and death rates. We, as the next generation of scientists and clinicians, can seize this moment to create lasting change and move toward health equity.

How?

  • Question assumptions. Race-based decisions in medicine are often due to force of habit, tradition, and education. Ask why and if there’s not a good reason, stop. Why do we give race as a defining characteristic in our case presentations? Why do we calculate creatinine clearance differently? Why do we prescribe differently?
  • Assess your biases. Try the Harvard bias test, for example. No one is without bias! Seek out training. Eradicate blind spots. Form accountability groups with colleagues. This work can be uncomfortable, but it’s necessary.
  • Solicit input. Whether you are a researcher or a clinician, the community you serve needs to be involved. Do not assume you always know what’s best. If you ask, and listen, you will discover the values and priorities of the community. Trust-building takes work and time. Demonstrate trustworthiness and remember that iatrophobia is justified by history.
  • In research, define race and specify the reason for its inclusion. Use a sociopolitical rather than biological framework, and name contributing factors. Name racism and related forms of oppression that may be operating[1].
  • In clinical care, assess and address social determinants of health. Advocate for equity-focused community practices: food banks, suspension of evictions, support for access to broadband internet to increase access to healthcare and education, and provision of paid time off for sick leave & quarantine, among other actions. Identify needed resources and provide them.[1]

 

Sustainable change is never straightforward, never easy, and rarely rapid. As early-career professionals, we have many years to fight this fight. Let’s not waste any of them.

 

References:

[1]Boyd, R., Lindo, E., Weeks, L., & McLemore, M. (2020). On Racism: A New Standard For Publishing On Racial Health Inequities. Health Affairs Blog.

https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/?utm_medium=social&utm_source=twitter&utm_campaign=blog&utm_content=Boyd&

[1] Haynes, N., Cooper, L., & Albert, N. (2020). At the Heart of the Matter: Unmasking and Addressing the Toll of COVID-19 on Diverse Populations. Circulation, 142 (2).

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.048126

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Diversity, Equity, & Inclusion Are Not Just Buzzwords— Practical Steps for People Who Teach

Those of us who work in science, healthcare, and academia often find ourselves teaching others, whether or not we set out to be educators. Residents teach medical students. Nurses precept new nurses. Graduate students teach undergraduates. And faculty roles for researchers and clinicians also include teaching loads. Yet for many of us, our training did not include any grounding in how to teach. We might not have brought the same theoretical rigor and deep expertise to our teaching that we have to our other roles. Now, as we are teaching in a world of rapid change and increased awareness around structural racism, we must approach equity in our educational practices with intention, but some among us may not feel prepared and we are already overwhelmed. We are already adapting to enormous change related to COVID-19, and the intellectual energy required to reexamine another entire part of your professional life can feel paralyzing. It can feel like an impossible task that there will never be time for.

Despite these barriers, I strongly believe that you can start (or carry on) right now, no matter where you or your institution are in the struggle for antiracism. Here are some immediate suggestions to make your practice as an educator explicitly equity-focused and antiracist, for folks who teach in all kinds of contexts (these topics work for self-education, too):

No matter what format you teach in, there are some basic practices you can adopt to establish a “floor” for equity and inclusion.

  • Can you pronounce the name of everyone in your group? Do you know what they prefer to be called and what pronouns they use? Some teachers inadvertently avoid calling on students because they haven’t bothered to learn these things and don’t want to make a mistake. Don’t be that teacher.
  • How much time does every person (including you) speak? Is anyone taking up more space than they need? Now, the era of video calls, some platforms can actually show you how much time each individual speaks for, and this can be eye-opening. I encourage you to actually measure and observe this at least once. It can be surprising to see how some groups are consistently dominating conversation at the expense of others.
  • Have you adopted principles of Universal Design for Learning in your teaching? If not, now is a good time to start. UDL is a set of principles that improves the experience for all learners by focusing on accessibility and flexibility and assuming diversity.
  • Are you yourself familiar with concepts of antiracism? Have you examined your own privilege, bias, and ignorance? Are you learning?

For those who teach in a classroom or seminar format, Dr. Valerie Lewis has shared some more tips:

  • Include an equity-focused reading with every topic (e.g., if you are teaching about asthma, include an article about disparities related to race and social determinants of health).
  • Message that equity isn’t a specialty; every field should address it as part of ongoing professional practice.
  • Create a dedicated class session for equity, and if possible do two— one at the beginning to frame the ideas for learning, and one towards the end to integrate the content you’ve covered with broader ideas around equity. This can help to lay the groundwork for ongoing reflective professional practice.
  • Audit your syllabus: can you include AT LEAST one scholar of color every week? You might have go-to reading lists that you’ve inherited or developed, but if your list doesn’t measure up, you can change it. Go to PubMed or google scholar. Look at professional societies. Ask colleagues. Crowd-source on twitter. This is a key way to amplify voices— remember that citations are academic currency.
  • Don’t be afraid to make mistakes. Be open with students that you are doing this intentionally and why, and take feedback.

This is not a checklist or an exhaustive resource for inclusivity. But I hope that if you are floundering as you try to figure out how to teach with a focus on equity and inclusion, that you’ve got a good first foothold. Let’s keep the conversation going— I’d love to hear more ideas. Hit me up on twitter @TheKnightNurse and let me know what you are doing.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Should you keep politics out of your career?

Advocacy is a core function of many health professions, including nursing and medicine. So why are we socialized not to engage with politically touchy subjects at work?

Funding for much of our work in science, medicine, and education comes from the government. Sometimes it comes from corporations that make pharmaceuticals or devices. Even in democracies like the U.S., legally protected free speech does not prevent organizations from restricting their employee’s participation in political activities or certain kinds of speech while working.

The current global public health crisis is igniting fierce debates around hot-button issues of workforce safety, inequality, prejudice, disparities, and personal freedoms. As the world changes rapidly, I am hearing lots of early-career folks wondering how to balance the call to engagement on divisive topics with the need for career stability. My profession, nursing, has a long history of activism and political engagement. I also work for a large university, where political engagement can rock the boat and raise eyebrows. This is a precarious position.

Here’s the rub: public health issues are inherently political. Think of political advocacy around tobacco and vaping, and food. These are everyday public health concerns and they are steeped in politics, yet they rarely result in career-ending political feuds; this kind of politics is generally tolerated in academic institutions. However, as we are now seeing, the relationship between politics and public health is stronger with rare and catastrophic events like the COVID-19 pandemic. Those of us in science and health professions are facing the ramifications of political decisions daily, such as access to PPE supplies, access to ventilators and medications, guidance to the public about masks and distancing, and travel restrictions. We feel this impact acutely, and many of us feel compelled to voice our opinions.

Yet, we may find ourselves at risk if we speak up about an issue with political implications, either at work or in outside public forums. Voicing dissent to institutional policy, governmental policy, or anything in between can be professionally and personally damaging. In the U.S., hospitals have been ordering staff not to speak to the media and terminating those who do not comply. This behavior can have a chilling effect on others’ willingness to voice concerns about safety. As a result of these gag orders, high-level decision-making is often missing key voices and information. The case of Dr. Li Wenliang, the Chinese physician who sounded early warnings of the dangers of the novel coronavirus, was reprimanded by the Chinese government, and later died of the disease, is a tragic example of just how the stakes are. Navigating the boundaries of political and scientific speech in life-or-death situations is not something we learned in graduate school.

The relationships among scientific data, lived experience, and government messaging are complicated, but that doesn’t mean they are untouchable in a professional context. Medical journals do not universally shy away from political perspectives. The Lancet, for example, recently  published an opinion piece pulling no punches in its assessment of American political leadership: Michael Marmot writes, “Apart from the mendacity, incompetence, narcissism, and disdain for expertise of the man at the top, there may be strong messages about the nature of US society and the response to the pandemic.” Not all professionals and academics are willing to voice such forceful political opinions, but this example shows that even strongly worded opinions can be embraced.

Can mixing politics and work hurt your career? Definitely. Is it possible to practice your profession apolitically? Maybe. Is that something you want to do? You have to decide.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Evidence: What’s good, What’s good enough, What’s dangerous? Lessons for now and later.

COVID-19 has created a complex environment for health research. In an evidence vacuum with a clinical imperative to act, we have few choices. They include relying on analogues (such as SARS or MERS), trying treatments based on theoretical biological plausibility, relying on anecdotal evidence and case reports, and rushing evidence from small studies that may have significant limitations into print. There is a need for answers that are definitive but also rapid: a condition that science as we currently practice it can’t satisfy. Additionally, peer review relies on content-area experts, which are hard to find for a rapidly evolving area when potential experts are also stretched thin with clinical and research roles. The result is that evidence may look different from what we are accustomed to.

Some healthcare practitioners and scientists have reacted with alarm when low-quality studies have been published by normally meticulous journals. Are we abandoning the RCT, they ask? Is appropriate statistical analysis no longer required? Does the name of a prestige journal no longer guarantee rigor? Is low-quality evidence worse than no evidence at all? Is it wise to publish clinical observations in a newspaper rather than a medical journal? Who is responsible when a public (or public official) not equipped to recognize the limits of early evidence spreads misinformation? Are resulting adverse events or medication shortages partially the responsibility of the publication? The researcher?

These are debates worth having, and there will be compelling arguments on both sides. No matter your stance, though, there will be an impact on the future of science.

Lessons include:

  • Critically reading studies and understanding their strengths and limitations remains a valuable skill. Just because something is in print doesn’t mean it should be in practice. Scientific education in all disciplines needs to continue to focus on this skill.
  • Perhaps the standard glacial pace of evidence dissemination can, in fact, improve. Faced with undeniable urgency, the mechanisms of publication are adapting. Turnaround time measured in days or weeks rather than months or years is possible.
  • Lots of content related to COVID-19 from academic and lay publications alike is open-access— because it is seen as for the public good. Perhaps that perception can broaden, and alternative payment structures will make science more accessible.
  • The translation of basic science to clinical application (bench to bedside) can move rapidly when needed. As my fellow blogger Sasha Prisco has noted, there are currently administrative barriers that hinder this work, and their long-term necessity may need to be reevaluated.
  • Real-time information sharing and collaboration occurs through multiple channels beyond academic journals, including social media sites.

Have you considered the potential impact of this pandemic on the future of scientific publication and knowledge dissemination? Has it changed your ideas about publishing, research, evidence-based practice?

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Leadership Through Unprecedented Uncertainty

Being an early career professional in health and science means moving along a continuum of learning and leading. The moment you clear a hurdle, you’re a mentor for people following you. Remember “see one, do one, teach one”? There’s the learning-leading continuum in action. Every day of our working lives, we are becoming leaders as we continue to learn.

For the past month, give or take, the U.S. has been in the midst of a panicked response to the global COVID-19 pandemic. Institutions have been scrambling to respond to rapidly changing conditions with scarce information and mixed messages from government and global bodies. Schools and healthcare organizations, where many of us work, have been particularly impacted. I have felt this stress acutely, as I’m sure many of you have. Will we be caring for affected patients? Will our PPE and medical supplies last? Will our research be put on hold? Will our students be able to graduate? Will we or our loved ones fall ill?

Even as our own anxiety ramps up, we may find ourselves needing our fledgling leadership skills more than ever. The public looks to us as experts. Patients look to us for guidance and comfort. Our students look to us for direction. Staff who work in our facilities look to us for instructions. How can we be there for these folks, even if we don’t feel all there ourselves? Here are some ideas:

  • Be present: find safe ways to be available, whether you’re on the ground, on video chat, sending emails, or anything else you dream up. Let people know they can talk to you and you’re there.
  • Be informed: Stay up to date, find sources of information you trust, and read with intention. This practice can help you be a source of authority and comfort when so much around us is chaotic.
  • Be honest: it’s OK to say “I don’t know” when you don’t know— especially if the next part is “but I promise to do my best.”
  • Be kind: Every person you interact with is facing stress now. Treat them kindly. Ask how they are, and listen to the answer. Allow a little grace where you might otherwise stick to strictly business.
  • Be transparent: If you are working on a plan, say so. If things might change, say so. If you are waiting on a person or a step that can’t be rushed, say so.
  • Be human: you don’t have to be a robot. People can see that you, too, are anxious or uncertain, and that doesn’t undermine your ability to lead. People can see that you have kids, or pets, or a partner, or dirty dishes. Sharing your self can be one of the most powerful ways to connect.

Ultimately, everyone is seeking stability, comfort, and connection. Much of this is beyond our control, but even a little leadership presence goes a long way.

Stay safe, friends, and may you come through these hard times with grace and wisdom.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Writing is Hard— And Here’s Why You Should Do it

If you are in academia, you are likely familiar with the “publish or perish” mantra. Publishing in peer-reviewed journals is absolutely valuable, both for researchers and for clinicians. It’s a robust way to develop and share knowledge. It can help you get promoted. It can raise your profile in your field. But for people with competing demands (teaching, clinical practice, the rest of your life), it’s not always accessible.

Don’t worry— there are other reasons to write and other ways to publish. In navigating what kind of writing and publishing is valuable, it’s crucial to understand your goals. One size does not fit all. The best approach for you depends on your professional trajectory. If you have an academic appointment and you are pursuing tenure and promotion, then yes, data-based and peer-reviewed publications are your priority. But perhaps your role is different, or broader— maybe you see yourself as a public educator or advocate, a clinical expert, or a mentor. Writing is hugely valuable in these roles as well, but it doesn’t necessarily look the same. Or, to put it in other terms, writing is like medication admiration. You need to check the “5 rights”: What’s the right drug (topic), dose (length), route (venue), time (frequency), and patient (author)?

If you are not (or not solely) pursuing an academic career in the sciences, think outside the box, and consider:

  • Writing about science and medicine for a popular audience— think of influential physician and nurse authors like Theresa Brown, Atul Gawande, Lisa Sanders, or Jerome Groopman.
  • Write for a clinical audience— in my field, Journal for Nurse Practitioners or American Family Physician, for example, publish articles on clinical topics.
  • Writing creatively, in health humanities publications (or some medical journals publish poetry on occasion). Or write to nourish your life outside of science and medicine (the poet William Carlos Williams was a physician).
  • Writing for a blog. Blogging is a great way to share ideas and influence rapidly and less formally.
  • Writing as a personal practice. Many highly successful people practice some form of journaling as a way of working out ideas and thoughts that later serve as the basis of important work. A writing routine– even if it’s ten minutes a day– can be a catalyst for creative and productive work.

If you want to write more, no matter what the content and context, consider:

  • Never “just” give a talk— can it also be a paper? A poster? Explore it fully, and expand the potential audience for your work by considering different venues and angles. Get more mileage from each project you take on.
  • Say yes. . . and say no. Take on projects and accept invitations that allow you to develop an idea— but only ones that align with your goals and interests. Don’t say yes if you truly don’t have the bandwidth, or if the offer doesn’t advance your progress in some way. But DO say yes to things that are outside of your comfort zone. You might expand your expertise and influence in valuable ways.
  • Join (or start) writing groups: accountability & feedback are invaluable. Colleagues who will read your work and give you mock reviews are precious. Develop these relationships early in your career and they will serve you well.
  • Look at author guidelines for publications you read (whether these are high-impact journals or tiny blogs). Could you make a contribution?
  • Think about your unique skills and experiences. What is it that you have that no one else does? What do you have to say that you haven’t heard said before? You have a unique voice and you should use it. I have heard many writers say they created work they wanted to read but couldn’t find. The novelist Barbara Kingsolver says, “don’t try to figure out what other people want to hear from you; figure out what you have to say.”This is great advice to produce writing with a strong point of view.

 How will you include more writing in your professional life?

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Civility in Scientific Debate

Disagreement, dissent, challenges to commonly held positions? Cool. Ad-hominum attacks, sexist language and images, name-calling? Not cool.

Critique and dissent can be eloquently expressed, and often they are. I have read thoughtful letters to the editor and received constructive, if painful, reviews of my work (side note: learn how to write constructive reviews!). There are well-established professional norms in these contexts. On social media, however, discourse is less measured and formal. A benefit of this democratization of publication means that ideas challenging power structures and status quo can propagate more easily, cross-pollination among disciplines flows naturally, and historically underrepresented voices can gain a wide audience. But a downside to this lack of gate-keeping is sometimes the deterioration of debate.

Scientists and clinicians use Twitter for education and conversation (for great examples, see #FOAMed— free open-access medical education). Many of us use the platform to communicate ideas and research findings to a wide audience, both other scientists and the public. Social media offers a channel to interact with people whose work you admire, too. It’s a great way to share your hard work, comment on debates, ask questions, and yes, disagree.

But Twitter isn’t without its downsides, one of which is immediacy: the second you hit publish, your words are out there, associated with your name. It’s too easy for something you dashed off in a fit of pique to come to represent your professional self. It’s also easy to forget that there are people behind the hashtags and handles: if you wouldn’t say something to a human in front of you, it’s likely not wise to tweet it, either— but the sense of anonymity encouraged by social media platforms can embolden some people. In combination, these factors can create conditions where bullying and other bad behavior, rather than reasoned debate, take over.

Take a recent online kerfuffle involving cardiology trainee Danielle Belardo, MD, and Jeff Nelson, who owns the website VegSource.com. Dr. Belardo recommends olive oil to her patients as part of a plant-based diet, and she shares this information on her social media channels. She bases her advice on scientific evidence and the recommendations of professional bodies such as the American College of Cardiology. There is plenty of conflicting evidence on dietary approaches to reduce risk of heart disease, and many disagree on the conclusions, including Nelson. Dietary patterns stir up lots of dissent, and that’s good. But rather than engage in conversation about the differing viewpoints on the science, Nelson posted an inflammatory meme including blatantly sexist imagery, in an apparent attempt to ridicule discredit Dr. Belardo. This behavior is, unfortunately, not unusual. People, especially women, who voice controversial ideas online are frequently subject to this kind of bullying and often to sustained harassment also. Outside of social media, a physician who promotes an evidence-based but controversial idea will likely have fans and detractors, but on twitter, she has trolls and bullies. Suddenly, rather than an intellectual back-and-forth focused on difference of opinion and evaluation of evidence, we have the digital equivalent of name-calling, schoolyard insults, and stalking.

This behavior isn’t only bad for the targets, it’s also bad for science. Unfortunately, incivility online can have a chilling effect of innovation and conversation. Afraid of triggering flame wars, some may hesitate to ask excellent probing questions. Afraid of trolls, some may hesitate to speak controversial truths. And fearing aggressive bullying, some (especially women, who are the targets of much egregious behavior) may resist speaking altogether. Diversity of methods, opinions, identities, and backgrounds should always be welcome in science, and it’s hugely detrimental to progress when brilliant people are silenced.

How can we promote civility and dissent, which are good for science? I don’t know that there’s an easy answer, but I will leave you with these words from social scientist Amy Cuddy, who has weathered her share of online incivility: “The only way to elevate the civility and quality of scientific debate is to radically depart from personal attacks and public shamings. We have to replace fear and indignation with excitement and curiosity. If there’s a genuine interest in understanding any complicated scientific phenomenon, there is a way forward. It requires openness, listening, trust, and collaboration.” (source: https://amycuddyblog.com/2017/11/29/civility-in-science-is-not-a-luxury-its-a-necessity/)

How can you contribute to openness, listening, trust, and collaboration?

#scicomm #supportwomen

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

 

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Support Your Colleagues in 2020: The Year of the Nurse

The World Health Organization (WHO) has designated 2020 The International Year of the Nurse and Midwife (coinciding with and honoring the 200th anniversary of Florence Nightingale’s birth.) “International Year of the Nurse and Midwife”

The WHO stresses that “strengthening nursing and midwifery – and ensuring that nurses and midwives are enabled to work to their full potential – is one of the most important things we can do to achieve universal health coverage and improve health globally.”  If you work in health care in a clinical, community, education, or research setting, you almost certainly work with nurses. In the U.S. alone, there are over 3 million registered nurses (via Bureau of Labor Statistics).

Do you know what roles nurses serve in in your community, and what their scopes of practice are? In many areas, nurses are not permitted to practice to the full scope of their education and training (which may include bachelors, masters, and/or doctoral degrees) due to both legal and institutional restrictions. This means we’re leaving much needed, highly skilled work on the table. Why, and how can we fix this?

The December 2019 issue of the Lancet includes an editorial about the value and potential of nursing. The authors note that “…for all its importance, nursing remains underappreciated. Perhaps the biggest barrier that continues to stifle the profession concerns gender and stereotypes. Most nurses are women, and nursing is still viewed by many as women’s work and as a soft science, rather than as the highly skilled profession it really is.” Though most readers likely feel they do not value women less than men, the institutions we work within demonstrably do. What are the gender and educational preparation of the president of the university, the CEO of the health system, the PI of the big grant? How many full professors in your department are women? What salaries do nurses make, what salaries do women make, and how do they stack up against others in an organization? If your organization is typical, you might be surprised at the disparities. AHA pledged to have no all-male panels (#nomanels!) at Scientific Sessions this past November— is that true of other events you’ve attended?

Understandably, some nurses have met the WHO’s announcement with skepticism. We’ve heard calls for recognizing and honoring nurses before, without much substantive change following. Can this time be different? I believe we can work to address the undervaluing of nursing as a profession and women as professionals, which is hindering improvement in global health. Institutions can support nursing— and I don’t mean with a pizza party during nurses’ week (although I do love pizza, so please don’t stop doing this). I mean with safe staffing, respect, leadership roles and adequate compensation. With decision-making power. With professional autonomy. This is easier said than done.

Providing this support means developing a better understanding of the breadth and depth of nursing expertise. As early career professionals, we are poised to set priorities for the coming decades of healthcare, research, and education. When it comes supporting nurses and nursing, ask yourself if you are truly walking the walk, and look for ways to do more.

Here are some ways to increase your awareness of the actual and potential impact of nursing:

  • Read the Journal of Cardiovascular Nursing or other nursing research journals. Learn what kinds of research nurses are doing and how it might impact your work.
  • Invite nurses to present at grand rounds. Their clinical expertise is often vast.
  • Invite nurses to be part of your research team— not only as staff to do your data collection, but as co-investigators. Doctorally-prepared nurses work as researchers, teachers, and advanced practice clinicians, and they are likely to have invaluable insights into aspects of science and health that others may not have.
  • Look at your citations when you write: are you including diversity, including professional role, gender, race, and nationality?
  • For nurses and those interested in nursing, have you affiliated with the Council on Cardiovascular and Stroke Nursing? Get involved, fill out a science volunteer form (committee assignments are made in April), and get in touch with the leadership.
  • Consider joining other professional organizations and getting involved with political causes— scope of practice and reimbursement issues are often hashed out by legislators, and voices supporting nursing are sorely needed. This includes from physicians!

What will you do to support nursing this year?

Has the image of nursing changed since these historical photos were taken? (Photos via Unsplash.com)

Has the image of nursing changed since these historical photos were taken? (Photos via Unsplash.com)

Has the image of nursing changed since these historical photos were taken? (Photos via Unsplash.com)

Has the image of nursing changed since these historical photos were taken? (Photos via Unsplash.com)

 

 

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.

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Climate Change & Cardiovascular Health: New Perspectives

I have always advocated making time to attend a talk that’s outside of your area of focus when attending a big conference. It’s a powerful way to experience new perspectives. On Monday, the last day of Sessions, there was a panel held in Main Event I— the grand stage, where the presidential session and the big-news late breakers are held— about climate change. That definitely qualifies as outside of my area. Climate change, at a cardiovascular health conference? Yes, the panelists argued, climate change is a dire threat to cardiovascular health, and we need our scientists and clinicians to address it.

Dr. John Balbus suggested several avenues through which climate impacts health, including air pollution, thermal stress and migration and conflict. These problems create cumulative physiological stress, which is a major driver of cardiovascular disease. Direct evidence of health impact can be seen. For example, during severe wildfires in California, Dr. John Balmes noted, not only did lung-related illness increase, but so did myocardial infarction.

Photo: Marcus Kauffman via Unsplash

Photo: Marcus Kauffman via Unsplash

AHA took a great step towards raising the profile of the climate problem by hosting this panel, and by doing it as a Main Event. I was dismayed, though, to see the room mostly empty.  Why does this issue not have traction? Is it “too big”— leaving folks feeling like they can’t make an impact, or any impact would be too distant to feel? Is it a question of importance vs. urgency— we see people dying vaping-related lung injuries right now, and we are facing the specter of climate-related illness less immediately? Is it that the clear lines of causation between human activity, climate change, and health problems aren’t yet clearly visible to all? I don’t know, but it is up to us as the next generation of health and science professionals to insist.

So here we are, as early career scientists and clinicians. We know there’s a problem, and we know it’s a big one. But what can we do, as busy, ambitious, career-focused young(ish) people, working in universities and healthcare organizations? Get ready to channel your inner Greta Thunberg and speak truth to power!

During the climate panel at sessions, Dr. Caren Solomon presented a framework for action with six ideas. Here’s how we can apply them to professional meetings and conferences, and maybe this will help you think about how to apply them at your home institution, as well.

  • Personal Behaviors: Traveling to a meeting is resource-intensive. For the trip to Philly this year, I tried to mitigate my impact by using public transit instead of taxis or Lyft, bringing a reusable mug/water bottle, skipping daily linen changes and housekeeping at my hotel, turning down the lights and heat when I left the room, forgoing items like bags, straws, and lids that I didn’t need, and eating plant-based (that’s a topic for another post!). These changes aren’t hard, but they do require paying attention. What else could you change to reduce your impact?
  • Institutional Decarbonization- Hosting organizations could focus on providing sustainable food and food packaging, reducing waste (think of all the printed papers and giveaways that wind up in the trash), or purchasing carbon offsets for meeting travel (organizations like Terrapass make this easy).
  • Education: The public views physicians and nurses as trusted sources. When we are knowledgable, the potential impact is high. Professional organizations like AHA can therefore facilitate the flow of information. AHA is on the right track, including a climate panel at scientific sessions. Maybe next year, we can work to increase exposure around this issue and boost uptake: promote the issue in conference materials, schedule it at a high-visibility time, and minimize conflicting sessions.
  • Advocacy: AHA recently joined a consortium of medical organizations focused on education and advocacy around climate issues https://medsocietiesforclimatehealth.org/ and @DocsForClimate). This is a great step! This group provides organization and resources to help health professionals educate local lawmakers, the press, and community groups. I’d like to see organizations do more to take up the link between climate and cardiovascular health directly, consistently, and visibly. That’s a great way to be a relentless force for a world of longer, healthier lives.
  • Nonprofits and public institutions generally have their financial information available, including financial relationships with companies and other organizations. Advocating for divestment can make some waves in an organization because it’s so closely tied to the bottom line, and it often requires a very compelling case to make change. Financial relationships can conceal conflicts between an organization’s stated values and its actions effectively— and it often takes guts to challenge the apparatus. But you have guts, right?
  • Protest & Non-violent direct action. We can be visible, as scientists, clinicians, and members of our professional organizations (including AHA). Speak out in public, wear your lab coat or your “Go Red” gear. Write letters to the editor. Attend a demonstration. We can leverage the respect our society affords us as health experts to encourage societal change.

 

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.