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The Early Career Professional’s Toolbox

Many professionals must hone several key skills over time to be successful at their jobs. Some of these skills are learned in academic settings. That is especially true for professions that require a prolonged educational stage (yes, I’m particularly winking at the roads toward MD & Ph.D. degrees!). But just as valuable are the skills that early-career professionals gain outside of the formal educational framework. And of course, both personal traits and the element of luck, play important roles in achieving success from an early career standpoint.

This past year has also brought on additional requirements (hello frequent webcam meetings!) that should be highlighted and appropriately incorporated into the early career “skills toolbox”. One must ensure forward momentum and “future-proofing” one’s advancement in an early career path. “Adapting to the times” is key, and there are evergreen tools that are essential to career advancement. Here I’ll share some of what I think are key tools in this present-day moment for an early career professional (specifically from my personal point of view, as a biomedical researcher – but hopefully I’ll add enough general value framework for the wider community as well).

Tool #1: Work ethic

This is obviously the most useful and versatile tool to have when going through early career progression and advancement. There is nothing that can replace dedication and diligence when it comes to building a career. This translates of course to the practice of “putting in the time”, but that’s not all there is to it. Work ethic to me also means figuring out the many ways in which work gets done! Here I’ll highlight the immense value in developing a work ethic that includes learning how to create and be part of a team. Sometimes projects are better served when multiple professionals with varying expertise and experiences team up (multidisciplinary collaborations). Also, work ethic is learning to optimize being both a mentee (learning from multiple mentors is the fastest way to advancing one’s skillsets) and being a mentor (passing on skills to peers and junior team members has immeasurable benefit to the work and community surrounding it).

Tool #2: Networking

I touched on this a little bit earlier, but this is worth spotlighting on its own. Other than creating teams with the explicit goal of accomplishing specific tasks or projects, an early career professional needs to put in effort towards expanding one’s own professional community of contacts. This is generally called networking, and every scientist and most professionals know the classic phrase “it’s not just about what you do, but also it’s who you know, and who knows you!”. Career advancement is a series of challenges that come sometimes routinely, and many times unexpectedly. Networking, having outside perspectives and individuals with various experiences outside of one’s immediate work bubble, is one of the best ways to gain and apply new skills towards overcoming challenges, and therefore securing career advancement. And yes, knowing and connecting with successful individuals, who demonstrated an ability to navigate through the dense forest of early career progression, is worth the effort it takes to network and connects.

Tool #3: Writing

Speaking to many scientists in my early career category, I frequently hear that writing is not a “favorite” activity for many researchers. It’s treated as a counter to the “real work”, which is the active “researching” tasks that we engage in. Writing is thought of as kind of an archiving practice, more passive than advancing the plotline as the research unfolds. I personally feel like this kind of thinking diminishes the importance of writing, not just as a valuable tool in career building, but also as a practice that contributes to personal growth and even enjoyment! There are many strategies developed towards advancing one’s writing potential. Recently my AHA early career blogger colleague Dr. Jennifer Kong wrote an excellent blog about writing strategies titled “25 Useful Tips for Establishing a Writing Routine”, check it out!

Tool #4: Public Speaking

This is by far one of the hardest tools to get comfortable with, especially in an early career stage! It’s been said that some folks have a greater fear of public speaking than death. It’s an extremely difficult skill to practice, let alone master. But the fact is: Public speaking is more integrated into many career paths than it is apparent at first glance. You don’t have to be standing in front of a podium in a lecture hall or stadium to require the use of public speaking skills. Company conference rooms, group meetings, office planning sessions, work retreats, team project implementations, all of these are examples where public speaking as a tool becomes essential. To focus a little bit back on science and medicine, researchers are very aware of the frequency in which their work requires them to publicly speak in front of peers, internal and external stakeholders, and sometimes the wider interested public. Oftentimes public speaking ends up being the main factor in elevating comparable applicants or competitors for a position or award. More importantly, public speaking is a valuable tool to utilize, amplify, and deliver acquired knowledge to a greater number of individuals that benefit and further advance the work. It is hard, but I would argue it’s one of the most important tools to get comfortable within an early career professional setting!

So after reading this blog post (thanks, by the way!), maybe find some time to think about the four tools spotlighted here, and see how they rank, in terms of ease of use and frequency of utilization, in your own current working environment. Identify which of these tools needs honing and sharpening to be more useful to your current situation. Then plan out a way to work towards getting comfortable at using that skill to improve your career progression.

“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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A Roadmap for Understanding COVID Vaccines

Yes, we are still in the middle of the COVID pandemic. With the help of more people getting vaccinated and mask mandates in effect, a post-pandemic world is no longer a mere imagination. While waiting for the pandemic to be over, there are some doubts about whether the COVID vaccines should be cleared to facilitate a faster transition back to normal life.

  1.  What are the leading COVID vaccines?

    Figure: Overview of the diverse types of vaccines, and their potential advantages and disadvantages (Dong et al. 2020).

Currently, two COVID-19 vaccines are authorized and then recommended for use in the United States–the Pfizer-BioNTech COVID-19 vaccine(Polack et al. 2020) and the Moderna’s COVID-19 vaccine(Baden et al. 2020). Both of the vaccines used a cutting-edge technology, the messenger RNA (mRNA) vaccine which has been developed in the 1990s.

As of December 28th, 2020, three other COVID-19 vaccines are undergoing large-scale (Phase 3) clinical trials in the United States: AstraZeneca’s COVID-19 vaccine(Knoll and Wonodi 2021), Janssen’s COVID-19 vaccine and Novavax’s COVID-19 vaccine(Sadoff et al. 2021). Both the AstraZeneca COVID-19 vaccine and Janssen’s COVID-19 vaccines (Johnson& Johnson) used a weakened adenovirus vector strategy to tackle the spike protein on the SARS-CoV-2 virus. The weakened virus vector serves as a “Trojan horse” to deliver “information” to the cells in order to stimulate the memory of immune defense against SARS-CoV-2 virus. The adenovirus-based vaccines are relatively less foreign to the public, currently they are used against a wide variety of pathogens such as Mycobacterium tuberculosis, human immunodeficiency virus (HIV), and Plasmodium falciparum. The AstraZeneca COVID-19 vaccine has already authorized to use in Europe on January 12th, 2021 and possibly obtains approval in the United States early 2021. On January 29th, Johnson& Johnson announced its interim clinical Phase 3 trial results and a single-shot Janssen COVID-19 vaccine is on the way for FDA approval.

Novavax COVID-19 vaccine, a protein subunit-based vaccine, just announced its interim UK Phase 3 clinical trial results on January 28th, 2021. It shows promising protection to the SARS-CoV-2 virus, as well as the UK and South Africa variants. The company has already signed purchase agreements with many governments including Australia and Canada.

Two other vaccines– Russia’s sputnik V vaccine and China’s COVID-19 vaccine developed by Sinovac Biotech are also the lead runners in the vaccine race. The sputnik V vaccine which has obtained authorization to use in Russia back in November 2020, just published its Phase 3 data on February 2nd(Logunov et al. 2021). It’s an adenovirus-based vaccine, similar as the AstraZeneca COVID-19 vaccine and Janssen’s COVID-19 vaccine.

China’s COVID vaccine used a relatively well-understood technology: an inactivated SARS-CoV-2 virus. The inactivated virus vaccine approach has been implemented for a wide range of vaccines such as polio vaccine, hepatitis A vaccine, rabies vaccine and most flu vaccines. So far it received some inconsistent results from Brazil, Indonesia and Turkey and it’s not applicable in the United States. Overall, the efficacy is encouraging (50.38% to 91.25%) and requires more data to reach a more consistent result.

  1. How to understand the efficacy?

It’s a numbers game or is it? The high efficacy (95%) data released from Pfizer and Moderna at the end of last year received with great applause. The 70% protection starting after a first dose from AstraZeneca seems less impressive. The AstraZeneca COVID-19 vaccine confirms 100% protection against severe disease, hospitalization and death in the primary analysis of Phase 3 trial suggesting a total success. The recent Phase 3 trial results from Johnson& Johnson’s single-shot vaccine shows 72% effective in the United States and 66% effective overall at preventing moderate to severe COVID-19, 28 days after vaccination. The efficacy number simply cannot be interpreted as the higher the better. Like all of the clinical trials, compounding factors need to take into consideration. Their vaccine impact may depend on sex, age, genetics, geography, the timing of assessment of the end-point, the percentage of population affected by new variant compared to the original variant.

The thing matters the most is to reduce hospitalization and death. So far most of the leading vaccines have showed great promise. At the current stage, whatever vaccine is available to you could protect you from getting serious disease and prevent the virus spread to your loved ones one way or another. Herd immunity could finally be reached if enough people are getting vaccinated in the near future.

  1. mRNA technology: what is it? And is it safe?

Considering mRNA vaccine is the new kid on the block, it’s understandable that certain hesitancy and reluctance towards getting vaccinated. mRNA therapy has been developed and used to target certain types of cancer for more than twenty years. It has recently been used to target SARS-CoV-2 virus. The nucleic acid fragment of SARS-CoV-2 virus spike protein is packaged in a lipid nanoparticle. Like how most vaccine works, it tricks your body to formulate a defense memory using a small piece of information from the virus. When the actual attacks occurred, you are protected with a pre-programmed defense mechanism already. It does not change your DNA. It just helps your body to remember what it feels like to successfully combat the virus. Some of the side effects from clinical trials could be another reason to cause hesitancy. Don’t blame the messenger. The individual response elicited by the vaccines is just a small fraction of what you might experience when the real attack occurs. Some extreme allergic responses, a few reported in a million cases are rare. The chance is as similar as winning a Powerball or Mega Millions lottery. At the end of the day, the benefits still outweigh the risks.

  1. Early progress and new variants

Israel’s vaccination program shows encouraging outcome, results from a recently published preprint(Chodick et al. 2021). It’s in agreement with the Phase 3 clinical trial results from Pfizer. Data collected by Israel’s Ministry of Health shows a 41% reduction in confirmed COVID-19 infections in people aged 60 and order. Close to 90% of that age group has been administered with the first dose of Pfizer’s 2-dose vaccine. For people aged 59 and younger, the infected cases and hospitalization are also dropped.

Viruses like SARS-CoV-2 mutate all the time. There are 3 concerned variants: the UK variant (B.1.1.7), Brazil (P.1) and South Africa (B.1.351) have already been found in the United States. With the surge of new variants of SARS-CoV-2, the effectiveness of the COVID-19 vaccine also dropped. Some new data from Johnson& Johnson and Novavax suggest that the COVID-19 vaccines can prevent a lot of mild and moderate cases, and are still very effective against preventing hospitalization and deaths. Other company such as Moderna, has already developed booster shots to combat new variants. If most of the population got vaccinated, it will stop the virus’s replication and ultimately stop mutation completely. The recommended measure is to vaccine as many people as possible at current stage.

In conclusion, no matter which vaccine you got or are going to get, as long as it’s approved and authorized by the FDA, the chance of having effective protection is still very good. At the end of the day, the benefits outweigh the risks.

Reference

Baden, Lindsey R., Hana M. El Sahly, Brandon Essink, Karen Kotloff, Sharon Frey, Rick Novak, David Diemert, et al. 2020. “Efficacy and Safety of the MRNA-1273 SARS-CoV-2 Vaccine.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa2035389.

Chodick, Gabriel, Lilac Tene, Tal Patalon, Sivan Gazit, Amir Ben Tov, Dani Cohen, and Khitam Muhsen. 2021. “The Effectiveness of the First Dose of BNT162b2 Vaccine in Reducing SARS-CoV-2 Infection 13-24 Days after Immunization: Real-World Evidence.” MedRxiv, January, 2021.01.27.21250612. https://doi.org/10.1101/2021.01.27.21250612.

Dong, Yetian, Tong Dai, Yujun Wei, Long Zhang, Min Zheng, and Fangfang Zhou. 2020. “A Systematic Review of SARS-CoV-2 Vaccine Candidates.” Signal Transduction and Targeted Therapy. https://doi.org/10.1038/s41392-020-00352-y.

Knoll, Maria Deloria, and Chizoba Wonodi. 2021. “Oxford–AstraZeneca COVID-19 Vaccine Efficacy.” The Lancet. https://doi.org/10.1016/S0140-6736(20)32623-4.

Logunov, Denis Y, Inna V Dolzhikova, Dmitry V Shcheblyakov, Amir I Tukhvatulin, Olga V Zubkova, Alina S Dzharullaeva, Anna V Kovyrshina, et al. 2021. “Safety and Efficacy of an RAd26 and RAd5 Vector-Based Heterologous Prime-Boost COVID-19 Vaccine: An Interim Analysis of a Randomised Controlled Phase 3 Trial in Russia.” The Lancet, February. https://doi.org/10.1016/S0140-6736(21)00234-8.

Polack, Fernando P., Stephen J. Thomas, Nicholas Kitchin, Judith Absalon, Alejandra Gurtman, Stephen Lockhart, John L. Perez, et al. 2020. “Safety and Efficacy of the BNT162b2 MRNA Covid-19 Vaccine.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa2034577.

Sadoff, Jerald, Mathieu Le Gars, Georgi Shukarev, Dirk Heerwegh, Carla Truyers, Anne M. de Groot, Jeroen Stoop, et al. 2021. “Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa2034201.

 

“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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Concomitantly Being the Mentee and Mentor

We all need mentors to help guide us through our careers. I am very fortunate to have had and currently have many generous and knowledgeable mentors. I rely greatly on them to provide feedback and advice on how to navigate the many challenges of being a physician-scientist.

As early-career trainees, we are often concomitantly seeking mentorship and are being a mentor to younger trainees. Throughout my clinical and research training, I have had the opportunity to mentor many enthusiastic and talented undergraduate/graduate/medical students and residents. Since I have been a mentee for much longer than a mentor, I feel comfortable finding advisors who can assist with my career development. However, I feel relatively inexperienced as a mentor. I find mentoring challenging in that it requires adapting to the needs and personality of the trainee. I am constantly refining my coaching style and trying to emulate many of the outstanding mentors that I have.

For this blog, I have compiled a list of some tips that I have learned or received from others on how to be mentor-able and how to be an effective mentor.

Tips on How to Be a Good Mentee:

  1. Find the “right” mentors for you. Various factors play a role in making a match. Finding advisors is one of the most important steps needed to advance your career. It is not necessary to always find the most senior faculty members to be your mentor. There are many benefits of having a junior faculty member as a mentor, which I have discussed previously.
  2. Be accountable.
  3. Be receptive to feedback.
  4. Be respectful and appreciative. Respect your mentor’s time.
  5. Be diligent. You have to do the work. Mentorship is a two-way street so think about the value that you bring to the relationship (especially relevant to trainees who are completing research projects with their mentors).
  6. Let your mentor know what your short and long-term goals are and what you seek to gain from the mentorship.
  7. Keep in touch with your mentors. Update them on your achievements even after you have completed your training and/or moved to another institution.

Tips on How to Be a Good Mentor:

  1. Do not do all the work for the mentee.
  2. Give a new potential mentee a task/assignment to complete as a trial run to determine whether the mentee is committed and dependable. This may prevent loss of effort trying to mentor a trainee who may not be motivated or interested in your field.
  3. Be knowledgeable.
  4. Be a good listener and communicator.
  5. Keep your promises.
  6. Provide constructive, honest feedback.
  7. Encourage diversity of perspectives.
  8. Be available or willing to make time to meet with the trainee.
  9. Be open to learning from your mentees.
  10. Know your role and what your mentees’ expectations are for the relationship.
  11. Help provide opportunities for trainees (e.g. encourage attending conferences, submitting abstracts/papers, applying for awards, etc.) and help your mentees network with others.
  12. Emulate the excellent mentors that you know.

These lists are not comprehensive. I would love to hear about your thoughts, experiences, and advice on mentorship. I am especially interested to learn about the experiences of early-career investigators who have started new labs.

Thanks for reading and hope you have a safe, healthy, and happy new year!

“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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Developing Your Career as an Academic Physician

For all early-career physicians out there, I am sure you were not only looking for the latest in science at AHA 2020 but also some guidance on career development, and the session “Developing your Career as an Academic Physician” was just perfect.  Here I will review some of the fantastic talks from this session.

It started with “Pearls for Becoming an Academic Leader” by Dr. Jennifer S. Lawton, chief cardiac surgery at Johns Hopkins University, and offered the perfect blend of inspiration, encouragement, and advice on being an academic leader. I am sharing some pearls from this talk:

  • DECIDE: Decide if leadership is right for you and why you want to be a leader?
  • PREPARE: Prepare to be a leader (leadership books/courses), gain experience (program director, lab director, multidisciplinary teams, write protocols for your institution), learn time management for different roles (clinical, academic, leadership, mentorship), and build your credibility.
  • COMMUNICATE: Keep your CV updated and make it available at a moment’s notice and be ready to articulate your 5 and 10-year goals.
  • ATTACH: Attach yourself to mentors and learn from their success/failures and seek their advice regularly. Find sponsors who can open doors for you.
  • 70/20/10 Rule: Being an academic leader is 70% on the job training, 20% is learned from mentors/sponsors and 10% is formal leadership training.

The follow-up amazing talk was “What Really is Work-Life Balance” by Dr. Sasha Shillcutt, Tenured Professor of Anesthesiology at the University of Nebraska Medical Center. Loss of control over work is an important reason for burnout and this talk really re-framed my concept of Work-Life balance as it emphasized the concept that we are in the “driver’s seat” of our career. Two main concepts that were presented are:

  • Time Management Traps & Myths: Learn to say “No” to tasks that no longer interest you and success is directly linked to saying no.
  • Set Boundaries: Successful health care workers set boundaries that are intentional, efficient, and healthy. It takes practice and planning to set boundaries but they make your life easy.

“Maintaining Clinical Skills While Working in the Lab” is a challenge faced by physician-scientists and Dr. Emily MacKay from the University of Pennsylvania discussed some remarkable strategies for this.

  • Cognitive Reframing: The idea is to reframe your perspective about a challenge into an opportunity while the objective facts of the situation remain the same. For researchers that spend most of their time in the lab, make the most of your clinical time and develop “deliberate practice” where the focus is on quality, attention to detail, mindful and purposeful performance of procedures.
  • Context Switching: If you hit roadblocks with one problem where the solutions are not obvious you can physically distance yourself from the problem, and then come back to it later and this will help you find a solution.
  • Handling Commitment: Using the Eisenhower matrix to identify tasks that are urgent and important and need to be handled quickly vs tasks are urgent but not important and can be delegated or tasks that are important but not urgent and can be scheduled.

I will encourage all early careers to watch this session and take notes as it is full of pearls for career development.

 

“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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HOW TO SAY NO: R5

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA, Mehnaz Rahman MD

For many of us, to nurture our continuous and whole sense of well-being, we are in a constant process of learning to say “no”. Here is one scenario that can help provide an effective framework for saying “no”.

Consider a new junior attending faculty member at the same academic institution where she trained as a Cardiology fellow. Her pursuit of wellness in this new role has fallen to the sidelines, as she first tries to establish a sense of authority within a society that has only ever known her as a trainee. While navigating this unfamiliar territory, a surprising source of anxiety has come from responding to requests to collaborate on projects. She consistently accepted almost every single one. The fellow in her aimed to please.

Although she approached each with the same work ethic, her interest in them was not as equitably distributed. At the end of her first year, her cup had “runneth over” – she was overworked and overcommitted admittedly she felt by her own doing.

She then realized that she had agreed to those undertakings because she did not quite have the words ready at the tip of her tongue to say “no”.  When respectfully declining a specific ask, she determined that it can help to have a practiced approach to the conversation, one that can produce a beneficial result for both parties.

As we discuss this scenario, we can recognize that in general, people appreciate ideas and potential solutions. Accordingly, we may not be able to fulfill every request, yet we can still be a resource and offer alternatives.

One framework for saying “no” is grounded in R5: Reframe, Refer, Reduce, Reorient, and Recommend. Saying “no” can be challenging. Sometimes we need to say “no” to the way the ask is presented or the specific focus of the ask.

If we can perceive benefit from modifying the ask so that it actually fits with our career goals and specialty interests, then we can say “no” to the original ask while reframing it to a more fitting ask for us.

If we choose not to reframe the ask, we can refer the asker to someone else who we feel could be interested in working on such a task.

Alternatively, we could reduce the original ask to limit the portion for which we would be responsible.

Further, often those asking do not know how full our plates are and may need to be kindly informed or reoriented, so that they can better understand your perspective as you say “no”; you can even solicit their input as you think about how to prioritize your time on pre-existing projects.

Finally, recommend a new deadline or seeking out more resources if you would find working on the opportunity valuable but time-consuming or limited in available resources.

Remember, those asking for your involvement are genuinely interested in working with you, recognize you as an asset, and will more often than not be receptive to your counteroffer. Saying “no” the right way will leave the door open to future opportunities that you may be waiting or looking for.

We can continue to recalibrate our expectations of ourselves, as we engage in projects that keep us passionate and hope that our journeys to wellness become smoother with time and 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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WELLNESS MATTERS

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA

WELLNESS

The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. The terms in this definition inspire similar words such as continuous (state), whole (complete), tangible (physical) and intangible (mental), as well as togetherness or community (social).

 PANDEMIC WELLNESS

Indeed, during the pandemic, we often say or hear, “We are all in this together”. The global community has rallied around each other to get through the coronavirus disease of 2019 (COVID-19) well. In the midst of a nation in turmoil with pandemics juxtaposed (coronavirus and racial and ethnic inequities), we find ourselves in the middle of it all as physicians.

SAFETY & WELLNESS

Along with everyone else in medical authority, we encourage those around us and all we serve to distance physically more so than socially. We want people to remain social, to enhance wellness. Yet, we need that socialization to be safe and physically distant, to foster tangible wellness.

 WELLNESS NOT CANCELLED

We encourage everyone to recognize that conversations, relationships, love, songs, reading, hope, joy, getting outdoors, music, family, and self-care should not and will not be canceled. This is the good stuff. The intangible components of wellness.

WELLNESS HEROES

So many of us in health care are sacrificing this period of our lives or in fact our very lives so that our patients can be whole. This altruism that led us here is continuous and indestructible by the #rona. Many of us turn to visual wellness inspired by COVID-19 to help capture the essence and sentiments of these challenging times. Art and other forms of creative expression of what’s inside of us or in society can motivate us to see more, be more, and serve more.

These matters at hand are crucial to help maintain our state of complete physical, mental, and social well-being. If we are honest with ourselves, we recognize that most of us live at best in a state of incomplete well-being. Yet, we can stand together against cancellation of our will and empower each other on this journey to wellness. It’s never been a destination. It’s always been a process that we continue to learn daily.

 

“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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Work life balance- Is This a Myth?

Work-life balance: for many in Cardiology it’s an elusive idea. Now, our worlds of work and “life outside of work” are even more blurred among Zoom meetings and facemasks.  However, over the years, I have learned 3 important concepts (Figure 1) that has made work-life balance POSSIBLE, not just a myth.

Figure 1. Outlining the three key concepts of work-life balance.

Concept #1: Who are you outside of work?

As Cardiologists, researchers, educators, and team members we know the day, night, and weekend hours that define our careers. However, how do you describe yourself outside of work? Who are “you” after shedding the scrubs and white coat, away from the office, hospital, and lab?   Beyond Cardiology, what are your interests?  The answers to these questions help to define you and an important part of your life. When we lose our work-life balance, we are losing a part of ourselves.

To begin recapturing your interests, look at your calendar over the next month, and schedule small increments of time (just 5-10 minutes!) to reconnect with your personal interests (of course staying safely physically distant for now).  These baby steps will move you closer to capturing the “life” in work-life balance.

Concept #2: “Balance” is dynamic.

How do you define “work-life balance”? Is it an equal distribution of time? Is it a certain quantity of time for specific activities?

Work-life balance is very similar to the field of Cardiology – it is constantly changing. For most people, work-life balance will not mean that there is “equal” or balanced time between work and personal life. Especially in Cardiology, our job usually engulfs the majority of hours in a week – clinical duties, grant deadlines, presentations, emails… and the list continues.  However, for work-life balance, one of the goals is to “balance” the transition from work to “life outside of work”. This means your presence, attention, and focus should completely shift from work to your personal interests and interactions. Work-life balance is beyond physically leaving the job, but balancing the mental transition to fully shift away from work.  It will take practice to avoid checking email or mulling over work.  The amount of time between work and your personal life will remain dynamic; but the “balance” is your ability to commit your focus and attention to those precious personal moments, just as you do for work.

Concept #3:   You are Responsible for You! 

Cardiology requires you to constantly learn and practice to achieve and maintain competency. You are upholding a professional commitment. The same commitment is required to grasp work-life balance.  You have to make a personal commitment to you!!  It is not sufficient to just “wish for it”.  We cannot expect anyone else to understand our needs or create our work-life balance.

To reframe this important concept, consider your self-care and work-life balance as critical as filling your car with gas (or charging your car):  you cannot function without it!  Your personal commitment has to be as strong as your professional commitment.   No, it’s not easy, but it is possible.  Some find it helpful to be accountable to a colleague or friend, check-in regularly (set a reminder) about small steps to promote work-life balance. We understand our responsibility to patients.  Now, it’s time understand your responsibility to you!

During these uncertain times of the COVID-19 pandemic, healthcare workers are working longer hours and under even greater stress. It is normal to feel overwhelmed. Now, more than ever, it is important to find creative ways to focus on precious moments and commit to your well-being!  Below are 5 tips to stay committed to yourself and safely connect with others:

  1. Take three minutes.  Listen to your favorite song, dance while nobody’s watching, or take a few extra minutes in a hot shower. You do not need a long time to be kind to yourself.
  2. Join a Virtual group or class.  Physical distancing and long work hours can be very isolating. Take advantage of the numerous virtual options to safely connect with others who have similar interests.
  3. Share and listen.  Try moving beyond texting and talk on the phone. Commit to that moment, engage in the conversation and focus on listening.  The human connection remains very powerful to strengthen our mind and body.
  4. Protect Your Time. I know it is easier said than done. However, learning to set boundaries is critical to sustain your commitment to work and participate in the joys of life.
  5. Be Kind to Your Body. Find time to sleep, eat healthy snacks, and participate in small amounts of physical activity. Mental health and physical health are equally important.

In summary, work-life balance is a journey, not a destination.  Remember, that “balance” in work-life balance is dynamic – the amount of personal time will change, but your commitment and focus to that time should only grow.

 

About the Author:

Heather M. Johnson, MD, MMM, FAHA, FACC is a Cardiologist & Preventive Cardiologist at the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital/Baptist Health South Florida.

 

“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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NEGOTIATING YOUR FIRST CONTRACT

American Heart Association Women in Cardiology Blog Series

NEGOTIATING YOUR FIRST CONTRACT

Victoria Thomas MD, Simone Bailey MD, Sherry-Ann Brown MD PhD

Women are less likely to negotiate their contracts than men 1-3. Approximately 20% of women do not engage in contract negotiation 1. Despite improvements over time in the number of women negotiating their contracts, disparities persist in compensation and rank 4-5. Further, few resources exist to specifically guide women on how to negotiate salary and other beneficial components of the contract.

Optimal negotiation of your contract positions you well for future opportunities, promotion, visibility, and professional satisfaction. Know the process of negotiating your contract (Box 1, Image), know the perks or components of your contract (Box 2, Image), and know the resources available to you as you navigate and negotiate your contract (Box 3, Image). When reviewing contracts, consider the entire package, including malpractice insurance (with tail), paid time off, noncompete stipulations, salary, and incentives 6. Remember, time is money! Negotiate the allocation of your time: in/outpatient, research, medical education, and administration. If you are in academics, consider your incoming rank, clinical title, future promotion opportunities, and research funding if applicable. A clinical title may not cost the department and could set you up for deserved recognition and administrative time. Contracts should specify the requirements and duties of the physician and the employer explicitly, provide clear compensation models, and define term and termination protocols.

Weigh all options, such as preferences for an academic or private practice setting. Be cognizant of important non-work factors: geographic location, significant others, children, and recreational activities, as these greatly affect working decisions. Be firm on your deal makers and breakers prior to contract negotiations 6. Ask for more than you really want. This will likely lead to compromise down to a mutually accepted agreement. Be sure to present special requests in a manner that creates shared interests, and have these written into the contract. It is acceptable to communicate your desires early on and your concerns as the process evolves and recommend modifications that you would like to implement. Remember, verbal promises or assurances are not contractually valid. It is also advised to seek legal counsel with expertise in physician contracts to help you identify loopholes, pitfalls, and modifiable terms.

When entering negotiations, remember to be respectful, humble, appreciative, and also know your worth. The 2020 Medscape Cardiology Compensation Report found that male cardiologists earn approximately 16% more than their female colleagues 7. The average salary for men was $449,000, while women averaged $386,000 7. A study has shown that women lose an average of $7,000  in their first-year salary and may lose up to $1,000,000 over the span of each of their careers 1. As a means to reduce the wage gap, women must increase their efficacy and advocacy through contract salary negotiations. Let the employer make the initial salary offer so that you do not ask for less than you may have been offered or lead them to think that salary is your top priority. Review national reports to determine average salaries for similar physicians in your state of interest and talk with trusted colleagues 8. Other factors such as call, relocation fees, sign-on bonus, student loan repayment, and continuing medical education time and expenses can be negotiated as part of your compensation packet.

In your negotiations, make your best pitch 9. Demonstrate your uniqueness as a candidate and show your creativity. Develop new strategies using your specific skillsets to benefit your employer in areas with knowledge or personnel gaps. Adequate preparation is the most emphasized skill in negotiating any contract. Look ahead of time at what your employer needs and listen well in conversations (in and out of the formal scheduled interview) and emails 9-10. Recognize that every conversation whether in-person, by phone, or through email is part of the negotiation process, and small talk is necessary (often sprinkled in fairy dust). Lead with confidence, and be open to concessions, to show your collaborative nature.

Align with the American Heart Association or American College of Cardiology Women in Cardiology Section, with an emphasis of early matriculation while in training. These organizations not only offer career development and networking opportunities, but they also offer sessions for contract negotiation. Contract negotiation preparation and practice will allow for greater success when navigating your first contract. This will help to overcome challenges related to compensation and promotion inequities, and better communicate career expectations prior to solidifying post-training employment.

BOX 1. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON PROCESS

  • Consider life outside of work: social climate, recreation, partner, children
  • Discuss shared priorities and interests to support solutions with your employer
  • Ensure the contract clearly states non-clinical roles and other promises which may have been made to you during the interview process
  • Get in writing any specific unique requests that you may desire
  • Review national reports on average salaries in your specialty and state
  • Speak with trusted colleagues for an idea of fair wages for your specialty
  • Ask for a higher salary if what is offered does not meet your expectations

 

BOX 2. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON PERKS

  • Sign-on bonus
  • Relocation stipend
  • Non-compete stipulations
  • Malpractice insurance coverage with tail
  • Inpatient vs. outpatient service
  • Salary
  • Student Loan Repayment Plans
  • Dedicated Administrative or Research Time
  • Bonus/incentives
  • PTO (CME, Vacation, Sick days, etc)
  • Academic rank, promotion, and protected time for academic pursuits

 

BOX 3. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON RESOURCES

  • PracticeLink (website); understanding the job search process
  • Getting to Yes (book); understanding negotiation
  • Good to Great (book); understanding the goals of your employer
  • ACC and AHA WIC Discussions; understanding strategies for women
  • Negotiation Skills: Negotiation Strategies and Negotiation Techniques
    to Help You Become a Better Negotiator; understanding power of negotiation
  • American Medical Group Association (AMGA) Compensation Survey;
    comparing compensation by specialty, region, and group size
  • Association of American Medical Colleges (AAMC) Faculty Salary Survey Results; comparing compensation within academia

 

REFERENCES:

  1. https://hbr.org/2018/06/research-women-ask-for-raises-as-often-as-men-but-are-less-likely-to-get-them
  2. Kugler, K. G., Reif, J. A. M., Kaschner, T., & Brodbeck, F. C. (2018). Gender differences in the initiation of negotiations: A meta-analysis. Psychological Bulletin, 144(2), 198–222
  3. Bowles  HR. Why women don’t negotiate their job offers.Harvard Business Review.https://hbr-org.proxy.library.vanderbilt.edu/2014/06/why-women-dont-negotiate-their-job-offers/. Published June 19, 2014. Accessed April 16, 2016.
  4. Jagsi  R, Biga  C, Poppas  A,  et al.  Work activities and compensation of male and female cardiologists. J Am Coll Cardiol. 2016;67(5):529-541.
  5. Mehta, L. S., Fisher, K., Rzeszut, A. K., Lipner, R., Mitchell, S., Dill, M., … & Douglas, P. S. (2019). Current demographic status of cardiologists in the United States. Jama Cardiology4(10), 1029-1033
  6. Fisher, Roger, William L. Ury, and Bruce Patton. Getting to yes: Negotiating agreement without giving in. Penguin, 2011.
  7. Lo Sasso  AT, Richards  MR, Chou  CF, Gerber  SE.  The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30(2):193-201.
  8. https://www.medscape.com/slideshow/2020-compensation-cardiologist-6012721
  9. Bowles, Hannah Riley, Bobbi Thomason, and Julia B. Bear. “Reconceptualizing what and how women negotiate for career advancement.” Academy of Management Journal62.6 (2019): 1645-1671.
  10. Fischer, Lauren H., and Anureet K. Bajaj. “Learning how to ask: women and negotiation.” Plastic and Reconstructive Surgery139.3 (2017): 753-758.

“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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How will COVID-19 Affect Return to High School Sports and ECG Screening?

August is traditionally very busy month in the pediatric cardiology office; visits for “sports clearance” flood the schedule due to something picked up on a high school sports physical such as chest pain. Most of these will be non-cardiac and receive reassurance; however, the cardiac causes in the pediatric population can be quite distressing. With the current COVID-19 pandemic we are seeing many cardiac effects of the virus— myocardial inflammation, dysfunction and coronary artery dilation or MIS-C (multisystem inflammatory syndrome in children). There has also been a reported increase in out of hospital cardiac arrest in the adult population, which could be attributed to those afraid to seek care, but none the less, a concern.

Cardiac effects play an important part in the recent discussions on return to school, as eventually return to school will mean return to school sports. Sports cardiologists have been following this closely and have been working to establish a safe way for return to sports in competitive athletes who have had COVID-191(click here for recommendations and see flowchart below), which may include extensive cardiac testing of those who had symptomatic COVID-19, most of which is based on the return to play myocarditis guidelines.2 These important decisions require individualization, knowledge of risk and what is happening in the community.

So what does this mean for the high school athletes? There is no doubt that exercise is great for everyone, especially with the rising obesity and the sedentary lifestyle. Organized sports participation has shown to have a positive impact on mental and physical health that extends beyond childhood.3 Many have raised concerns about the development and health of children by not attending school, along with decrease in social interaction and activity from organized sports during the stay-at-home orders and while we work to defeat COVID-19 spread.

Prior to the pandemic, the question of universal ECG testing for high school athletes always started a conversation, but could that change? Critics say that the false positives create distress and extra healthcare cost, that follow up is problematic and that it has not been shown to change outcomes. Others argue saving one child from the devastating event of collapsing and dying on the field is worth it, and a recent study showed ECG with H&P is more likely to detect a condition associated with sudden cardiac arrest (SCA) than H&P alone, and also improved cost efficiency when interpreted in the right hands.4 All agree it is important to have a good plan in place for SCA at all sporting events, including an emergency response plan in place specific to cardiac arrest.

With so many affected by the virus, at varying severity, I can’t help but wonder if this will change the way we assess our young athletes for participation in sports when it is safe to do so. While healthcare costs are always a problem, with a new virus and unclear long-term outcomes, we must be conservative. Perhaps this may provide an opportunity to learn more about ECG screening, as we will likely see a larger amount of patients who have had COVID-19 coming to our offices for clearance. This may provide an opportunity to gather evidence on the continued debate of whether ECG screening is effective.

Until we know more, what we do know is it is safer to be conservative, to assess benefit and risk and provide appropriate counseling to families on signs and symptoms of SCA. We also must continue to reassess and stay up-to-date on new knowledge and testing related to COVID-19 recovery and sports. Most importantly, it is important that we continue to advocate for heart safe schools which include having AEDs, training in CPR, and emergency response plans related to Sudden Cardiac Arrest. With more kids participating in school from home, this could be a great opportunity to engage the whole family in CPR and AED education to improve the safety and survival of our communities and at home.

 

References

  1. Phelan, Dermot, et al. “A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection.” JAMA Cardiology, 2020, doi:10.1001/jamacardio.2020.2136.
  2. Maron, Barry J., et al. “Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task  Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis.” Journal of the American College of Cardiology, vol. 66, no. 21, 2015, pp. 2362–2371., doi:10.1016/j.jacc.2015.09.035.
  3. Logan, Kelsey, and Steven Cuff. “Organized Sports for Children, Preadolescents, and Adolescents.” Pediatrics, vol. 143, no. 6, 2019, doi:10.1542/peds.2019-0997.
  4. Harmon, Kimberly G, and Jonathan A Drezner. “Comparison of Cardiovascular Screening in College Athletes” Heart Rhythm, 2020, www.heartrhythmjournal.com/article/S1547-5271(20)30406-9/pdf.

“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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How is the AHA leading the way in Cardiopulmonary resuscitation (CPR)?

In writing this last post as a junior blogger, I decided to highlight the tremendous efforts by the American Heart Association (AHA) to improve cardiovascular care in the field of cardiac arrest and cardiopulmonary resuscitation (CPR). As we know, the AHA is a worldwide leader in first aid, CPR, and Automated External Defibrillator (AED) training – educating millions of people globally in CPR every year. Here, I will share some fun facts about CPR, and you can refer to the AHA website for further details about this important topic.

Important CPR statistics

  • Majority of cardiac arrests occur outside of the hospital, with estimated 475,000 Americans dying from cardiac arrests every year [1]
  • Bystander CPR is a key component in the out-of-hospital “chain of survival” [Figure 1] and studies have shown it improves survival in cardiac arrest [1-3].

Figure 1: The adult out-of-hospital “chain of survival”. Each link of the chain from left to right is numbered 1 through 5: 1- Recognize cardiac arrest and activate the emergency response system, 2- early CPR with high-quality chest compressions, 3- Use AED for rapid defibrillation, 4- basic and advanced emergency services and 5- post-cardiac arrest care and advanced life support [2].

  • Bystander CPR has been increasing over the recent years in both men and women. Despite that, survival improved in men only, but not women [2]. This is important as it highlights that more work is needed to identify additional predictors of survival in women with cardiac arrest.
  • Efforts mandating CPR training in high schools in multiple states [5] and availability of AED in public places, including airports [Figure 2], have helped in increasing the awareness and familiarity of bystander CPR in cardiac arrest [4].

  • Figure 2: A photo of Automated External Defibrillator (AED) in one of the airports.

Personal Experience

From a personal experience, I have visited multiple high schools in my home country as well as in the United States, and have participated as an organizer in the sessions teaching high school students how to perform effective CPR. It is inspiring to see junior students interested in learning and saving lives. The takeaway from my experience is that engagement plays a major role in spreading the word and encouraging the general public to take the extra step and learn how to perform basic and advanced life support techniques.

In conclusion, it is important to remember that the general public are oftentimes our first “link” in the chain of survival; making them an important part of our efforts to improve survival and cardiovascular care in patients with cardiac arrest. A strong chain of survival improves survival and recovery after cardiac arrest. Although there have been improvements in CPR and advanced life support, there remains room for further improvement, and perhaps we can do our part by encouraging our patients, friends and relatives to take the first step and learn how to perform effective CPR and possibly how to use AEDs!!

I have added a few online references for those interested in sharing this with their patients and encouraging them to sign up for both the online and class programs [3,6]!!

References:

  • Meaney PA, Bobrow BJ, Mancini ME, et al. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association [published correction appears in Circulation. 2013 Aug 20;128(8):e120] [published correction appears in Circulation. 2013 Nov 12;128(20):e408]. Circulation. 2013;128(4):417-435. doi:10.1161/CIR.0b013e31829d8654
  • Malta Hansen C, Kragholm K, Dupre ME, et al. Association of Bystander and First-Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative. J Am Heart Assoc. 2018;7(18):e009873. doi:10.1161/JAHA.118.009873
  • CPR facts and stats:

https://cpr.heart.org/en/resources/cpr-facts-and-stats

  • Chain of Survival:

https://cpr.heart.org/en/resources/cpr-facts-and-stats/out-of-hospital-chain-of-survival

  • Mandatory CPR training in high school:

https://www.sca-aware.org/schools/school-news/mandatory-cpr-training-in-us-high-schools

  • CPR AED and first aid classes:

https://cpr.heart.org/en/course-catalog-search

“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.”