early career – Page 2 – The Early Career Voice

11 Women Cardiology Leaders – How to Overcome Adversity & Thrive

August 17, 2020August 17, 2020 Renee Bullock-Palmer, MD

Summarized by Nidhi Madan MD Sarah Rosanel, MD; Cynthia Kos DO, Renee P. Bullock-Palmer MD, Kamala P. Tamirisa MD and Purvi Parwani MBBS MPH. Edited by Marissa Bergman.

Presented by the ACC Women in Cardiology (WIC) Section, AHA WIC Section and Women as One, this webinar highlighted a panel of female cardiologists with leadership roles in the field. The opportunity of gathering 11 female leaders of international Cardiology organizations comes rarely and the webinar was incredibly inspirational. It was co-moderated by ACC WIC Chair Dr. Toniya Singh, MD, Cardiologist at St. Louis Heart & Vascular and AHA WIC Chair, Dr. Annabelle Volgman, MD, Professor of Medicine, Rush College of Medicine;

The webinar focused on providing guidance, empowerment and optimism to women in cardiology through personal journeys and experiences. The presentations equipped attendees with the necessary skills and qualities to more than just survive, but, rather, thrive, during the ongoing pandemic and racial crisis.

Cindy Grines, MD, FACC, MSCAI

President of the Society of Cardiac Angiography & Interventions.

“Accept the situation and have a game plan.”

Dr. Grines began the presentation with her personal journey. She had an extremely successful cardiology career in Michigan for over 25 years. Then, she decided to move, for family reasons, and began a new position as Academic Chair of Cardiology in New York. She was told during the interview process that her focus needed to be 90% on academics, research productivity, mentoring the faculty, and gaining the program a national presence. Over the next 1.5 years, she worked hard towards these goals and exceeded the expectations. Yet, despite going above and beyond in her professional duties, Dr. Grines was terminated from her position without a valid reason – with claims that it was a “business decision” and “trying to merge some roles.” She alluded to how she handled this unprecedented situation, and formulated a game plan. She negotiated a severance package and found her current position, with which she is very happy. Her presentation emphasized the importance of networking and destigmatizing what might feel like a humiliating and isolating situation. Dr. Grines concluded with words of motivation:

“You need to pick yourself up, brush yourself off and get back in the saddle and ride that horse again. The bottom line is change is good and when these things happen to you it’s going to motivate you to do something different and to prove yourself.”

Roxana Mehran, MD, FACC, FACP, FCCP, FESC, FAHA, FSCAI

The Cofounder of “Woman As One.”

“Don’t give up on your goals.”

Dr. Mehran’s presentation started with a bang: “Celebrate Women!” She continued with powerful words, “When we focus on our goals, we can achieve everything and we should never give up on our goals. They are yours, cherish them, fight for it, you will achieve it.”

Dr. Mehran was born in Iran and she dreamt of being a doctor since she was quite young. Amidst the hostage crisis in Iran, her family immigrated to Queens, NY. Despite facing poverty and restarting her life as an outsider, she never lost sight of her aspirations and eventually became an interventional cardiologist. With her determination and strong will, Dr. Mehran was one of the first female fellows at Mount Sinai. She pursued her career and continued her mission to contribute to science and clinical outcomes. As a woman in a male dominated field, she felt the inequalities in interventional cardiology, and she made it her new goal to ensure women are heard. Ultimately, she co-founded “Women As One” to encourage women not to accept inequalities or harassment in any form. As she explained, “You just have to see it all, keep your eye on the ball just like they tell you in baseball and in tennis… and make sure you hit that bull’s eye. Work hard and it will come to you.” She concluded with her favorite quote by Maya Angelou,

“Do your best you can until you know better, then when you know better, do better.”

Athena Poppas, MD, FACC, FASE

President of the American College of Cardiology

“Strategic Leadership & Change Management”

Strategic leadership has never been as important as it is during the challenging times of the pandemic. Dr. Poppas referred to the importance of influential leadership and emphasized that one does not need a title to lead. These times are an incredible opportunity for everyone to step up and contribute. She explained that strategic leadership is not linear, but mostly circular – anticipating, recognizing challenges, interpreting and making decisions, staying aligned but learning along the way. She then shared some of the key tools from her leadership toolbox:

Authenticity is essential.
Use influential skills rather than just telling someone what to do – utilize the tools of change management to bring people along.
Manage conflict and work together.
Realize one’s own strengths, be honest about those strengths and bounce ideas off friends and allies. Be cognizant about weaknesses with a goal to improve them.
Put yourself out there and seize opportunities.

Dr. Poppas concluded by reiterating that change management and strategic leadership is a continuum and a continuous cycle of learning. At the same time, succession planning with mentoring and helping others is key, so that there is an entire group capable of replacing you.

Andrea Russo, MD, FHRS

Immediate past President of Heart Rhythm Society (HRS)

“Resilience”

In Dr. Russo’s first week as President of HRS, a controversial topic of Maintenance od Certificate (MOC) surfaced. HRS was looking into ways to create a less disruptive and more customizable educational program and certification. Therefore, HRS put together an MOC Task Force and conducted a member survey assessing the feasibility of other options. Throughout this battle, resilience helped her look into options that would be relevant to the HRS members. The COVID-19 pandemic put the annual HRS meeting in jeopardy. She led the team, which considered the safety of travel and alternate ways to deliver education. Arrhythmias related to the coronavirus needed attention with protocols; how to deliver EP care to patients in the COVID era while also protecting the EP team by reducing their exposure became a priority. To answer these questions, HRS put together a group called the COVID-19 Rapid Response Task Force to collate the major information and provide guidance. There was an outpouring of volunteers and these documents were prepared in record time. This experience emphasized the resilience of a collective resolve from the volunteers who contributed to the HRS staff. Dr. Russo concluded by saying that COVID did jump start the utilization of online educational platforms and digital health to successfully deliver the HRS 2020 content online. She explained that one of the most rewarding experiences of her presidency was the ability to share ideas, work together with leaders from around the globe and improve knowledge.

Christine Albert, MD, MPH, FHRS

President of Heart Rhythm Society

“Embrace Change, Be Creative”

Dr. Albert’s advice is, when one cannot change the adversity, it is important to change gears and embrace the new opportunity. Listening to new suggestions, moving forward and ultimately bringing the group along as a leader are an integral part of being creative. Advances in digital forms of communication in COVID times are one such example of embracing the change. She ended with these empowering words, “Don’t be afraid to forge ahead in adversity.”

Mariell Jessup, MD, FAHA

Chief Science & Medical Officer of American Heart Association

“Believe in your Capabilities”

Dr. Jessup’s presentation focused on how it takes courage to overpower impostor syndrome and its nagging question, “Are you capable?” She pointed to Michelle Obama’s comments as a guiding example: “Am I good enough?” “Of course!” She argued that courage might not be easy to find every moment, and that friends and mentors play an important role against a doubtful mind.

She referred to Eleanor Roosevelt’s challenging life and quoted, “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I have lived through this horror. I can take the next thing that comes along.’ You must do the thing you think you cannot do.”

Dr. Jessup offered several more phrases and quotes to empower and remind women that it is vital to focus on courage to lift up mentees. She was reminded of Queen Elizabeth’s quote, “When life seems hard, the courageous do not lie down and accept defeat; instead, they are all the more determined to struggle for a better future.” Another voice of reason she found very relevant is Winston Churchill, regarding sharing courage “I never gave them courage; I was able to focus theirs.” She concluded her presentation on an uplifting note – “Have the courage!”

Michelle Albert, MD, MPH, FAHA, FACC

President, Association of Black Cardiologists (ABC)

“Remembering your purpose”

Dr. Albert emphasized being innovative and creative while also being kind and compassionate in a society facing healthcare disparities. It is important to remember the purpose, when attempting to have an impact. She also emphasized harnessing one’s background to help focus on one’s individual passion and follow that purpose.

Raised by her grandparents, Dr. Albert witnessed hardship and segregation, and she perceived how the socioeconomic background of the patients influenced healthcare. As she explained, “The largest gap in healthcare is in cardiovascular medicine”.

Dr. Albert further highlighted the importance of appropriate support, including key mentorship and faith to overcome adversity. She stressed that being disciplined; bold, collaborative and always thinking outside of the box are key for achieving ultimate professional purpose.

She concluded by warning against transactional relationships or being predatory in the professional setting.

Chiara Bucciarelli-Ducci, MD, PhD, FESC, FRCP

CEO, Society of Cardiac Magnetic Resonance (SCMR)

“What opportunities can this adversity bring?”

Dr. Bucciarelli-Ducci believes there are endless opportunities and each challenge simply leads to more opportunities. She is a transformational leader, someone who tries to identify the need for change, create a vision, guide change through inspiration and work collaboratively. She always aspired to be that woman in cardiology and her experience has taught that with change always comes resistance. She stressed the importance of listening to all parties while honing the power of negotiation. She quoted Socrates, in emphasizing the power of a collaborative team, “The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”

Her Italian background, upbringing and world history inspire her tremendously. To Dr. Bucciarelli-Ducci, the COVID-19 pandemic parallels what happened during World War II (WWII). Just like WWII, she believes that this pandemic is creating new ways of thinking, working and connecting with people across the globe.

Sharmila Dorbala, MD, MPH, FASNC

President, American Society of Nuclear Cardiology (ASNAC)

“Be Optimistic”

In Dr. Dorbala’s experience, “Optimism is one of the keys to success.” She believes that whether one looks at the glass as half-full or half-empty is a matter of perspective and choice. One can choose to be an optimist and train oneself to focus on the positives, and that optimism gives one confidence to take risks and then becomes contagious.

She provided an example of contrasting optimists and pessimists and how they view the world differently. Optimists see challenges as being temporary, something that can be conquered and used as a stepping-stone to better solutions, whereas pessimists view challenges as insurmountable obstacles. She referenced her research interest in cardiac amyloidosis to illustrate how optimism has influenced her own career. Dr. Dorbala actively chose to be optimistic and stayed in this field despite the hurdles she encountered. She always remained passionate about her field and confident that her hard work would lead to opportunities. She believes that the advances in medicine seen today are because the medical community chose to focus on the potential of the future.

Her overall advice for professional life is to have the integrity to do what is right, irrespective of the consequences, focus on excellence and be passionate about the cause. She reminds us to never underestimate the importance of having an optimistic outlook to gain confidence and to look for opportunities by embracing risks.

Judy Hung, MD, FASE

Incoming President, American Society of Echocardiography (ASE)

“Forget the noise and forge ahead”

Dr. Hung emphasized that during one’s medical career there will be many instances of biases and inequality, intentional or unconscious. She advised that these injustices should not distract one from pursuing their goals. To her, it is important to always stay in the lane. Dr. Hung explained that one could transform anger and sadness into positive energy, and make an impact professionally. Her strongest advice to women in cardiology is to stay focused and not let negative attributes of mental energy sway one away from their focus.

Biykem Bozkurt, MD, PhD, FHFSA, FACC, FAHA

President of Heart Failure Society of North America

“Create Change and acknowledge the ‘never-evers’ ”

In a time that has left everyone grappling with unprecedented personal and professional challenges, how can do you thrive as leaders? Dr. Bozkurt argued, “most advancements come from acknowledgement of the ‘never-evers’”. “You have to face obstacles head on” or else face “stagnation and complacency.” She offered words of wisdom that adversity creates opportunity for resilience to get out of one’s comfort zone and create a meaningful change.

The COVID-19 pandemic has exacerbated a constant truth of the profession – doctors are witness to human suffering, but, at the same time, healing. “Do not sanitize suffering…learn from it… and teach the next generation,” said Dr. Bozkurt. She cautioned against disinfecting the truth out of uncomfortable realities. Amongst the suffering and sacrifice lies empathy, humility, and growth.

Dr. Bozkurt cited the story of Marguerite Matisse as a compelling example. Marguerite suffered from severe illness at a young age, requiring a tracheostomy. Despite poor health and a prominent scar, she became a lifelong muse for her father, the renowned artist Henri Matisse. As he once explained, “I don’t remember adversity, I remember resilience.” Dr. Bozkurt hopes that when the world looks back on the current healthcare, economic, racial, and political situations, Matisse’s quote will ring true.

Visit this website for access to this important webinar.

Summarized by Nidhi Madan MD Sarah Rosanel, MD; Cynthia Kos DO, Renee P. Bullock-Palmer MD, Kamala P. Tamirisa MD and Purvi Parwani MBBS MPH. Edited by Marissa Bergman.

“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.”

Bring Your Whole Self to Work

August 14, 2020August 14, 2020 Nasrien E. Ibrahim, MD

“Pretend you are going to be interviewed by a conservative, old white man in a bowtie”.

This was the advice I was given when I asked what I should wear, how I should do my hair, and how I should present myself when I interviewed for medical school. I remembered those words when I interviewed for every step of my journey in medicine since, including 1 residency, 3 fellowships, and my first “real” job as an attending. I wore conservative-colored suits (I remember my younger brother telling me I looked like a flight attendant before one interview- not the look I was going for, but okay), always straightened my hair (I never wore my natural curls), and I always thought of that advice before every interview- conservative, old, white, man, bowtie.

Fast forward to “attending’hood”, I would never heed that advice. I started wearing my hair curly as a protest to what “professional” hair should look like, presented on stage in pink blazers and dresses, and brought my whole self to work. When I interview prospective internal medicine residents or cardiology fellows, the most important 3 pieces of their application in my opinion are their letters of recommendation, their personal statement, and their extracurricular activities outside of medicine. While the abstracts, presentations, and publications are fantastic, they do not tell me who you are as a human being. From the letters, you get a glimpse of how others see the applicant, from the personal statement you hear a story, and from the extracurricular activities you learn about passions. My favorite part of the interviews is talking to candidates about who they are, what lights that fire within them, and what kind of vibe they bring to medicine. When I read your application, I want to know your story.

I love what I do in medicine- advanced heart failure and transplant cardiology- I love the research I do but I also love my life outside of medicine. And I am always confused when people are surprised that I love college football, I love LeBron James, my favorite radio show is The Breakfast Club, and I listen to trap music. I love going to concerts, throwing outrageous birthday parties, and going on girls’ trips. I care deeply about equity in medicine and politics that affect the most vulnerable among us and will continue to work my butt off to crush inequities in organ allocation. To me, these are not 2 different worlds. This is just my whole world. So yes, I will keep bringing my whole self to work.

To be completely honest, I am not sure how I should advise my mentees, most of whom are women and men of color, on how to dress or style their hair or carry themselves during their interviews. People of color are judged more harshly, and I would not want my advice of bringing your whole self to the interview be the reason they did not get the position. But then again, who wants to be at a place that does not accept all of them.

I still say, bring your whole self. Every part of it. The authentic you.

And to my mentees I say, continue sharing your magic with a world that desperately needs it.

My Experience at BCVS20

August 12, 2020August 12, 2020 Sasha Prisco, MD, PhD

Thank you to the organizers for putting together a vibrant and informative fully virtual AHA Basic Cardiovascular Sciences Scientific Sessions 2020 (BCVS20) conference this year!

While I have attended many meetings and classes virtually this year, BCVS20 was the first major scientific conference that I attended virtually and I did not know what to expect. I was pleasantly surprised by the many benefits of participating in the meeting virtually but there were many things that I missed about attending meetings in person.

I enjoyed the convenience of being able to work in specific sessions into my usual work week of attending clinic, doing lab experiments, and attending classes and into my personal life. Additionally, I liked being able to watch some sessions in the comfort of my home, sitting next to my dog. Similar to fellow AHA blogger, Dr. Mo Al-Khalaf, I also appreciated being able to easily jump between many live sessions without having to run across a large convention center. Moreover, I felt that it was sometimes easier to pay attention to certain talks without the distraction of being in a crowded area with many simultaneous presentations. I was impressed by the quality of the presenters’ talks and efforts by the participants to stimulate lively discussions.

I did not take time off to attend the meeting and I felt that the week of BCVS20 was extremely busy for me. Although I appreciate the convenience of having a fully virtual meeting, I miss being able to take a short reprieve from some of my usual responsibilities to give my undivided attention to specific sessions. Furthermore, due to my other obligations, I was unable to attend some of the very valuable, live early career sessions. However, the ability to rewatch the BCVS20 sessions (which are available for 90 days after the meeting) will allow me to catch up on many of the sessions that I missed!

While there are many benefits to attending in-person meetings, not least of which is being able to see your friends and colleagues in person, having a virtual meeting allows people throughout the world to conveniently participate in and attend a meeting. I hope that conferences in the future will continue to be a hybrid in-person and virtual format to accommodate everyone’s busy schedules.

For those of you who attended the BCVS20 meeting, don’t forget to provide your feedback on the meeting via the link emailed to you. If you missed registering for the meeting, it is not too late to get access to the recorded sessions. I hope to continue seeing many of you either virtually or in-person during future AHA meetings!

Interviewing a first-time conference attendee

August 11, 2020August 11, 2020 Mo Al-Khalaf, PhD

Conference attendance is a core component of the journey graduate students go on, seeking to advance their knowledge and expand their network within the field of their academic pursuit. This year, unlike any other year before it, some students and early career professionals are experiencing their very first major conference participation and attendance in a virtual setting. The current global pandemic and response to it has forced many major conferences to cancel their planned in-real-life settings, and many have opted to switch these important annual gatherings to a brand new all-virtual format. This of course is a valiant effort to continue providing a platform for networking and sharing knowledge within the community.

While many of us have had the chance in previous years to attend and participate in classic conference formats, I continued to think recently while attending #BCVS20 about how is this unique virtual experience being perceived by the first time major conference attendees? The all-new format and change in typical factors that come into play when one is attending a conference, normally in an unfamiliar location in a city or country, all add up to a very novel introduction to this core component of career advancement. It would be quite illuminating to engage and discuss with a first-time attendee about this experience, and there at #BCVS20, I was lucky to know and have a chance to interview a first-timer to major conference attendance, one who also happens to be my friend and soon-to-be Master’s in Science degree holder, Ms. Supriya Hota (Twitter: @supriyahota28).

Here is a lightly edited version of the interview we conducted on webcam (Zoom meeting!), shortly after the end of the #BCVS20 meeting:

Mo: To start with a big-picture view of the experience, could you tell us how the overall experience was like, after many hours of content, over 4 days of back-to-back sessions, full of novel basic science research?

SH: If I were to summarize my overall experience in three words, it would be: thrilling, fascinating, and inspirational! My colleagues and mentors, including yourself (Blogger note: Happy to be part of the team!) have always told me great things about the AHA conferences, and I must say #BCVS20 was truly one-of-a-kind, even when it was a virtual one this year. Every day of the conference, I was able to feel the energy and enthusiasm right from my small computer screen! #BCVS20 was also a life-changing experience for me because it truly encouraged me to pursue higher education in the field of cardiovascular sciences. So here I am, looking forward to attending more conferences like #BCVS20 and networking with potential supervisors in the near future!

Mo: Focusing on the virtual format for the event, as a first-time attendee for a major international meeting, do you think the setting was adequate and sufficient in meeting your expectations and intentions for attending a meeting like this?

SH: Primarily, my expectation was to get an update of the basic science research that is happening in the field, especially in the area that I study, which focuses on the role of inflammation in heart failure. I also intended to interact with the presenters by asking questions. The virtual format was more than sufficient to meet those intentions. For example, I was able to jump from one concurrent session to the other, so that I didn’t miss a presentation I was interested in. Therefore, I leave #BCVS20 with a substantial amount of information, not only in my research area, but also other areas in the field of cardiovascular science. On top of that, accessing materials and on-line sessions was very convenient via the BCVS Heart Hub. Moreover, I was able to focus on the presentations and take note of the specific details on images or graphs via the virtual format more so than I would’ve been if I had attended the real-life conference, because either I would have been sitting too far from the screen or distracted by attendees leaving or entering the room. Also, the virtual format gave me the courage to ask questions to the presenters, because as a graduate student who is very early in her career, I would have been hesitant to ask a question in a big room full of well-known scientists. Lastly, most of the sessions were on-time, giving everyone the opportunity to discuss the scientific data and personally encourage the presenters via supportive messages in the chat window, like “Looking forward to your presentation”, “Good Luck” and appreciate the presenters’ work by saying “Fascinating work”, “thank-you for sharing your research”, which I don’t think would have been as possible in a real-life conference.

Mo: Conferences usually serve two main advances to folks that attend them, (1) acquire the newest and most cutting-edge knowledge of what’s happening in the field, and (2) expand one’s network of professional connections within the field. Do you think those two components of conference attendance were served well in a virtual format?

SH: I think the program planning committee has done an outstanding job with displaying the newest and most cutting-edge research. The virtual format has fully served this purpose. As for networking, I do not think the virtual format can ever be equal to in-person meetings. Communicating via message chat is not as engaging as face-to-face communication, which, in the virtual format, might also be a limitation to some people for various reasons, (e.g. they might not have a working camera, they don’t feel comfortable engaging with other attendees from home, etc.). Despite these drawbacks of the virtual format, I think the planning committee and the early career committee have made a significant effort in providing networking opportunities to the attendees. At the same time, most attendees have made good use of those opportunities.

Mo: Follow up – Do you think paring and amplifying social media engagement between conference attendees (and organizers) can help with filling-in some of the networking gaps that precipitate by the virtual format compared to in-person meetings?

SH: I am in full support of amplifying social media engagement because it does assist with networking in a convenient way. For example, I saw that many presenters are actively recruiting talented individuals for open positions in their research programs. What would be a faster way to advertise for this position in the scientific community other than social media? I was disappointed every time some principal investigators were not on social media (Twitter). Even though I could tweet exciting facts about their research, I am still unable to engage with them one-on-one and it will not benefit them in return because others cannot follow their research. Therefore, social media, especially Twitter, assists in promoting one’s research to those who were not able to attend the conference and to the rest of the scientific community. I think social media and its ability to privately message individuals fills in a gap as well, because it gives the attendee the comfort and privacy to have a conversation with another attendee, which is not possible in the chat window of a virtual format where hundred others are listening or using the same message chat box.

Mo: Some of the advantages of virtual meetings include ease of access, lower financial commitments, increased diversity of participants and content being shared at those meetings. Would you say these advantages are persuasive enough for you to recommend this experience to another potential first-timer attending a major conference?

SH: I would definitely recommend BCVS to other potential attendees. As mentioned earlier, the two main purposes of conferences are to acquire the newest and most cutting-edge knowledge in the field, and expand one’s network of professional connections, which the #BCVS20 provided to its attendees. In addition, for sure the lower financial commitments and ease of access due to virtual format are persuasive enough for international graduate students like me to attend.

Mo: Any other comments or advice to give to future conference attendees that have a virtual meeting coming up on their calendars?

SH: I would recommend the following to future virtual conference attendees:

Before the start of the conference:

Create your own schedule for the conference, outlining the sessions you will be attending and when you will have breaks (very important! virtual conferences, like in-person meetings, can still be tiring.)
Make sure that your computer is connected to a working camera and microphone and has all the necessary plug-ins and applications installed for you to watch and participate in the online sessions.
Take the time to explore the Home Page from where you will access all the materials, on-line sessions, and on-demand options.

On the days of the conference:

Actively take notes – this prevents you from getting distracted!
Ask questions and/or provide a supportive or appreciative comment on the presenter’s work (that’s the least you can do)
Tweet about the presentation that fascinates you (Don’t forget to mention and follow the presenter!). Try to make your tweet intriguing by stating takeaways and attaching eye-catching scientific diagrams and results from the presenter’s talk, when allowed.

After the conference:

Organize your notes and create a recap or summary to share the valuable knowledge with your team.

Mo: Thank you so much for this illuminating discussion! And I look forward to attending more conferences where we get a chance to chat and share how those experiences translate to our common goal of advancing our professional career journeys.

From Race-Based Medicine to Fighting Structural Racism

August 5, 2020August 5, 2020 Elizabeth Knight, PhD, DNP

“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

On Blood and Bridges: Remembering Congressman John Lewis

July 28, 2020July 28, 2020 Anika Hines, PhD, MPH

I was recently reading a Time magazine article, which included previously unreported coverage of Congressman John Lewis, the Civil Rights icon, who succumbed to cancer last week. When asked why he continued to tell his story, he responded:

…it affects me — and sometimes it brings me to tears. But I think it’s important to tell it. Maybe it will help educate or inspire other people so they too can do something, they too can make a contribution.

As history tells us, Congressman Lewis, then a 25-year-old leader of the Student Nonviolent Coordinating Committee (SNCC) and coordinator of “Freedom Rides,” helped lead a march for voting rights from Selma, Alabama towards the state capital of Montgomery over the Edmund Pettus Bridge. The protestors were met with force by the state and local police. Mr. Lewis’ skull was fractured by the strike of a club. His was just one of numerous injuries endured by protestors. This fateful day—“Bloody Sunday”—March 7, 1965, is commemorated annually. People at home watched in shock and dismay as the protestors were brutalized. The ferocity of the images pricked the consciousness of the nation and resulted in many joining the cause. Their humanity wouldn’t allow them to sit passively and watch other humans decimated.

I gave a little blood on that bridge…

Fast forward 55 years…

On March, 13, 2020, the US declared a state of emergency in response the COVID-19 pandemic. US citizens across the country were advised to shelter-in-place to slow the spread of the novel coronavirus that had invaded our shores. Away from typical distractions of work, traffic, and the hustle of everyday life that usually occupies our minds, many sat fixated on the television as we watched cases and mortality increase. Amidst this vacuum, we were confronted by shocking visuals: a video of a police officer kneeling on the neck of an unarmed black man for 8 minutes and 46 seconds. In the context of social distancing, Americans were challenged to face themselves. The reality of racial inequities in the US, previously shielded by a cognitive dissonance (e.g., “we don’t know what happened before the video”), was now proximal and palpable. We had nowhere to go. We had to sit with it. As in the 1960s, we were outraged by the inhumanity – as we should be.

As a Black woman, it’s difficult to think of a time when I wasn’t completely aware of race relations in this country. Seeing others enlightened and even corroborating the stories of injustice in the US that I have known to be true as early as middle school was encouraging. However, I’d like to challenge our comfort a bit further. The same racism that cracked the skull of a peaceful protestor and kneeled on the neck of an unarmed man is the racism that ignores a black mother’s request for medical attention, dismisses the reports of pain of a black patient with a clearly broken bone, or assumes that black bodies die sooner as a matter of biology. Racism is both the lifeblood and the heartbeat of racial disparities in health and healthcare.

Racism built the communities in which we live, the public schools we are able to attend, and the types of businesses in our neighborhoods that provide basic necessities, such as food. It built our Capitol building and the home of our nation’s chief executive. It even built our most premier educational institutions and their medical and research empires. Racism lives in our silence as much as (if not more than) it lives in violence. It quietly sits within the foundations of our institutions and leaches its contaminants into our social spaces in a way that is both proliferative and reinforcing.

So, where do we go from here? Congressman Lewis once recounted a story of hearing Dr. Martin Luther King, Jr. speak. He spoke of:

…the “spirit of history” inviting him to take his place.

Though it may mean protesting, it may also be interpreted as taking an active role in addressing health disparities in our respective places. If you’re reading this, your place is probably in healthcare, research, policy, or in the community; if not, it could also be finance, criminal justice, human resources, or administration. Regardless of your position, everyone can and MUST make a contribution if we desire to see the best of what our society could be. As during shelter in place, if we can steady ourselves long enough, we will hear the echoes of humans in despair beckoning our individual and collective humanity to act. Together, we have to “slow the spread” of racism—a pandemic¹ that stretches as far back as our nation’s earliest years.

Let’s honor Congressman Lewis. This is our bridge. Let’s be human.

References

Williams DR and Cooper LA. COVID-19 and Health Equity—A New Kind of “Herd Immunity” JAMA. 2020;323(24): 2478-2480.

My Professional Journey

July 21, 2020July 21, 2020 Sherry-Ann Brown, MD, PhD

I was fascinated by the body’s circulatory system in high school. I was also concerned about heart disease being the number one killer of adults in the world. I figured I would become a cardiologist and help save hundreds, thousands, or even millions of people over time in personalized and public health care from fatal heart conditions. I suspected then that I would one day be a physician in cardiovascular diseases.

In college, everyone knew. I majored in Physics, spent lots of time in Spanish, and met my humanities and social sciences requirements, yet everyone knew I was destined for medical school. I completed all my premedical studies, volunteered at a local hospital, and shadowed doctors, and pursued research. My high honors senior thesis for the Bachelor’s and my excellent Master’s thesis were ultimately based on analyzing blood samples to determine health and disease and make predictions, using quantitative analytical methods in genomics and transcriptomics (gene expression profiles). Those studies in the blood were the closest I could get to the circulatory system as a physics major doing biomedical research at that time. It was fantastic!

By the time I started medical school, I figured that if I didn’t become a cardiologist, then I would be an oncologist or practice medical genetics (thinking that would be the closest thing to genomics). In medical school didactics, I quickly learned that medical genetics back then wasn’t what I thought it would be, and it didn’t focus on adults as much as I would have liked. Oncology lectures focused less on the conversation with the patient and more on signaling pathways that I had not yet begun to understand. I decided maybe that was not for me either. The physiology of the heart indeed captured my heart; the lungs and kidney were great too. So there I was, back to the heart and its circulatory system.

In my third year of medical school, I faced a dilemma. I enjoyed Psychiatry, Radiology, General Surgery, Orthopedic Surgery, Family Medicine, and Pediatrics, among other rotations, as well as my electives in Cardiology. What was I to do with my life as a doctor? I could almost see myself doing any of those! Almost.

During the PhD of my MD/PhD program, I shadowed a general cardiologist. I noticed that most of his patients were older and already in atrial fibrillation or heart failure. I asked myself, “Where are the 40-60 year olds before this happens?” I decided to create Preventive Cardiology. That was in 2006. I googled and saw that it already existed! In fact, we had just recruited a brand new faculty cardiologist, whose focus was prevention. I quickly became her mentee and spent some time in clinic with her. I realized that when it really came down to it, I saw myself managing and even more so preventing heart disease.

Then one day, I saw an email about a pilot research study in cardio-oncology. Thankfully, I was able to be a part of the study and learn more about this emerging field. This was in 2010. Almost a decade ago, I realized that my calling in medicine was to practice preventive cardiology and cardio-oncology and pioneer the merging of the two.

So, in my fourth year of medical school, I spent lots of time in various Cardiology clinics, to gain knowledge and exposure in other fields within Cardiology. I also had the opportunity to spend time in Medical Oncology and Radiation Oncology clinics, as well as with the radiation therapy technicians, treatment planners, and medical physicists. I performed literature reviews on my own and brought in articles to discuss with the Cardiologists, Medical Oncologists, and Radiation Oncologists. My favorite paper then is still quoted today in many experts’ presentations on ischemic heart disease risk resulting from radiation therapy.

With such incredible exposure to Cardiology, Oncology, and Cardio-Oncology patient care, research, and education, I thought about what I wanted to do most in the world as a professional. It became clear to me in my fourth year of medical school that I wanted to manage and, even more profoundly, prevent heart disease in the general population and in individuals with a current or prior history of cancer, and especially too in women. During that year, I got to present on my learning experiences in patient care, research, and education to the entire Cardiology department.

In 2012, in my last year of medical school and the MD/PhD program, I matched into the highly selective clinician investigator program at Mayo Clinic in Rochester, MN. I signed on the dotted line in advance for Internal Medicine Residency, Cardiology Fellowship, and Postdoctoral Research Fellowship. Everyone, therefore, knew I was for sure destined to #ChooseCardiology.

During my second year of residency, during my Oncology rotation, I cared for a woman with congestive heart failure thought to be due to anthracycline therapy administered many years before. That blew the whole thing open. I informed my faculty and advisors in Oncology, Preventive Cardiology, and Cardio-Oncology that I desired and planned to pursue both Preventive Cardiology and Cardio-Oncology and find ways to merge the two.

Over seven years at Mayo Clinic, I was, therefore, able to focus much of my research and subspecialty training and learning efforts in Preventive Cardiology and Cardio-Oncology (see CardioOncTrain.com). I also had the privilege of several clinic sessions in Heart Disease in Women. To me, all three are related, in so many ways.

My mission, therefore, is to protect the heart from ischemia, arrhythmia, cardiomyopathy, and other ailments in the general population, and particularly those individuals with a current or prior history of cancer (and especially in women).

Thus, I am now a cardiologist, with special emphases in preventive cardiology and cardio-oncology, especially in women. I am also a poet, and writing poetry about science, medicine, and now the heart has truly become one of my greatest joys (see LyricalMezzanine.com).

I share this story with you as an example of an individualized pathway in #ChooseCardiology. Perhaps you too are leaning towards areas in Cardiology to which you have not had much exposure, yet you know somebody has to do it, and that it must be created. Don’t let the unknown obscure the certainty of your calling. Find mentors and advisors who will believe in your potential and vision and spur you on, and who will one day be proud and excited to see your passion become reality.

A Graduating Fellows Guide to Pediatric Cardiology Resources

July 20, 2020July 20, 2020 Alyssa Vermeulen, DO, FAAP

July is an important month for medical education— whether it’s graduating from med school and starting intern year, finally becoming a senior or starting fellowship. With fellowship ending for me, and starting for many, I started to compile a list of resources for pediatric cardiology to share.

Many of these resources were passed down to me by seniors or mentors, but also many were found on twitter (read more about how you can use this to your advantage in my previous blog). Some emerged recently during COVID-19 in an effort to bring pediatric cardiology together virtually and bridge education gaps for webinars, lectures and more.

For online resources, I recommend creating a folder on your browser and saving sources for easy access later. Another helpful thing for me was saving the links to Moss & Adams, Mayo Clinic Board Review, & Lai echo e-books in this folder so that you can access them anytime and not have to carry the books around(you can find the codes in the front cover of the book).

Below are websites for great lectures, webinars and reading, clinical resources, apps, podcasts, important organizations and ways to find job postings. Enjoy and please share!

Websites for Lectures, Reading and Resources:
Heart University– Educational video on pediatric and adult congenital heart disease (ACHD) includes pathology lectures by Dr. Robert Anderson. They also host great webinars on various topics with leaders in the field.
SPCTPD– PC-NES (Pediatric Cardiology National Education Series), a lecture series that was started to provide education to fellows during the pandemic— you can access all the previous lectures that were given on various topics with lecturers from around the country, this is planned to continue in the fall.
SCMR– Cardiac MRI case based webinars.
ACHA– ACHD association with webinars on various topics.
Dr. Robert Pass EP lectures; Excellent weekly EP conferences(Mondays 7am EST) with the Mount Sinai pediatric cardiology fellows, past conferences are on this YouTube page and the link to join live is sent via pediheartnet(see below), you can also find Dr. Pass on his podcast(below) and on twitter!
Multimedia Manual of Cardio-thoracic Surgery– Surgical videos and descriptions geared towards surgeons but helpful to explain and see common CHD procedures).
Cardiology Notes– Summaries of various chapters from Moss & Adams, Lai Echo, as well as other pediatric cardiology tests and resources.
Parameterz– website for Z scores to use for echo, easy to use on desktop or phone
Virtual TEE (Toronto) – TEE simulator.

Podcasts:
Pediheart– Peds Cardiology Podcast hosted by Dr. Robert Pass (above) – review of recent literature and topics usually with a great guest, tune in each week (released Friday) and learn to appreciate Opera too.
Cardionerds– Mostly geared toward adult cardiology with some overlap to Peds.
PCICS– Cardiac ICU topics and discussion with various leaders in the field.

Apps: (links are to the apple store, but they should be available through google play too!)
EP tools lite– Various EP calculators including WPW pathway localization tool.
Heartpedia– Great resource for education for patients, medical students and residents with easy to use interactive diagrams of common CHD and repairs.
Pacemaker– Using the patient’s chest XR, snap a picture of the pacemaker and this will tell you who the maker is (Medtronic, St. Jude, etc.)
Practice Update– Follow topics (i.e. Cardiology) and receive virtual “stacks” of the latest literature on that topic with quick reviews and links to full text.
Dimity– Use this app to make patient phone calls from your phone so your number shows up as the hospital line and not your number or unknown. Very helpful for home call!

Conferences/Organizations: all conferences through 2020 are now virtual allowing you to access more content. Remember as a fellow your membership and registration is usually discounted or free, take advantage while you can!
ACC– Annually in March.
ASE– Annually in the summer (virtual August 8-10) and only $75 for fellows).
PICS-AICS Cath focused conference annually in September.
AHA– Annually in November.
PCICS Annually in December for those interested in cardiac ICU. Bonus fact- they are also hosting virtual meetings on experience and research related to COVID-19 and pediatric cardiac care.
PAC3, PC4 & NPC-QIC– Collaborative organizations to improve outcomes in congenital heart disease, along with these are great organizations for quality improvement and outcomes research and hold an annual conference along with webinars.
CHOP pediatric cardiology update Annual dedicated pediatric cardiology conference in February.

Job Postings: below are links to sites that may be helpful as you are looking for jobs, don’t hesitate to reach out to people, have your mentors reach out or cast a wide net, you may find opportunities that aren’t posted.
Pediheartnet- A list server with job postings; this also facilitates discussion between cardiologists around the world, this is the server that the weekly EP conferences (above) will be sent out on and other great opportunities- a must join!
Other sites for job postings-
Congenital Cardiology Today
CareerMD Pediatric Cardiology Job Bulletin
NEJM Career Center ACC Career & AHA Career Center – refine your search by specialty and receive emails with new postings.

Happy July, and don’t forget to be kind and welcoming to someone new in the hospital, you were there once too!

Knowledge Advances Incrementally

July 20, 2020July 22, 2020 Mo Al-Khalaf, PhD

Learning and advancing one’s personal and professional goals is a dynamic and active process. We never truly “finish” learning anything. We get better and better at tasks the more we practice them. We increase the accuracy of our data the more analysis on bigger and more relevant sets of samples we collect and measure. The scientific method is built on accepting the facts as they get unveiled, fully realizing that optimization and accuracy comes gradually with more work done and more information gathering.

One of the present global issues that I want to address here is the erroneous practice of some individuals that point out shifts in recommendations and gradual changes in the understanding of a scientific/medical phenomenon, and using these shifts and changes in the information shared as basis for doubt and denial for the whole process. Certainly when it comes to complex and novel discoveries/puzzles to solve, there will be a period of optimization and incremental advancement in understanding. These could lead to changes in conclusions from where things were first reported, to where they are now, and to where they will be in the future as more and more science is uncovered and facts are checked and replicated.

The act of refuting what we presently know and understand of a novel discovery or challenge to tackle, simply because the present understanding doesn’t match exactly what was previously reported and shared, is simply an act of refusing to accept that human beings are, by nature, dynamic learners. We gain more as we try, experience, and process information. Humans are not the kind of species that begin and end their lives with the same genetically programmed set of actions and behaviors inherited from the previous generation and are carried down to their progeny. Each one of us knows more now than we knew when we were younger. Experience matters. Time to perform more measurements and analysis brings us closer to accuracy and understanding. In other words, we get wiser as a whole, the more we experience and accumulate data.

Individuals that insist on focusing on the divergence of information coming from science and medicine, that’s separated by a non-trivial amount of time, are trying to sow doubt and nullify the value gained by executing the scientific method to its fullest potential. Accuracy, and a full understanding of anything complex, requires optimization, replication and diverse set of experts working separately and together, to incrementally achieve the most precise understanding of a challenge or novel discovery.

Our society benefits from scientifically assessed and understood information. Evidence-based decision making is far superior to other forms of societal choices, made by and for the public. And as mentioned here, the precision and accuracy of scientific information gathering advances the more time is allowed for investigation and understanding. We should celebrate and embrace changes accumulated with more data analysis and scientific rigor applied to test the facts uncovered along the way.

It is a self-correcting and enhancing mechanism, built into the scientific method and research process that we implement as scientists and healthcare researchers and providers. Sure this means that some data and knowledge will shift with time, but this should be seen as progress, and we should not let mis-informers and pseudoscience spreading behavior and individuals hijack the system of self-correction and improvement built into our method.

And as a last point to make: Scientists, medical researchers, and everyone involved in healthcare, research and academia should find ways to communicate and/or amplify voices of communicators that are on the front-lines of providing evidence-based information to the public. The best use of the scientific process is when the product of this process is shared with everyone.

Residency and Fellowship Interviews During COVID-19

July 10, 2020July 10, 2020 Sasha Prisco, MD, PhD

As early-career physicians started residency and many physicians began fellowship training this month, it’s hard to think that recruitment for next year’s residency and fellowship classes is beginning soon. The COVID-19 pandemic has disrupted many of our usual routines and processes. Similarly, this year’s residency and fellowship interviews are going to be different than previous year’s interviews. The Association of American Medical Colleges (AAMC) has now recommended that all interviews for medical school, residency, and fellowship be conducted virtually this year.

There are many potential benefits of virtual interviews, including but not limited to:

Lowering the financial burden of traveling and housing during interviews.
Not having to spend time traveling and potentially being able to interview at more programs without physical distance complicating scheduling. For example, one can interview at a West Coast program one day and interview at an East Coast program the same or following day.
Missing fewer days of work/school/rotations for interviews.
Not having to frequently pack and unpack and worry that you forgot to pack something important.
Not having to tour a campus during the winter months (especially in heels) or drive in the snow.
Sleeping in your own bed before an interview.

For those of you who will be interviewing virtually for residency and fellowship programs this year, I have gathered some advice from my Cardiology fellowship program director (@rhythmkeys) and program coordinators (@UmnCardsfellow). Of course, also ask your mentors and other colleagues for advice. Remember that this is a new experience for both you and the programs so there may be some road bumps and steep learning curves.

Be open-minded. Fight the urge to stay at the same training institution because of unfamiliarity with a new city and/or program.
Spend time researching the programs and cities that you are interested in. Many programs (including ours) will have virtual tours/videos of our facilities and city. Take advantage of the publicly available information about a program/city (i.e. Google Maps is a great way to explore a campus/city in the comfort of your own home).
Ask more questions about a program and environment than you usually would if you were interviewing in person in order to get a feel for the culture/environment of a program since this may be more difficult to determine when interviewing virtually.
Try to consider the interview as “normal” as possible. Be professional. Be prepared. Login into your computer and the virtual meeting early in case you encounter technical difficulties.
Do not worry too much about technical difficulties. Virtual interviews are also new for the programs. Most programs will have contingency plans in place if there are technical difficulties.
Here is some great advice on how to master the art of virtual interviews from fellow AHA early career blogger, Dr. Barinder “Ricky” Hansra (@RickyHansra).
Reach out to current or past trainees at a specific program. Most of us are happy to talk about our experience in the program. If any of you are interested in the Internal Medicine or Cardiology fellowship program at the University of Minnesota, please feel free to contact me! Interviewees at our program will be able to still meet with current fellows during their interview days and I assume that this will be a part of interviews at most programs.

Depending on the experience of the programs and applicants this year, perhaps virtual interviewing for medical school, residency, and fellowships will continue in the future. Interviewing virtually may be more convenient and cost-effective. Best of luck to all of you interviewing for medical school, residency, fellowships, or jobs this year and stay safe!