early career – Page 3 – The Early Career Voice

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

July 2, 2020July 2, 2020 Elizabeth Knight, PhD, DNP

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

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

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

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

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

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

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

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

Transcatheter Interventions of the “Forgotten Valve”

June 17, 2020June 17, 2020 Lina Ya'qoub, MD

We have witnessed tremendous advances in the transcatheter therapies for various cardiac conditions in the past couple of decades! The “forgotten valve” usually refers to the tricuspid valve, due to the fact that most of the research in the literature is on the left-sided heart valves. In the past two decades, although there has been progressive interest in implementing transcatheter techniques to treat tricuspid valve pathologies, we are still in the early stages of this development. So, I decided to write briefly about some of these transcatheter techniques, which will continue to improve in the future; as we get more experience with these tools and continue to implement the advances in related technologies.

Tricuspid Valve Interventions

There are two main types of transcatheter interventions of the tricuspid valve: repair and replacement.

Tricuspid Valve Repair

Tricuspid valve repair can involve the tricuspid annulus and/or leaflet coaptation. Leaflet coaptation is performed using the off-label use of MitraClip (Abbott) in the tricuspid valve (also known as TriClip), mainly because of the device availability and operator familiarity [1]. There are other repair systems to repair the tricuspid leaflet coaptation, including Forma (Figure 1) and Pascal systems from Edwards Lifesciences. The Forma repair system consists of a spacer that occupies the regurgitant orifice and thus decrease regurgitation. The Pascal repair system consists of two paddles, clasps and a spacer, thus overcoming some of the limitations of Forma repair system regarding anchoring and dislodgement [1]. Other repair interventions involving the annulus are usually performed using sutures or an annuloplasty ring (Figure 2) [1].

Figure 1: Forma repair system (Edwards Lifesciences), which is a transcatheter approach to improve the leaflet coaptation of native tricuspid valve by occupying the regurgitant orifice area [2].

Figure 2: Cardioband (Edwards Lifesciences) is a transcatheter annuloplasty ring for the tricuspid valve [3].

Tricuspid Valve Replacement

The first transcatheter tricuspid valve replacement was performed by Kefer et al in 2014 using the balloon-expandable SAPIEN valve (Edwards Lifesciences). There are 6-7 types of dedicated transcatheter tricuspid valves that have been developed in the recent years; these include NaviGate (NaviGate Cardiac Structures, Lake Forest, California), Edwards Evoque, Medtronic Intrepid, Lux (Chinese designed and manufactured self-expanding prosthesis made from bovine pericardial tissue mounted on a nitinol stent frame), and Tricares (TRiCares GmbH, München, Germany) valve is a self-expanding prosthesis made from bovine pericardial tissue mounted on a nitinol stent frame. Figure 3 illustrates a NaviGate valve, which is the first tricuspid prosthetic valve implanted in humans in the United States, which was performed by Navia et al in November 2016 [1]. It is an example of a self-expanding dedicated tricuspid valve with 3 pericardial leaflets.

Figure 3: NaviGate valve, which is currently available for transcatheter tricuspid valve replacement [4].

Caval Stenting

In addition, stenting of the inferior and/or superior vena cava has also been performed to mitigate the effects of tricuspid regurgitation on the central venous system. It is another option for those patients with tricuspid regurgitation, but there are concerns that this procedure might ultimately promote significant hemodynamic deterioration, with ventricularization of the right atrium and increased load on the right ventricle. Ongoing studies are being conducted to assess these effects and the outcomes of this procedure [1].

Do transcatheter interventions of the tricuspid valve affect mortality?

So far, the current evidence we have is from observational studies suggesting improved mortality in patients treated with tricuspid repair/replacement compared to medical therapy [1]. Overall, these transcatheter interventions have shown significant improvement in patient’s symptoms and New York Heart Association (NYHA) functional class, despite only moderate reduction in tricuspid regurgitation severity [1]. There are multiple ongoing trials assessing the impact of these therapies on outcomes. The TRILUMINATE trial is one example, which is comparing outcomes of tricuspid clipping to medical treatment in patients with functional tricuspid regurgitation.

In conclusion, there are several transcatheter therapies that have been developed for treatment of tricuspid valvular pathologies, most commonly for functional tricuspid regurgitation, in the past few years. Although most of these techniques are still in their early stages, the initial results of the observational data are promising. I look forward to seeing the advances in these therapies in the near future, as we continue to build our experience as operators and familiarize ourselves with these new advanced tools.

References

Lluis Asmarats, Rishi Puri, Azeem Latib, José L. Navia, Josep Rodés-Cabau: Transcatheter Tricuspid Valve Interventions: J Am Coll Cardiol. 2018 Jun, 71 (25) 2935-2956. https://www.onlinejacc.org/content/71/25/2935
Edwards Transcatheter Approach to Tricuspid Regurgitation – Josep Rodes-Cabau, MD https://rutherfordmedicine.com/videos/Edwards-Transcatheter-Approach-To-Tricusp-FD2C5E468
Nickenig, G. TRI-REPAIR: 30-Day Outcomes of Transcatheter TV Repair in Patients with Severe Secondary Tricuspid Regurgitation. Presented at TCT 2017 https://www.edwards.com/gb/devices/transcatheter-valve-repair/cardiobandtricuspidsystem
First U.S. Transcatheter Tricuspid NaviGate Valve Successfully Implanted https://www.dicardiology.com/content/first-us-transcatheter-tricuspid-navigate-valve-successfully-implanted
TRILUMINATE Study With Abbott Transcatheter Clip Repair System in Patients With Moderate or Greater TR (TRILUMINATE) https://clinicaltrials.gov/ct2/show/NCT03227757

Pandemics Juxtaposed

June 16, 2020June 16, 2020 Sherry-Ann Brown, MD, PhD

Many of you are wondering about what I as a leader in various ways am thinking about the racial pandemic, juxtaposed with the coronavirus pandemic.

In the coronavirus pandemic, I had been starting my emails with something like, “I hope you have been able to stay well during these unprecedented times”.

This morning, I started to write an email to a group of people.

At first, I typed, “I hope you are well”.

Then I deleted that and started over.

And then wrote, “I hope you are sorting through these multiply tumultuous times.”

I deleted that too and skipped that intro altogether, and instead decided to share it with you all.

Let me tell you why. You should already be able to figure this out, but let me walk you through it.

Here it is.

Plainly and simply.

I hope you are NOT well.

I hope you are not OK with seeing what is going on in the world around you. I hope you are not OK with the global ignorance we have as people. I hope you’re not OK with the complacency with which we live our lives.

I hope you are NOT well.

I hope that your heart has been breaking inside due to centuries and decades of injustice.

I hope your well-being has been ruffled knowing that all are NOT well.

That all is NOT well.

We all agreed that as a society the goal is to be well.

However, the goal we should desire is for all to be well.

We cannot be true to ourselves until we honestly recognize that all are not well until the futures of our black men, women, boys, girls, and babies in this country and around the world are well.

Until then, how can you be well?

Together, in community, how can we be well?

We can be well when we start to admit that we are not.

We can be well when we commit to open dialogue and truthful conversation about race.

We can be well when we recognize our ineptitude as a society at understanding and addressing what ails us.

We can be well when it finally legitimately rings true that all men, women, boys, girls, and babies in the United States are indeed understood, recognized, perceived, and treated as equal.

Virtual #QCOR20 and the future of cardiology academic meetings

June 12, 2020June 12, 2020 Aaysha Cader, MD, MRCP

Much like many recent academic cardiology meetings, the American Heart Association (AHA)’s Quality of Care & Outcomes Research 2020 (#QCOR20) meeting took place virtually as well, owing to limitations posed by the COVID-19 pandemic. Having attended AHA Scientific Sessions 2019 as an international delegate, this was both my first time attending QCOR as well as my first virtual QCOR. There was a wide range of content encompassing cardiovascular outcomes research, abstract presentations, plenary sessions and also an online interactive early career session via zoom.

So, as I logged into HeartHub (https://www.hearthubs.org/qcor ) for the sessions, in the comfort of my pajamas in a time zone a dozen hours apart, I found that the platform was rather unique, convenient and user-friendly. Talks were pre-recorded in good quality, but what really stood about the #QCOR20 format was the chat function that ran simultaneously with the ongoing talks. Completely flattening all medical hierarchies, this allowed for extensive, insightful and interactive discussions in an informal manner between speakers and attendees, irrespective of where they stood in the totem pole of medicine. This also served to obviate some of the conventional barriers of Q&A sessions at large meetings, allowing for more questions as well as the active engagement of more junior delegates.

Additionally, Virtual QCOR registration came with on-demand access to recorded lectures as well as other available conference materials including handouts for until three months after sessions, allowing one to catch up on sessions that might have been missed.

This was particularly useful, because, that very weekend SCAI also hosted their annual scientific sessions virtually. In a parallel world, I wouldn’t have dreamed of testing my efficiency with two parallel meetings. But the effort to attending both was significantly less than usual, including financially, involved no flights, commutes or time off work, and conveniently, I could switch between windows to “pop in” to the sessions of my interest at either meeting.

Despite some of these conveniences, I found myself missing the buzz of in-person meetings: the anticipation of results of late-breaking clinical trials, discussions of live cases, interaction and camaraderie of meeting colleagues face to face from the around the world, seeing new technology in the exhibit calls and especially, coming to think of it, the downtime off work and the absolute joy of travel.

Basically, the nerd, the wanderlust, and the human in me didn’t quite agree entirely with this virtual format. But that’s personal. And while we can agree that the science and education will certainly find its way to clinicians, many of the other goals and expectations of such annual academic conferences hinges on in-person meetings. These include small-group practical education, meeting and networking with peers, sharing of experiences, and potential collaborations borne thereof, none of which can be effectively achieved by a virtual meeting. From the perspective of scientific associations, building agendas, policy-making, professional skills development, and interactions with industry are all far better achieved with face-to-face interactions.

With restrictions to air travel, dwindling economies, social distancing measures and the varying commitments of the global medical community facing different phases of the pandemic in their respective countries, there has been much discussion on the future of medical conferences. Given the current climate, delegates (especially international) may re-evaluate priorities, with considerations of finances and if in-person presence was in fact, absolutely necessary.

And as many more international cardiology meetings are successfully converted into virtual events, and many more physicians adapt to this convenient method of education, it begs the question if this indeed will be the default arrangement for the foreseeable future? Further, into the future, academic societies ought to consider the possibility of combining the best of both worlds, so to speak, with a “hybrid” format, offering the in-person meeting as well as the virtual format, thus giving delegates who might prefer it, the option of attending sessions live from the comfort of their homes.

Also, while large global meetings with thousands of delegates might survive the pandemic and transition into hybrid conferences, what of the smaller meetings? Some of these are dedicated to niche specialties for smaller audiences, offering opportunities for hands-on learning and more intimate networking with experts and mentors. Only time will tell if such smaller meetings will indeed prevail.

Virtual meetings may have sufficiently filled the void of medical education and academic discourse that occurred as a result of cancellations of in-person conferences. Part of this void has also been filled by increased interactions between peers on social media platforms, particularly twitter, with renewed importance of the role of social media ambassadors. In more ways than one, virtual meetings may even have brought the world closer, with many of us logging in at the same time from different time zones. But let’s be real: We can dissect a trial on twitter all we like, but it will never be the same as the standing room only attendance at late-breaking clinical trial sessions. Also, let us seriously spare a thought for the principal investigator presenting his/her pioneering research to a computer screen: that is nowhere near the real thing.

The impact of COVID-19 on the course of major professional meetings has been huge. While Science will always find a way to reach us, meetings are so much more than just science. The whole world is adapting to a new normal and it will be interesting to see how this pans out for the medical community.

Lessons I’ve Learned as Chair

June 12, 2020June 12, 2020 Mo Al-Khalaf, PhD

Being a recent graduate just entering the professional stage of one’s career is an especially turbulent time. This is magnified for ones that had a prolonged academic journey, such as advanced medical training, pursuing master’s/doctoral degrees, and any other unique situation that can lead to a long journey of being an official student on paper (because unofficially we’re all students of life, until the end!).

However long and winding road one takes, there comes a time when the stage is set to exit being a student and enter the professional field. This stage is simply known as Early Career (using the naming convention most widely used, including at the American Heart Association). This part of a career journey has the uniqueness of blending learning many new life skills, and professionally performing up to the standards expected from achieving the academic endpoint one has reached (MD, PhD, or any other).

One way a young professional can advance their learning curve and become professionally savvy and focused is by seeking and actively participating in committees within organizations related to their working field. Committees provide a platform where members interact regularly, discuss and plan actions related to the work environment, provide community-building opportunities, and essentially expose their members to a variety of learning experiences that are highly beneficial, both directly and indirectly, in progressing their early career professional journey.

Here I present my personal experience as an example. I have recently concluded my term as Chair of the trainee committee in my institute, and have recently been granted full employment status as part of the reorganization of the employment structure here. I’m now exactly placed in the “Early Career Professional” stage of my journey. Being part of a committee provided me with many extra layers of understanding on how everything functions within the institution. My long academic stage provided me with skills and experiences within the realm of science, laboratory research and academic scholarship, but precious few glimpses of structures and professional actions outside the lab and classroom settings.

(Image from Pixabay.com CC0)

Working within a committee, and chairing a committee in my personal example, comes with its own learning curve, which can be a daunting thought for an already overwhelmed young professional (or senior student or trainee). But the rewards are plenty, and the effort is worth it at the end. Committee membership can be a rich source for personal and professional education. Some lessons are generalized for everyone to gain, other lessons are more individually centered, for each person to uniquely grow from. Some of the many lessons I’ve learned recently I’ll share here.

I’ve learned how a budget in an institutional structure is managed (which is different from how a personal household budget is done). I’ve learned the names of so many other professionals within the organization outside of my daily interactions. I’ve learned more about the administrative structure of the place where I work in. I sat in meetings that shape the direction of the future of the institution. I learned about leadership, and even more about teamwork. I learned the great value and appreciation for creating a close-knit community within a professional organization. As human beings, we have been creating and living in villages for thousands of years, and nowadays the professional network one works in can be part of that village. Here as well is where one can find opportunities to increase the equity, diversity, and inclusiveness of the professional community within the institution or organization. I had first-hand experience in this. Providing support and a platform for the under-represented can create an entry point for the larger effort required within the whole organization, institution and wider society. We should use all the tools at our disposal (and create new tools when necessary) to continuously provide better results for members of our community that are under-represented or marginalized.

My pitch here at the end to you is to seek out, create when possible, and accept opportunities, to be active in your work organization, and professional societies, during your early career stage (and moving forward). My personal endorsement goes to being an active member of a committee at your institution, and then to expand into national and international societies that exist in your professional field. There is much to learn, a community to join, to build, and a lot to gain towards advancing your professional path, and maybe, the society as a whole.

Black Lives Matter- Doctors, We Need to Talk

June 11, 2020June 11, 2020 Nasrien E. Ibrahim, MD

I immigrated to America with my siblings and mom in the summer of 1998. Three years later on April 7, 2001, when I was a freshman in college at the University of Cincinnati, the Cincinnati Police killed an unarmed Black teenager named Timothy Thomas, igniting several days of protests. That was the first time I came face-to-face with the cruel reality of racism, police brutality, and violence against the Black community in America. After Timothy Thomas came many others. Sean Bell. Oscar Grant. Trayvon Martin. Rekia Boyd. Eric Garner. Michael Brown. Tanisha Anderson. Tamir Rice. Walter Scott. Freddie Gray. Sandra Bland. Samuel DuBose. Alton Sterling. Philando Castile. Stephon Clark. Atatiana Jefferson. Breonna Taylor. Ahmaud Arbery. [and many, many more…]. And most recently, George Floyd- who like his 6-year-old daughter Gianna said while sitting on the shoulders of one of her father’s best friends, retired NBA player Stephen Jackson, her “daddy changed the world”. The world watched in horror as a police officer kneeled on Mr. Floyd’s neck for 8 minutes and 46 seconds as he pleaded for his breath, killing him on May 25, 2020. Protests erupted all over the world.

I wish I knew the answers. I wish I knew how to change the world. I wish I knew how to change the reality of being Black in America. What I do know is that this time it feels different. This time I am hopeful. This time I have witnessed people speaking up who never speak up. I have seen hearts shattered all over the world and emotions exploding across every continent. Systemic racism is a disease in America and the system needs dismantling. Change can no longer wait.

Why did I say we needed to talk, doctors? Because we desperately need to. Violence, police brutality, and injustices against the Black community are a public health crisis. How do we expect to talk to Black patients about blood pressure and glucose control without addressing the trauma Black women and men experience on a regular basis living while Black in America? We took an oath, to serve mankind, now is our time to step up like we have never stepped up before. This is not a bipartisan issue; this is a human issue.

Academic and non-academic medical institutions all over America kneeled on June 5, 2020 in remembrance of Mr. George Floyd after they issued statements (ranging in directness of messaging) denouncing his soul-crushing murder. While this display was profound, we cannot stop there. We must move past the vigils, remembrances, thoughts, and prayers, emails, diversity and inclusion workgroups, and committees, and meeting after meeting after meeting, to the implementation of initiatives that dismantle the systemic racism ripe in medicine. Black women and men are grossly underrepresented beginning in medical school all the way to professorships, tenured positions, chiefs of divisions, and medical school deans.

I do not know all the answers, but I do have some suggestions:

When you get invited to speak at a school about being a doctor, rather than feel good for the day and add it to your curriculum vitae, connect with a Black student or 2 that may be interested in medicine and mentor them. Find out if your institution has a summer program for minority students interested in medicine and get them connected. Maintain a relationship with them and guide them through their journey in medicine. You may be the only person that has made them feel like they belong in medicine and that their dream is within reach.
Recruit Black women and men into your residency and fellowship programs and mentor and sponsor them throughout their training. If they are interested in research, provide them with opportunities to work with your team. Amplify their voices and work on the national and international stages you have the privilege of presenting on. Recommend them for local, national, and international committees. Recommend them for speaking opportunities. Connect them with your colleagues and friends at other institutions during their job searches.
Recruit Black women and men into your institutions and work hard to retain and promote them. Recommend them for leadership positions. Guide junior faculty in their research efforts and put them on your grants. Cite their work. Get them to the podium on national and international stages. Invite them to meetings where big decisions are being made. Recommend them for local, national, and international committee positions (other than the cliché “Diversity and Inclusion Committee” positions). Recommend them for promotions and tenure.
Let go of the idea that Black patients are the responsibility of safety net hospitals alone. In any given city, there are more Black residents than what a single hospital can handle. Go into Black communities and build relationships and welcome Black patients into your hospitals. If Black patients say they are not comfortable being cared for at your hospital, then you desperately need to change the face of your hospital.
Which brings me to my next point, diversifying your hospitals means diversifying the faces from environmental services, valet, and food services all the way to division chairs and hospital presidents.
Speak up right then and there, every single time, in defense of your Black students, trainees, and colleagues when discrimination occurs in your presence. And defend them when they are discriminated against when they are not present.

Nothing seems to have changed since I immigrated here in 1998 but I do feel that this time is different. My fellow doctors, this is not the time to watch from the sidelines. It is not the burden of Black doctors to dismantle the systemic racism that plagues medicine. Use your privilege to act, I promise you will not lose it. When this wave of protests, kneeling, and anti-racism training settles, I want us to remember those horrific 8 minutes and 46 seconds and remember the role we each must play in dismantling systemic racism.

Rest in paradise Black Queens and Kings. We will not let up.

Black Lives Matter- today, tomorrow, and forever.

Taking a public stand for social justice

June 10, 2020June 10, 2020 Sasha Prisco, MD, PhD

My heart is broken after the recent events and the loss of George Floyd’s life in Minneapolis, my beloved home over the last couple of years, along with many other recent tragedies that highlight the racial injustices in the United States. Like many, I hope that these events will lead to fundamental changes and improvements in our society.

I admire the institutions, organizations, companies, leaders, and my colleagues who are making public statements in support of efforts to lead to social justice. I think that it is important to acknowledge that as a society, we are now expecting many organizations, institutions, companies, and leaders (political, academic, organizational, etc.) to take a public stand against racism, a topic that many organizations and businesses previously shied away from making public comments on. This is a positive shift in our culture. One of the initial ways to lead to long-lasting change is to acknowledge that there is a problem. My home institution, the University of Minnesota was quick to make a public statement condemning racism and social injustices after George Floyd’s death. As researchers and healthcare providers, we know that there are health inequities, magnified by the COVID-19 pandemic which my fellow AHA blogger, Dr. Anika Hines (@DrAnikaLHines) recently discussed.

Furthermore, as healthcare providers and researchers, we are often leaders in our communities and are able to provide a voice to those who are disadvantaged. Another fellow blogger, Dr. Elizabeth Knight (@TheKnightNurse) recently wrote about the importance of advocacy by healthcare providers. Racism and social inequalities are public health issues. Many organizations that we are a part of have made public statements for social justice. The American Heart Association and American College of Cardiology have made a joint statement with the Association of Black Cardiologists against racism and social inequities. Similarly, the American Medical Association and Association of American Medical Colleges have also made public statements condemning racism and advocating for change. Additionally, many healthcare providers across the country have kneeled and protested for #WhiteCoatsforBlackLives over the last couple of days. When the organizations and institutions that we are a part of take a public stand against racism and social injustices, we then feel supported in our efforts.

I encourage trainees to pay attention to which organizations and institutions are making statements against racism and social injustices and are committed to making changes.

Be an active ally. Listen and learn. Be kind. Be safe.

Mastering the Art Of A Virtual Interview

June 8, 2020June 8, 2020 Barinder Hansra, MD

The COVID-19 pandemic has created an entirely new (and robust) world of online platforms. All across the globe classrooms, meetings, conferences, and social get-togethers have become virtual. Companies such as Zoom (Zoom Video Communications, San Jose, California), WebEx (Cisco WebEx, Milpitas, California), and BlueJeans (BlueJeans Network, Mountain View, California) have allowed us to maintain social distancing while maintaining the ability to round as teams, attending meetings, and even conduct interviews. However, for many trainees, interviewing for residency and fellowships is challenging on the best of days but needing to conduct an interview online has its unique set of problems. This past year, as a chief cardiology fellow, I was able to interview a number of candidates. Some did a fantastic job while others struggled. Here are a few tips to help this interview season be even more successful.

Practice makes perfect: One of the great features of Zoom (and others) is the ability to record video calls, making it an incredible tool for interview preparation. You can optimize a lot of in your interview by seeing how the lighting is affecting the way you appear on screen, are you fidgeting too much, and how is the video/audio quality. I would recommend having a few mock sessions with friends, family, and even a mentor to get feedback. It is key trainees get enough practice before the real deal.
Get rid of distractions: In face-to-face meetings, distractions are shared by the interviewer and candidate – we are often able to laugh at them together. However, if your dog or child runs into the room when you interview it’s a lot harder to laugh. Even small things such as text messages, emails, or noises from the outside of your own home can be a distraction that may be hard to recover from.
Maintaining eye contact: This may be one of the trickiest parts of an online interview. If you look at the person you are talking to then the camera doesn’t capture your eye contact. If you look into the camera, then you don’t get to see the body language or facial reactions of the interviewers. I recommend the second option – look into the camera when speaking. You can look down at the screen to get cues about how the interview is going when the interviewer is speaking.
Double-check the date and time zone: Since we are not traveling for an in-person interview, it is important to make sure you have the correct date and time. If you are interviewing with a program in another time zone you do not want to be late because you did not take the time difference into account. This will be especially important for those interviewing on the different coasts, or if interviewing in a state such as Arizona that does not have daylight savings.
Don’t be afraid to ask questions: Training programs have had to adjust during the COVID pandemic so don’t be shy to ask what steps institutions have taken and what is their plan for going back to “normal.” You may have specific goals you want to accomplish during your training – share this on the interview to see if the program will be able to help you fulfill your goals. Remember to ask the most important questions on the interview day that will better inform you about the program, you can always follow up with an email if more questions come to mind.

Interviewing is a challenging skill to perfect however, with preparation and keeping a few of the above-mentioned tips in mind, you can set yourself up for success. You’ll feel more confident and relaxed during your virtual interview by taking these tips into account, and hopefully match at your top program.

Image website addresses:

Panel with female interviewer: https://www.forbes.com/sites/zackfriedman/2018/12/05/most-common-interview-questions/#508966cc8e3c
Online interview image: https://www.wayup.com/guide/community/ey-245237-sponsored-video-virtual-interview-guide-expert/

Scientific Sessions during the pandemic

May 28, 2020May 29, 2020 William Aitken, MD

I didn’t know what to expect when I logged in to the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions earlier this month but having attended I’m definitely a fan of this new virtual format. As a trainee, the largest barriers to attending conferences are usually finding the funding and arranging the time off from work. Not having to worry about missing work on Friday and the cost of a roundtrip flight and hotel for the weekend was a huge positive.

In the couple of weeks since the conference, it’s also been great having access to sessions I missed. With so much going on during the live scientific session, it’s easy to miss a lot of really interesting new research being presented. Being able to go back a couple of weeks later and look through the content has made it much more digestible and eased any fear of missing out I had.

It did take me a little bit to get comfortable navigating the HeartHub (https://www.hearthubs.org/qcor), but then again I usually get turned around at in-person conferences too. Once I was in virtual sessions, I was surprised by how interactive the chats were and how relaxed they felt. Not sure why it felt less formal than an in-person conference but “attending” while having a coffee in my living room, rather than wearing a suit in a conference room sure didn’t add any stress.

Looking forward to #AHA20 online!

What will training look like in the post-pandemic era?

May 26, 2020May 26, 2020 Adham Karim, MD

I remember my first week of internship very clearly – I was a part of my first code blue as a physician. Later that week, I had to have a goals of care discussion with a patient who had been in the hospital for 3 weeks (longer than I had been a doctor at that point). These were new experiences that I was eager for, but I was fortunate to have my routine that maintained a sense of normalcy for me, very much like naptime to my toddler. I was diligent in pre-rounding and seeing all my patients before my attending showed up, and would have formed a plan for their care before 8 AM.

Once the COVID-19 pandemic was in full swing here in the US, a lot of these things that were part of my routine as an intern suddenly went to the wayside. At my institution, interns were instructed not to pre-round on patients such as to minimize contact and potential infection transmission. Family meetings could only be conducted via telephone, or in some cases, video conference. Code blues were no longer a mad dash to the patient’s room, but rather, different hospital wards had different teams, such that a provider taking care of COVID+ patients does not go to a code blue for non-COVID patients and vice versa.

Rounding on these revamped inpatient teams has been…interesting to say the least. I can’t tell you the amount of times I or an attending will ask the patient a question about the patient and the response is “I don’t know, I haven’t seen them.” It’s great that interns are more comfortable admitting they don’t know something rather than lie about it, but at the same time, I can’t help but feel a sense of lack of ownership on their behalf.

Everybody will tell you that intern year sucks, and it’s rough, and they would hate to go back and do it again. But many people will also admit that they are impressed with how much they have learned and managed to push themselves beyond their perceived level of comfort during that time frame. I didn’t particularly enjoy coming to the hospital early each day I was on an inpatient service just to see my patients and review their charts, or going to the patient’s room for the umpteenth time in a day, but there have been a number of times where something meaningful was gleaned, and my ability to think critically and manage patients independently grew a little that day.

The thing that bothers me the most about these precautions is the huge change to goals of care discussions and family meetings. The logic behind it – minimizing spread of infection and exposures – makes sense and I agree with it completely. But it’s hard to develop good rapport with an individual only over the phone, and similarly, it’s difficult to comfort another human being digitally. There’s something about the physical presence of another person, the eye contact, and even the slightest gestures, that can help make the worst day of someone’s life a little less painful.

It’s quite fortunate that these protocol changes came more than halfway through the academic year, when interns at least have a handle on what things to look out for and have developed their own sense of alarm from glancing at the chart. I can’t imagine starting intern year where I only physically interact with “my” patients during rounds with my attending, or via telephone, unless there is some kind of emergency.

On the other hand, this is accelerating our embrace of telemedicine on the outpatient side, which is good for both patients and providers in many cases, and from my anecdotal experience, has resulted in a lot fewer “no-shows.” Interns are afforded more sleep, and arguably learning to pay more attention to vital signs changes and lab value changes – or at least they’re getting a better sense of when they should actually get up and go see the patient (sometimes at the urging of their senior 😊). This could simply be an inevitable step in the evolution of medical education that was accelerated by the pandemic, but I can’t say I feel that all these changes should be here to stay.

Whether it was fumbling through morning rounds and trying to formulate a new plan based on overnight events, or developing my emotional intelligence and flexing that empathy muscle, these were formative experiences for me during my intern year that have significantly contributed to my development as a clinician. These could just be the ramblings of a dinosaur, much akin to the older physicians talking about their paper charts, fibrinolytics and 48 hour calls, but I do hope some of these changes can be undone soon, for the sake of our trainees as well as our patients and their families.