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COVID-19: Looking for a silver lining

It’s July 2020, and the COVID-19 pandemic shows no signs of ending. A friend recently asked me if I ‘d ever imagined such a scenario when I decided to do medicine. The answer is no. None of us, not even our mentors had trained for a pandemic of this magnitude. Still, while this is still far from a “when life gives you lemons make lemonade” scenario, looking for those elusive positives in this global catastrophe is just one way to remain optimistic in the face of such unprecedented adversity.

So unprecedented, in fact, that as our hospital committees initially met to formulate new standards of operation, I found that as fellows in training (FIT) and (very) early-career physicians, my colleagues and I had much to contribute in terms of protocols and guidelines, even in guidance documents of national societies. With the need for rapid update of data and protocols in an extremely volatile situation, a FIT and early career COVID response team was formulated, to submit recommendations on a variety of aspects ranging from infection control, requirements for personal protective equipment (PPE), zonal divisions of hospital, allocations of responsibility and treatment protocols of infected staff, based on international guidance. It was something I had never done before, and taught me the important aspects of healthcare administration, outside of clinical work, and a renewed appreciation for what those in management do (It’s not easy to keep everyone happy!)

These testing times were also an opportunity to lead with empathy, help cultivate an essence of team spirit, and collective resilience as a team. When we had an initial outbreak of cases among our healthcare workers in April, I learnt what real leadership is – the importance of being transparent, even in the face of chaos. I learnt what it means to be present and to lead with empathy, to “be there” for junior colleagues and nurses. In the sea of misinformation, I also learnt to speak up for what was right, with authorities, rectify misconceptions especially relating to evidence-based treatment and push for the changes that were needed. Even now, everybody is still apprehensive. In more ways than one, the pandemic offered an opportunity for a much-needed change of culture within work environments, and more open discourse between peers and colleagues, a positive change that we hope will last beyond these difficult times.

While we educate ourselves on everything that isn’t cardiology, most formal training especially in terms of procedures, is still on hold as we respond to the pandemic. Locally, we have somewhat adapted to a virtual learning platform for residents. However, practising in South Asia, exposure to cutting edge technology and insights from international leaders in the field has generally been limited to the ability to be able to travel for in-person meetings overseas. Despite the chaos, the learning must not stop — while restrictions to international travel may have blocked the networking opportunities of in-person meetings, in a strange paradox, the online interactions might just have brought the world closer.

Just this week, I attended webinars from 2 different continents, without having to apply for any educational leave. Moreover, most of these virtual meetings and webinars are free of cost, and especially for fellows, the opportunity to participate and interact with world-class faculty. (Disclaimer: They are by no means a substitute for the real deal, but I’m trying hard to count the positives here!).

Like so many others I know, 2020 was supposed to be “my year” too. But tough luck. It’s not easy having to endure the stress of colleagues and family falling sick, and having to battle on, knowing fully well that it might very well be you, next. It’s important to embrace the situation and cultivate positive vibes, engage in self-care and your own wellness, however limited the options may be. By not being able to travel to see family, or even out of town for a break, it has been overwhelming to say the very least, but I can safely say that I’ve probably helped more people in the last few months, than I have on all my years as a doctor. That would probably be the biggest silver lining of them all—the opportunity to serve so many people. But in uncertain times like these, we’re all apprehensive. We don’t know when this will end. It’s a marathon, not a sprint, and we need to find the silver lining in this new normal, for the sake of our own sanity. At the same time, it’s also imperative that we consolidate the positive effects of the pandemic, the growth it has led to, and incorporate them into our practice as physicians and people.

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

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Highlighting Karen A. Griffin, MD, FAHA, FASN, FACP – Fellow of the American Heart Association (FAHA)

The Fellow of the American Heart Association (FAHA) is open to researchers and medical professionals with an interest in cardiovascular disease and stroke. To be eligible for this fellowship, one must have up-to-date membership of either Premium Professional or Premium Professional Plus of one of the AHA councils for at least two years and must be affiliated with the Council in which the application will be submitted. FAHA is not only a reflection of stature, but also a record of valuable service to the AHA and the council.

Karen A. Griffin, MD, FAHA, FASN, FACPDr. Karen Griffin, who presented a seminar in April 2019 at the University of Tennessee Health Science Center (UTHSC) Department of Physiology, has carried the FAHA designation for several years, but now serves as Chair of the Council on Hypertension. The Council’s mission is to “Foster excellence in hypertension research and education and to be a relentless force for a world of longer, healthier, lives.” Dr. Griffin was a Fellow of the American Society of Hypertension (ASH) for many years until recently when ASH became a part of the Council of Hypertension, which was an exciting venture for both Dr. Griffin and the Council. In 2016 she was nominated by Dr. Chris Wilcox, Chief of the Division of Nephrology and Hypertension at Georgetown University, and elected by the Council members as Chair-elect.  In that role she served as Chair of the program committee for the Council during which time a fourth concurrent session was added to the Hypertension Scientific Sessions that nicely dove tails additional clinical programming from ASH within the Council meeting.  This session, known as Concurrent D, consisting of Clinical Practice/Clinical Science and Primary Care tracks, was purposed to enhance translational advances from research to clinical practice as a means of improving patient care.

Dr. Griffin received her medical degree from Rush Medical College in Chicago, and subsequently completed her internal medicine residency and clinical/research fellowship in nephrology at Rush. She began her 28-year career at Loyola University Medical Center and the Edward Hines, Jr. VA.  and is currently a Professor of Medicine (Nephrology) at the Stritch School of Medicine, Loyola University and Renal Section Chief at the Edward Hines, Jr. V.A.  As a clinician, she is primarily focused on hypertension in kidney disease and has been Director of Loyola’s AHA Designated Comprehensive Hypertension Program.  Her research focus has been on the role of hypertension on the progression of chronic kidney disease and the impact of altered hemodynamics in the development and progression of diabetic and obesity-related nephropathies. She has received research funding from the NIH and Merit Review and published more than 80 articles, invited reviews and book chapters. Dr. Griffin has served as chair of the Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development Services of the Scientific Merit Review Board in addition to chairing the VA Merit Review Renal Study Section and National Kidney Foundation of Illinois, Research committee. Additionally, she has served as a reviewer for several NIH study sections. She has also served as chair of the Professional and Public Education committee for the American Heart Hypertension Council and was a member of the American Society of Nephrology Hypertension Advisory Group.  Dr. Griffin is recipient of the American Medical Women’s Association Awards for Leadership and Academic Excellence, the Student’s Choice Award from the Department of Physiology at the Medical College of Wisconsin, and the Arthur C. Corcoran Memorial Lecturer of the Council on Hypertension.

Yet, despite her numerous accomplishments as a physician scientist, she holds fast to her belief in compartmentalization as a strategy for a balanced life.  As a physician scientist the demands on one’s time are challenging and necessitates often working extended hours but she has learned the art of multi-tasking and makes an effort to get off the grid to prevent burnout and have time for family and friends. Dr. Griffin encourages early career professionals to create a life outside of work, which translates to increased productivity when returning to work.  Dr. Griffin, for instance, enjoys bicycling, pilates, gardening, fishing, and horse racing. Do you have any similarities?

Dr. Griffin also urges early career professionals to set short term achievable goals for the week and to tackle each day with vigor and passion, completing each defined task and moving goals closer to completion. In addition, you should network and become part of FAHA, along with the Fellows In Training (FIT) program, in order to open doors and participate in AHA leadership. These steps will lead to career advancement as well as being a mark of achievement. Finally, she says to not get discouraged as we all face those hurdles along the way and the difference between those that succeed and those that don’t is an unwavering persistence, be it with grant submissions, publications, promotions, etc.

Likewise, as Chair (and Member-At-Large) of the Council on Hypertension, Dr. Griffin encourages membership in the Council because “it is all inclusive of basic and clinical research making it a hub for all specialties related to the field of hypertension research in addition to realizing the translation of such research to the evaluation and management of patient care.  The annual Council meeting is of a size that allows excellent opportunities to network and enjoy the fellowship of scientists and clinicians that form the hypertension community at-large in addition to seeing good friends acquired over the years of Council membership.” She encourages you to submit your abstracts for Hypertension Scientific Sessions 2019, held in New Orleans, Louisiana, from September 5-8, 2019 and hopes to see you there!

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Bigger Isn’t Always Better: My 3 Tips on Maximizing the Small Conference Experience

In my March blog, I wrote about a few of my tips to get involved in our cardiovascular professional societies. I received a lot of great questions and feedback from trainees across the spectrum of cardiovascular disease through Twitter, LinkedIn, and email, so I thought I would share some similar content this month.

As busy cardiology fellows in training (FIT), finding the free time to attend more than one professional conference in an academic year is tough. Trying to choose among the various local, regional, national, and international opportunities can be difficult, not to mention the financial and time commitments required to attend multiple meetings in a year. As I have become a more senior cardiology FIT, I have come to appreciate the value of attending smaller, disease or topic-specific conferences. Here are 3 of my tips to make the most of these opportunities.

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1) Search the CME offerings of academic institutions around you: Most large academic medical centers host continuing medical education (CME) programs focused on specific topics or diseases throughout the year. They are often held on weekends but are usually less time-intensive than the national professional society meetings. Despite their smaller sizes, the organizers will still invite preeminent clinicians and scholars in the relevant fields, which make these meetings terrific opportunities for FITs to access thought leaders and craft collaborations. I recently attended a weekend-long CME course focused on hypertrophic cardiomyopathy at an academic institution in a neighboring state. At the conference, I reconnected with a long-distance mentor who was invited to give a lecture, met a junior faculty member and brainstormed cross-institutional collaborations, and learned about HCM from internationally renowned clinicians and scientists. In addition, taking a deep dive into a topic of your interest can be a welcome respite from the hectic cognitive shifting we are forced to do at larger conferences.

MindTheGraph.com

2) Find a way to participate: While smaller conferences usually do not have much room for flexibility in the programming, the organizers may allow FITs to present cases to accompany the didactics. Offer to present a case that ties into the talk of a speaker whom you are most interested in meeting. By doing so, you can “break the ice” with your case presentation and worry less about initiating interaction with the speaker. You may also have the course registration fee, if there is one for FITs, waived through participating. Along the way, stay responsive over email and telephone and obey the organizer’s deadlines for submission of your materials. If you notice that the conference does not have an avenue for FIT involvement, offer to contribute by presenting a case or submitting a poster. Last year, I advised one of my mentees to contact the organizers of a sports cardiology course she was interested in attending. Even though there were no publicized opportunities for FIT engagement, she let the organizers know about her interest in attending and enthusiasm to contribute. The organizers invited her to the course and extended discounted registration. This year, she is on the course planning committee and is spearheading the FIT case and poster presentation sessions!

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3) Follow up after the course: Send an email to the course directors and your new contacts after the course. Let them know how much you enjoyed the experience and that you would be delighted to participate in the same or a similar conference again. Close the loop with new contacts and propose next steps to move those potential collaborations forward. Connect with each other through social media, as well.

 

What are your tips for maximizing the small conference experience? I would love to hear them over the next month – share them with other #AHAFIT and me on Twitter and LinkedIn!

 

 

 

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My Three Tips for “Getting Involved”

While we are still incorporating the knowledge from AHA Scientific Sessions 2018’s late breaking trials like REDUCE-IT and TRED-HF into our daily practices, the AHA has already started planning for Scientific Sessions 2019 being held in my current home of Philadelphia, Pennsylvania. My co-AHA Early Career Blogger, Jeff Hsu, M.D., Ph.D., and I are excited to serve as Co-Vice Chairs for the AHA’s Fellow in Training (FIT) Programming Committee, and we are hard at work incorporating feedback from AHA18 into our vision for AHA19. For a recap of the AHA18 FIT/Early Career Lounge experience, check out my November blog here and FIT Insight blogger Anum Saeed, M.D.’s January blog here.

Becoming involved in my professional societies as a trainee has been hugely rewarding for me, but admittedly, making those first breakthroughs was not easy and took a few years to accomplish. In this blog, I will share 3 of my tips that can help you seize these opportunities.

1) Seek out a well-connected sponsor: Our professional societies are very eager to involve more FITs and Early Career members in a majority of their initiatives. Often, they advertise and require an application for trainee-specific opportunities like blogging, editorial, and leadership council positions. But, there are a host of positions that are not filled via an application-based process and are frequently offered to trainees through a personal connection within the society. If you have applied to formal engagement opportunities and your application has not been selected, instead of being discouraged, seek out a well-connected sponsor within the society with whom to share your motivation. Faculty usually know of other available opportunities for trainee involvement within their own councils or committees and can connect you with other members volunteering in clinical and research areas of your interest.

 

2) Offer concrete ideas when you make contact: When you connect with a society member whether in person, via telephone, or via email, instead of just saying that you would like to “be involved,” offer a few concrete ideas for the society and its mission. By doing this, you can demonstrate your enthusiasm and establish your dedication to the potential role. Your new sponsor will be more likely to engage with you and find an opportunity for you that is aligned with your interests and skills.

 

3) Form relationships with trainee colleagues who are already involved: When societies have formal councils or committees comprised of trainees, they often rely on them to disseminate news and opportunities nationally and internationally. While tip #1 can definitely help to launch your involvement, following the same practice with your FIT and Early Career colleagues can sometimes be more impactful. Trainees’ professional networks are usually smaller than those of the faculty in society leadership positions, so when we are asked to submit names of colleagues for opportunities, our selection pools are more limited. In the AHA18 FIT/Early Career Lounge, I met multiple medical students, residents, and fellows who expressed interest in the AHA FIT program and shared their feedback with me after Sessions. In turn, when I was offered the chance to nominate FITs and Early Career members for other roles, these new colleagues were at the top of my list.

 

If you are a FIT or Early Career member, watch out for emails about AHA Scientific Sessions 2019 programming in the coming months. If you have a great idea about what you would like to see at AHA19, reach out to Jeff (@JeffHsuMD) and me (@noshreza) on Twitter!

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Representation Matters: How Can We Improve Equity and Diversity in Our Professional Lives?

This past August, the phrase “Representation Matters” commonly graced entertainment and popular culture headlines. Why? In what was ultimately called “Asian August,” several major movies starring Asian-American actors were appearing in theaters, led by the first American film to feature an all-Asian cast in 25 years – “Crazy Rich Asians.” This fervor was inspired by over two decades of under-representation of Asian-American culture in the entertainment industry.

As I am an Asian-American, this particular movement did indeed resonate with me in my personal life. However, I regrettably was not mindful about it in my professional life. Throughout my training, I felt that I had worked with, learned from, and/or befriended men and women of a wide variety of colors, beliefs, and socio-economic backgrounds. Perhaps it was because I was fortunate to train in programs that were diverse, but I don’t necessarily recall reflecting on the diversity nor the benefits of diversity.

In early December 2018, Dr. Hannah Valantine visited our campus at UCLA to deliver our Medicine Grand Rounds lecture, and she was kind enough to meet with many of our faculty and trainees. A renowned physician-scientist and advanced heart failure/transplant specialist, Dr. Valantine is the NIH’s first Chief Officer for Scientific Workforce Diversity. She led an outstanding, eloquent, and (of course) evidence-based discussion on the importance of improving the diversity in academic medicine. She highlighted the emphasis that the NIH is placing on this mission, and the resources her office has developed to not only educate professionals on the issues at hand, but also a toolkit they have created to help promote diversity at our institutions, including how to create a diverse talent pool and perform unbiased talent searches.

Dr. Valantine presented data showing that while there has been improvement in diversity of trainees early in their training, there remains a significant “transition barrier” for diversity upon entering the junior faculty stage of an academic career (between “Postdoc” and “Independence” in the slide below).

 

Further, she also mentioned data supporting the improved performance of more diverse groups. In an article from Nature this past year, the subjective and objective benefits of diversity were featured. Interestingly, in an analysis of over 9 million scientific articles, one group found that research “papers written by ethnically diverse groups were cited 11.2% more than were papers written by non-diverse groups.”

With clear reasons for why we should work to focus on a culture of equity and diversity in our scientific workforce, I realized that I will soon be at a stage where I will be choosing the members of my research team. In the spirit of the New Year and with the help of tools provided Dr. Valantine, I have made the following “resolutions” to myself to help prepare myself as I embark on organizing a research team in the future:

  • Discover and explore my implicit biases: There are online resources/tutorials on implicit bias, including an excellent one from my home institution, UCLA, as well as tests you can take to discover your own implicit biases. Regrettably, after my first test, I already learned that my results suggested, stereotypically, “a moderate association for ‘Male’ with ‘Career’ and ‘Female’ with ‘Family.’”
  • Be mindful of the benefits of diversity when present: Whether in a research group or the team I am rounding with in the hospital, I plan to acknowledge these benefits when present, whether aloud or to myself.
  • Follow the NIH Scientific Workforce Diversity blog: It is an excellent reminder of reasons and ways to create an effective & diverse scientific team.

 

In one of her excellent blog posts from last year, Dr. Valantine wrote:

“Our nation is presented with the unique opportunity of connecting an increasingly diverse talent pool of scientists with the full range of biomedicine careers encompassing basic discovery to health applications, a critical part of the NIH mission to advance human health.”

 

I am grateful that the NIH has placed high priority on this mission, because indeed, Representation Matters, and in the field of academic medicine, representation can lead to better science and better treatments for our patients.

 

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Beyond Embargoes: A Vision for Future Scientific Sessions

At my first two AHA Scientific Sessions, I sat in the Main Event Hall, shoulder-to-shoulder with my co-fellows, eagerly awaiting the results of the Late Breaking Clinical Trials and guideline updates. I remember whispers cascading across the room after the presentation of NEAT-HFpEF in 2015 and the hundreds of cellphones in the air snapping pictures of the hypertension guideline release in 2017. This year as an AHA Early Career Blogger, I learned the results of the Late Breaking Clinical Trials with other news writers at embargoed media briefings. These intimate press conferences are routinely offered to health care journalists at major medical meetings and by top medical journals. Members of the media receive early access to manuscripts and data and discuss trial findings with investigators and outside experts with the understanding that nothing should be published until after trial results are publicly released. Generally, media pieces are published very soon after the embargo is lifted. At my first embargoed briefing, I heard one reporter’s question that has spurred me to imagine a new, more inclusive future for scientific meetings.

On Sunday of Sessions, I joined other health care reporters for the VITAL and REDUCE-IT presentations. In VITAL, 1 gram/day of omega-3 fatty acid supplementation (containing 460 mg of eicosapentaenoic acid [EPA] and 380 mg of docosahexaenoic acid [DHA]) was not effective for primary prevention of cardiovascular events in healthy middle-aged adults. In REDUCE-IT, icosapent ethyl (a purified EPA) at a dose of 2 grams twice daily reduced cardiovascular events among patients at risk for or with known cardiovascular disease and with high triglycerides already on statin therapy with good LDL-C control. After both trials were presented, one news writer probed the primary investigators’ thoughts on communicating these results to patients. The reporter wondered if the trials could be interpreted as sending mixed messages about the cardiovascular benefits of omega-3 fatty acids to the general public. Both trials’ primary investigators acknowledged this concern and systematically reviewed the differences in drug composition, patient populations, and study goals that, in their estimation, led to the outcomes. Multiple panelists implored the journalists to integrate these differences into their stories with hopes that consumers and potential patients would be able to understand the distinctions on their own.

After the briefing, I walked to the Main Event Hall to re-experience the Late Breaking Clinical Trials and thought about how we translate these breakthroughs, frequently announced at scientific meetings, to the public and our patients. Recent data suggest that the use of social media at cardiovascular conferences, a key approach to broadcasting late-breaking scientific developments, is rapidly growing. At these meetings, physicians comprise the largest group of Tweeters and compose nearly half of all tweets.1 Identifying the full scope of our social media audience, though, is more elusive. Ensuring veracity in scientific communication has become progressively challenging as the attitudes and tools to perpetuate misinformation have spread. We know that across multiple information domains, false news spreads faster, farther, and deeper than the truth.2 Just this week, Dictionary.com chose “misinformation” as the 2018 word of the year.3 Clinicians and scientists are now especially vulnerable to this insidious erosion of public trust.

How do we combat the propagation of falsehood while encouraging this new democratization of science? I have thought about how the importance of trust was so admirably exemplified in a recent study of blood pressure reduction in black barbershops.4 What if we could leverage our meetings to spread science to where our patients are and with trusted people delivering the message? The AHA has recognized this opportunity and does have programs in place, like “Students at Sessions”, to share Scientific Sessions with non-medical communities.5 Can we imagine a future state of Scientific Sessions where internationally recognized clinicians and scientists deliver a talk at a barbershop or civic center in the host city, where community leaders are invited to participate in panels and plenaries, where large scale cardiovascular risk screenings happen just outside our conference center doors?

The 2019 Scientific Sessions will be held in my current home base of Philadelphia, Pennsylvania. I am looking forward to learning the results of the next round of Late Breaking Clinical Trials and guideline updates in the Main Event Hall, but next year, I hope to sit shoulder-to-shoulder not only with my cardiology colleagues, but with my fellow citizens, community leaders, and patients.

 

References:

  1. Tanoue MT, Chatterjee D, Nguyen HL, et al. Tweeting the Meeting: Rapid Growth in the Use of Social Media at Major Cardiovascular Scientific Sessions From 2014-2016. Circ Cardiovasc Qual Outcomes. 2018;11:e005018.
  2. Vosoughi S, Roy D, Aral S. The spread of true and false news online. Science. 2018;359:1146–1151. doi: 10.1126/science.aap9559.
  3. Italie, Leanne. “Dictionary.com Chooses ‘Misinformation’ as Word of the Year.” Associated Press, 26 Nov. 2018, https://www.apnews.com/e4b3b7b395644d019d1a0a0ed5868b10.
  4. Victor RG, Lynch K, Li N, et al. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med. 2018;378(14):1291-1301.
  5. “High schoolers enjoy peek into world of cardiovascular science.” American Heart Association News. 21 Nov. 2017. https://newsarchive.heart.org/high-schoolers-enjoy-peek-into-world-of-cardiovascular-science/.

 

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Why Attend #AHA19?

After returning home from the #AHA18 Scientific Sessions a few weeks ago, I was eager to tell my colleagues back in Los Angeles about my experience.

“What did you like about it?” they would ask. While my replies would consistently begin with, “Well, despite the freezing cold…” I found my answers that followed were widely varied. The innovative science, the networking with potential collaborators, the audible excitement over Late Breaking Clinical Trial results, the discussions about whether the trials would be practice-altering, the reunions with old friends from earlier in my training. There were countless things to choose from.

Curious to whether other trainees shared the enthusiasm I had for #AHA18, I asked some who attended to describe their favorite part of the meeting. Here were their responses:

David Paik, PhD (@dtpaikPhD), post-doctoral fellow at Stanford University:

“This year’s meeting in the new 3-day format was highly organized, with superb talks from all breadths of clinical & basic cardiovascular research. The focus on early career & mentorship was excellent, and I hope it continues in the next years’ meetings!”

Aly Sanchez, MD (@AlySanchezMD), Internal Medicine resident at the University of Miami:

“There were many new things introduced at AHA this year & a huge focus on prevention as well as women’s health. I loved seeing the force behind the women in cardiology movement. It’s great having inspirational females leading as well as the supportive men making this happen. The AHA could not have sent a better message & we should continue to remind ourselves to be a relentless force for a world of longer, healthier lives.”

Kevin Shah, MD (@KevinShahMD), Advanced HF & Transplant Cardiology fellow at Cedars-Sinai Medical Center:

The networking! The Scientific Sessions and especially the AHA FIT and Early Career programming provided a tremendous opportunity to connect with old friends, meet new colleagues, and gain valuable career advice from faculty as we continue to grow professionally.”

Their sentiments and mine may have been palpable via Twitter feeds or news releases, and this year, the AHA offered a live-stream of Scientific Sessions for those unable to attend in person (see posts by Dr. Saurav Chatterjee and Dr. Dan Tyrell).

Yet nothing compares to attending Scientific Sessions in person. As elegantly summarized by Dr. Elizabeth Knight in her recent post, there are serendipitous collaborations that can arise from wandering around the meeting, as well as new research ideas that can emerge from a “cross-pollination among disciplines.”

In trying to encapsulate my own reaction to the meeting, however, I realized that the most important benefit of attending #AHA18 in person came down to one emotion: Leaving inspired. Inspired by meeting your heroes in cardiology, by meeting peers who are doing outstanding research, and by learning about new topics that can influence your own research ideas.

Moreover, it is one thing to read about the results of a late-breaking clinical trial from home. It is another experience entirely to be immersed in a crowd of colleagues who are hearing practice-altering results together for the first time. The first results slide of the REDUCE-IT trial presented at #AHA18 actually elicited applause:

 

Overall, I like to compare it with how you interact with your favorite band or musical artist. You can listen to their album from the comfort of your own headphones. Or you can go to their concert and see them perform your favorite songs live while surrounded by other passionate fans, augmenting the impact of the music. Some prefer the former, but I always choose the latter when I can.

Save the date for #AHA19 – November 16-18, 2019 in Philadelphia. Come and be inspired. See you next year!

 

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FIT Programming at Scientific Sessions 2018

One of the most exciting additions to this year’s Scientific Sessions is the weekend of programming targeted toward fellows-in-training (FIT) and early career members in the American Heart Association Early Career/FIT Lounge. The AHA FIT program was developed in 2016 and was established engage young healthcare professionals through meaningful educational opportunities that facilitate career growth and development. From 2016-2018, nearly 1,000 fellows from ACGME-accredited Cardiovascular, Vascular Neurology, or Pediatric Cardiology fellowships enrolled in the program and enjoyed perks like complimentary AHA membership and free access to the AHA family of journals. Earlier this year, the national AHA FIT Steering Committee reconvened with the goal to create a new and dedicated Scientific Sessions experience for FIT and early career members to network, relax, and learn.

In June, the AHA FIT Steering Committee, chaired by Dr. Ileana Piña, commissioned a FIT Planning Subgroup to create Sessions 2018 programming. Ten AHA FIT members from across the country answered the call for nominations and joined Dr. Jared Magnani on monthly conference calls to make the programming a reality. In the spring, FITs completed short surveys regarding their experiences at Sessions 2017 and shared their thoughts about their overall experience, how many FIT sessions they attended, and suggested topics for future programming. Our Planning Subgroup reviewed those surveys to inform the design of our focused and high-yield events. By October, we had come to consensus regarding the format and topics for our events, and we spent the month leading up to Sessions extending invitations to faculty and FIT panelists. Initially, we were unsure of how our programming and direct outreach would be perceived, but we were humbled by how supportive and enthusiastic our clinicians, scientists, and mentors were about our efforts. In the final two weeks, we led a social media campaign to advertise the event schedule and engaged medical students, residents, and FITs from across the country to join.

The first day of programming exceeded our expectations with almost all sessions being standing room only! Saturday kicked off with an introduction to the FIT program by our AHA liaisons. We then held back-to-back content session with leaders from sports and pediatric cardiology. Drs. Ben Levine, Rachel Lampert, and Eugene Chung shared their pathways to specializing in the care of the athletic patient and offered their thoughts on how FITs can pursue their interests in this field. Dr. Antonio Cabrera led a similar panel discussion with prominent pediatric cardiologists. We were then joined by Dr. Ivor Benjamin who spoke about his successful research career and imparted upon us the importance of finding mentors early in our careers. The most popular session of the day was our panel discussion for residents and medical students interested in pursuing cardiology fellowship. Drs. Eric Yang, Friederike Keating, Frederick Ruberg, and Vincent Sorrell led a lively conversation about the do’s and don’ts of the application and interview process and offered their viewpoints on what makes a stellar applicant. We finished the afternoon with an intimate breakout session with leading women in cardiology. Drs. Martha Gulati, Michelle Albert, Sharonne Hayes, and Erin Michos shared stories about the challenges they have experienced throughout their careers and offered inspiration for young trainees in STEM careers.

Looking ahead to post-Sessions, the program will continue to expand our AHA FIT membership and create innovative opportunities for FIT engagement within the AHA. Keep an eye out for our new FIT Insights Blog and AHA Early Career Blogs, opportunities to learn peer review through our Trainee Reviewer program, and more!

 

To keep up with all of the events in the Early Career/FIT Lounge, follow the hashtags #AHAFIT and #AHAEarlyCareerBlogger.

 

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Sports Cardiology: Experts’ Advice for Trainees

As the AHA’s largest meeting of the year kicked off today in Chicago, the AHA Early Career / FIT Lounge, with its prime position at the main entrance to the exhibition hall, was the venue for the first ever Sports Cardiology session dedicated to early career trainees at Scientific Sessions. With the bustling crowd of Sessions attendees lining up alongside the FIT Lounge as they awaited registration check-in, many peered in to the first Early Career / FIT session of this year’s conference, in which an expert panel of Sports Cardiologists shared their insights on this emerging field within cardiology.

This session’s faculty panel consisted of:

  • Ben Levine – Professor of Cardiology and Exercise Sciences at UT Southwestern in Dallas, Texas
  • Rachel Lampert – Professor of Cardiology and Electrophysiologist at Yale University in New Haven, Connecticut
  • Eugene Chung – Associate Professor of Cardiovascular Medicine and Director of the Michigan Medicine Sports Cardiology Clinic in Ann Arbor, Michigan

Sports Cardiology Early Career / FIT Session at #AHA18 Scientific Sessions

Along with Dr. Beth Hill (@BethHillDO, Cardiology Fellow at Scripps Clinic), I was fortunate to moderate the discussion from this distinguished group. They shared their stories about their varied paths towards Sports Cardiology, which included influential encounters with athletic patients, personal experience as a high-performing athlete, and sheer passion for sports and exercise physiology.

As Sports Cardiology is a relatively nascent sub-specialty, there currently is no distinct path for interested trainees to follow. At this time, only one formal training program in Sports Cardiology exists – the well-established Cardiovascular Performance Program at Massachusetts General Hospital, directed by Dr. Aaron Baggish. However, with the recent publication of a Sports Cardiology Core Curriculum by the ACC Sports and Exercise Cardiology Council (Baggish et al., JACC 2017) and rising interest in the field among trainees (Afari, JACC 2017), the field appears primed for growth.

The panel offered many salient pieces of advice for trainees interested in pursuing a career in Sports Cardiology, which I have done my best to distill into the following points:

  • Choose What You Love: Fellows seeking to become Sports Cardiologists often ask which sub-specialty they should choose (i.e., EP, Imaging, Heart Failure) to best position themselves to enter this field. The panelists agreed that the answer is to choose the area that best suits one’s own interests. More importantly, they advised to not forget that Sports Cardiologists are, by definition, Cardiologists, and to not lose sight of the importance of a thorough grasp of General Cardiology when practicing as a Sports Cardiologist.
  • Seek Specialized Training in Exercise Physiology: “What distinguishes a Sports Cardiologist from a General Cardiologist?” Dr. Levine made the argument that Sports Cardiologists offer the extra expertise in exercise physiology and understand the physical demands imposed on the cardiovascular system by elite athletes. Assessment of athlete physiology must go “beyond the Bruce protocol.” Indeed, the 2015 AHA/ACC Guidelines specifically state that “the exercise testing protocol [of athletes] should be based on maximal performance rather than achieving 80% to 100% of the target heart rate to come as close as possible to the level of exertion achieved during competitive sport” (Zipes et al, Circulation 2015). Every effort should thus be made to recapitulate this degree and mode of exertion. Further, the elite athlete’s response to various maneuvers, such as tilt table testing, may be different, and a deep understanding of these nuances are incredibly important in this unique population.
  • Educate and Network: While there has been increasing awareness of the specialized cardiovascular care needs of the athletic population, it remains important for budding Sports Cardiologists to educate those providers in their network who tend to be the first contacts with athletes. This group includes primary care and sports medicine physicians, sports trainers, and student health centers, as these providers are often the first ones to hear about potentially concerning cardiac symptoms in athletes. Along these lines, athletes themselves can benefit from education on their own cardiovascular health, as they are not immune from disease regardless of their level of fitness. Trainees are encouraged to consider giving educational talks to athletes in the community (e.g., cycling and running clubs) and volunteer at athletic events to help disseminate these important issues.

While the session was filled with many more helpful tips for interested trainees, the panel’s ultimate recommendation was to make every effort to attend the ACC’s Care of the Athletic Heart meeting next year, which will take place in June 2019 in Washington, D.C. As a participant in last year’s Athletic Heart meeting, I strongly agree.

Overall, the panelists engaged the audience in an excellent discussion, and this topic served as an excellent segue for the eagerly awaited release of the AHA’s physical activity guidelines, which will be announced this Monday, November 12th at Scientific Sessions.

(Left to Right) Faculty Panelists: Eugene Chung, Rachel Lampert, and Ben Levine;
Session Moderators: Beth Hill, Jeff Hsu

 

For more information on the rest of my experience at #AHA18, please follow my Twitter feed (@JeffHsuMD) as well as the hashtag #AHAEarlyCareerBlogger.