Leading the Rounds

Dr. Lindsey A. Criswell, is the director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Prior to joining NIAMS, Dr. Criswell was vice chancellor of research at the University of California, San Francisco. She has a bachelor’s degree in genetics and a master’s degree in public health from the University of California, Berkeley, and an M.D. from UCSF. As the NIAMS director, Dr. Criswell oversees the Institute’s annual budget of nearly $625 million, which supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases. Between 1994 and the time she became NIAMS director, Criswell was a principal investigator on multiple NIH grants and published more than 250 peer-reviewed journal papers. In this episode, we discuss her journey as a leader in medicine and science. Welcome to Leading the Rounds. Questions We Asked: When did you start to see yourself as a leader? What experiences helped you build your leadership style? When you stepped into your current role, did you feel ready? What are the greatest challenges you face in your current leadership? When do you know when a good opportunity comes along to pursue? Were there things in your training that weren’t addressed?How do you avoid being “scooped” in medical research? How does one decide what leadership route to choose? How has failure impacted you as a physician, scientist and leader? Quotes and Ideas: My leadership style reflects my own personality “It really does take a team effort to be successful in science and medicine” “There’s no one way to be an effective leader” You can learn a lot by observing people you respect in positions of leadership “I’m in a stage in my career where I really want to make an impact” “As an investigator, if you can’t communicate effectively at the appropriate level… you’re not going to be successful.” Most, if not all, of the impactful research done is a team effort “Just say no” 

Dan Dworkis, MD PhD FACEP is the Chief Medical Officer at the Mission Critical Team Institute, a board-certified emergency physician, and an assistant professor of emergency medicine at the Keck School of Medicine of USC where he works at LAC+USC. He performed his emergency medicine residency with Harvard Medical School at the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital / Brigham Health, and holds an MD and PhD in molecular medicine from the Boston University School of Medicine. Dr. Dworkis is the founder of The  Emergency Mind Podcast , and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure. Questions We Asked: Why did you feel the need to create The Emergency Mind? Is poise under pressure a learned skill or innate? What are valuable skills you have learned creating The Emergency Mind? How does someone successfully improve through a performance loop? What are ways to decrease stress while performing procedures? How does the Emergency Mind address team dynamics? How do you build a well functioning solid team?How do you run a successful debrief?  Advice for medical leaders under pressure? Book Suggestions? Quotes & Ideas: Applying knowledge under pressure is a separate learned skill What happens when you are trying to intubate a patient and miss the first time? How do you recover and make the second attempt? Prepare-> Perform-> Recover-> Evolve “Create an environment that sets you up for success” Experiment and be a scientist of yourself: Build->measure->learn Exposing yourself to stressful scenarios outside of the hospital can help you build skills to help clinically Use self-talk to help yourself manage acute stress When debriefing, learn to separate outcome from performance. You can sometimes have a poor outcome with perfect performance and also a good outcome with poor performance. Debriefs can use outcome vs. performance on a 2x2 matrix. Never Waste Suffering. Both ours as providers and the patients. Harness the wisdom in the room around you Practice when you are outside of pressure and then slowly introduce it to stressful situations Book Suggestions: Thinking Fast and Slow by Daniel Sources of Power by Gary Klein “A Failure to Disagree” paper by both Ghosts of the Fireground by Peter Leschak 

Intro: Dr. Thomas Varghese Jr. is the Associate Chief Medical Quality Officer and Chief Value Officer at the Huntsman Cancer Institute, and Chief of General Thoracic Surgery at the University of Utah. Dr. Varghese is a national leader in minimally invasive applications for general thoracic surgery, recognized by Castle Connolly as one of America’s “Top Docs”, and is ranked in the top 10% of the nation by Press Ganey for patient satisfaction scores. His research interests bridge the world of Educational Research and Health Services Research, specifically in the arena of optimizing performance at the patient, surgeon and system levels. He created the Strong for Surgery program, which is now a formal Quality Improvement program of the American College of Surgeons, and active at 331 clinical sites across the nation and 3 state surgical collaboratives.Dr. Varghese holds national leadership positions in the Society of Thoracic Surgeons, Thoracic Surgery Directors Association, American College of Surgeons, and the Society of University Surgeons. Dr. Varghese is active on social media and is the Deputy Editor of Digital Media and Digital Scholarship for the Annals of Thoracic Surgery.Questions We Asked: Where did your passion for leadership come from? Who were your mentors and what made that relationship special? Have you found your mentors formally or informally? How can you create a good formalized mentorship program? How do mentors effectively help their mentees find their career path? How do you create a good mentor/mentee relationship? How can those in the majority be allies to minority groups in medicine and science? How do you be comfortable saying “I don’t know”? Quotes & Ideas: “Never stop looking for best practices” You can and should have different mentors for the various areas of your life (academic, career, social, spiritual, etc.) “Mentorship is someone with a particular knowledge or skills that shares them with someone else who does not have it on their own.” “A mentor does not always have to be older than you.” Identify OKR (objectives and key results) and set a time deadline for it “An ally is someone who builds a culture of inclusion” and “A leader is someone who betters the culture of those they lead”. Leaders need to be allies. “Are we better today than we were yesterday, and are we going to be better tomorrow than we were today and how do we achieve that.” “Diversity doesn’t end because you hire the next diverse faculty. You have to make sure they thrive in their position.” “You don’t know, doesn’t necessarily mean you don’t act.” “MD means make decisions.” “We are living in the greatest time in history.” “Seek your tribe members” Books Suggestions: The 4 Disciplines of Execution by Sean Covey Peter Drucker Start With Why by Simon Sinek Adam Grant 

COL (Dr.) Cristin Mount is an Army Critical Care Medicine physician currently stationed at Madigan Army Medical Center in Tacoma, WA. She graduated magna cum laude from the University of Scranton and completed medical school at the Uniformed Services University in Bethesda, Maryland in 2003. She did an Internal Medicine Internship and Residency at Madigan and moved to Walter Reed Army Medical Center in Washington, D.C., for Critical Care Medicine fellowship. After fellowship, she returned to Madigan as the Director, Critical Care Services and promptly deployed with the 28th Combat Support Hospital to Baghdad, Iraq where she served as the sole Intensivist and the theater consultant for Critical Care and Internal Medicine. She is the only woman to serve as Chief, Department of Medicine and the Deputy Commander of Medical Services.  Currently she serves as the Critical Care Medicine Consultant to the Army Surgeon General.She is a Master of the American College of Physicians, and past Governor of the Army Chapter of the ACP. She is married to COL George Mount, an Army Rheumatologist, and they have three small boys under the age of 7.Any views expressed during this interview reflect those of Dr. Mount and do not represent official views of the Army Medical Department, Department of the Army or Defense Health Agency. We hope you enjoy this episode where we discuss her journey through medicine and leadership as well as leadership in the ICU. Welcome to Leading the Rounds. Questions We Asked: How did you become involved in medical leadership? How did you adjust to becoming a leader out of training? What are some things that help you lead in stressful situations? Can you discuss your article Ten Leadership Principles from the Military Applied to Critical Care and why you felt writing it was important? What is unique about leadership in the Intensive Care Unit? How do you develop a good care team? How do you balance being firm in a stressful leadership moment vs. being aggressive and condescending? How do you practice adaptive leadership? Advice for medical leaders? Books? Quotes & Ideas: When taking a new leadership position, “recognize that you’re going to feel overwhelmed, and then sit back, learn, and ask questions.” In moments of panic, “put your helmet on, put your kevlar on, and march in a straight line.” You can study leadership, but you also need to practice. Look for everyday small moments where you can practice your leadership skills so they are ready when you need them. “Every day there's an opportunity to practice a leadership technique in your personal or work life.” Ten Leadership Principles from the Military Applied to Critical CareLeadership in the ICU: contrasts between problem solving without assessment of why things are happening vs. paralysis by analysis To be a great leader in the ICU, you have to be able to make decisions without having all of the information. “The success of the team means the success of the patient.” In addition to placing yourself in stressful situations, you can rehearse in your mind what you would do if you would have been placed into that environment. “As you are in a position to set boundaries to which work is not allowed, you have to set them.” Book Suggestions: Complications by Atul Gawande We Were Soldiers Once and Young by Lt. Gen. Harold G. Moore and Joseph L. GallowayThe Liberation Trilogy by Rick Atkinson 

Intro: In this episode we interview Dr. Karla Williams and Dr. KeAndrea Titer. They are assistant professors of Internal Medicine at The University of Alabama at Birmingham. They are passionate about diversity, equity, and inclusion and both work to design initiatives and curriculum focused on recruitment, education, and building community. This includes the AIRR initiative, which we discuss in the episode. In this episode, we discuss creating a welcoming culture in medicine and working to drive cultural change through seeking to understand others. Welcome to Leading the Rounds. Questions We Asked: What inspired you to develop the Clear the AIRR initiative? What’s the difference between a macro and microaggression? How should physicians deal with microaggressions? What does your program look like practically? How can leaders manage microaggressions?How do you create a culture of occupational wellness? What advice do you have for medical leaders? Book suggestions? Quotes & Ideas: Microaggression initiative (AIRR): Assessing, Identifying, Responding and Reporting As a leader, it is important to develop a culture where problems can be discussed openly and solutions can be made. As a trainee, it is important to seek out mentors who will feed into your career aspirations. Diversity and Inclusion programs should highlight mentorship, sponsorship and support “You have not been selected to this program because someone felt sorry for you. You have worked incredibly hard for this.”Occupational Wellness: Being in a career that you enjoy, providing value to those you are serving, and having a space to balance your own self care “You should work to see the best in everyone, but never be afraid to challenge them as well.” -Dr. Williams Enter to Learn, Depart to Serve Don’t be afraid to go against the grain and change the culture of medicine. Books: Dr. Williams & Titer suggested reading The Bible as a way to learn leadership 7 Habits of Highly Effective People by Steven Covey 

Today we have the privilege of having a panel of three guests for this episode. Today’s guests are the Chief Residents in Internal Medicine at Walter Reed National Military Medical Center. They include John Blickle, Melanie Wiseman, and Rainey Johnson. All three of them have dedicated time to the study and practice of medical leadership and we look forward to following them as they continue to grow as leaders. In this episode we discuss the transition from trainee to leader, how to make leadership training a priority, and lessons from their time as chief residents. Welcome to leading the rounds. Questions We Asked: When did you first recognise the importance of medical leadership?What valuable things did you learn from the leadership curriculum at Walter Reed?What is something that you learned you were initially doing poorly? What can someone do to improve as a leader if they don’t have a formal training program? What surprised you transitioning into a leadership position as a chief resident?What were the little things that you did to change the culture of your residency program?What advice would you have for medical trainees? Quotes & Ideas: You won’t have extra time during residency for leadership training, you have to make the time -John “To take care of our patients best, we have to learn these [leadership] skills.” -Melanie Listen Aggressively -Melanie The way that you set an example has an impact on the expectations of the group, even if they are not explicitly said - Rainey Create a culture of feedback and make sure there aren’t barriers preventing you from obtaining honest feedback -John When you get feedback, take a moment to accept it before you begin to defend yourself -Melanie As leaders, we should continuously be looking for opportunities to grow -Rainey A leadership training activity: contrasting a great attending and a terrible attending and reflecting on why “Culture is difficult to change… because it’s changed by lots of little acts that show what the leadership values” -Rainey They chose the value that they were going to care “If a message can be misinterpreted, it will be misinterpreted.”-John “Don’t just do something, stand there.” -John “You can’t change the culture if you don’t understand the people in it and what they value.” -John “If you haven't read hundreds of books, you are functionally illiterate, and you will be incompetent, because your personal experiences alone aren't broad enough to sustain you.” -Jim Mattis Books: The Culture Code by Dan Coyle It’s Your Ship by D. Michael AbrashoffCall Sign Chaos: Learning to Lead by Jim Mattis 

James (Jim) Wright obtained his MD from the University of Alberta in 1968, his FRCP(C) in Internal Medicine in 1975 and his Ph.D. in Pharmacology from McGill University in 1976. He is a practicing specialist in Internal Medicine and Clinical Pharmacology. He is also Co-Managing Director of the Therapeutics Initiative, Editor-in-Chief of the Therapeutics Letter and Coordinating Editor of the Cochrane Hypertension Review Group. He sits on the Editorial Boards of PLoS One and the Cochrane Library.Questions We Asked:•How did you become involved with pharmacology and drug prescription? •How would you define appropriate use? •Does financial implications to the patient play into appropriate use? •What do most physicians not know when they prescribe medications? •How does overprescribing play into medical waste?•Why is there a disconnect between systematic reviews and clinical guidelines? •How does bias play into drug testing? •How can we successfully collaborate with pharmaceutical companies without including bias into research? •How do everyday clinicians decide how to treat patients based on guidelines vs systematic reviews? •What makes a good systematic review? •What advice do you have for trainees who want to do good for their patients? •Book Suggestions? Quotes and Ideas:•Appropriate use of medications means that the benefits outweigh the harms of the medication •Every time a patient takes a medication, they are reminded of their medical condition that needs treatment. •Many psychiatric medications get onto market only due to short term medical trials, but many are prescribed for long term conditions. •Leaders should push for non-industry funded trials that evaluate the long term effectiveness of medications. •ALLHAT trial as an effectively run drug testing study  •We don’t want a situation where marketing is the driving force and not research •Choosing Wisely Campaign Book Suggestions: •Sickening by John Abramson •Our Daily Meds by Melody Petersen •Anatomy of an Epidemic by Robert Whitakers  

Dr. Paul Thomas is a board-certified family medicine physician practicing in Detroit, Michigan. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of three books: Direct Primary Care: The Cure for Our Broken Healthcare System, Startup DPC: How to Start and Grow Your Direct Primary Care Practice, and Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine. We hope you enjoy this episode with Dr. Paul Thomas about how to dress and present yourself as a leader. Questions We Asked: You just released a new book, Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine. What inspired you to write about this? How should you dress for a medical school or residency interview? How does virtual interviewing change things? How should you set up your background? Where do you draw the line between standing out and blending in with your dress and attire? How does appearance play into effectiveness leading teams and organizations? Is there a way to dress well when you have to wear scrubs? How do patient expectations change your dress? How much of dress is reading the room vs. holding yourself to a higher standard? You talk about house calls as a DPC physician, how does this change the interaction? How did you learn how to dress and carry yourself well? Book Suggestions? Quotes and Ideas: Medical School Interview: Blue or gray suit, white shirt with a colored tie. Leather shoes and a belt that matches. If you have a choice between a solid or swivel chair, choose the solid chair so you don’t fidget. Virtually: face a light, make sure the camera is eye level, set up and test your microphone. Make your tech setup pristine. Sprezzatura: When everything is perfect, you can introduce a splash of personality that highlights a creative part of yourself You should dress with the goal of looking professional so you can instill confidence and better care for your patients. Wear clothing that makes you look mature and confident. If you are a physician in a leadership role, you should take the time to dress well and change if needed. “If you want to be a leader… you should look the part and lean into dressing your best.” “If dressing well makes you stand up straighter, speak more clearly and develop trusting relationships with your patients, then do it.” Book Suggestions: Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine by Dr. Paul Thomas Atomic Habits by James Clear 

Dr. Peter Pronovost is a world-renowned patient safety champion, innovator, critical care physician, researcher, and entrepreneur. His scientific work leveraging checklists to reduce catheter-related bloodstream infections has saved thousands of lives and earned him high-profile accolades, including being named one of TIme’s 100 most influential people and receiving a coveted MacArthur Foundation “genius grant” in 2008.As Chief Quality & Clinical Transformation Officer at University Hospitals, Dr. Pronovost is charged with fostering ideation and implementation for new protocols to eliminate defects in value and thereby enhance quality of care. Previously, Dr. Pronovost served as the Senior Vice President for Patient Safety and Quality at Johns Hopkins Medicine as well as the founder and director of the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. Dr. Pronovost was elected to the National Academy of Medicine in 2011, elected as Fellow of the American Academy of Nursing and has received multiple honorary degrees. Dr. Pronovost is an advisor to the World Health Organizations’ World Alliance for Patient Safety and regularly addresses the U.S. Congress on patient safety issues. In response to a White House executive order, Dr. Pronovost co-chaired the Healthcare Quality Summit to modernize the Department of Health and Human Services quality measurement sQuestions We Asked: •How do you like the nickname Mr. Checklist? •How do you inspire those on your team to believe in themselves? •How do trainees fit into the safety paradigm? •How do we make quality something that everyone wants to be a part of? •What advice do you have for young leaders in healthcare? •Book Suggestions? Quotes & Ideas: •“Stories are the most potent force for change in the world.” •Steps that go before checklists: believing and belonging •Everyone is a part of the healthcare team and involved in patient care •“The secret of great care is love” •“If you have to drive change you have to believe in people and you have to love people.” •Stop believing that you’re just a _____ and start believing that you can make a difference •Teams that make good decisions are diverse and have independent input •Healthcare teams play “shorthanded” because we marginalize members of the care team •Experiential wisdom or time with the patient is often inversely correlated to medical wisdom •In 90% of sentinel events, someone knew something was wrong before the event happened•Three ways we change behavior: Regulate it, use economic incentives, and use the network effect •“Change progresses at the speed of trust, and trust grows when we do things with rather than to people.”•As an executive, your job is to illustrate why we are doing something, and then inspire others to figure out how to do it. •“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. -Margaret Mead•Be scientifically sound and ruthfully practical •Change is almost always transdisciplinary so it pays to be curious and learn about other fields •Be humble, curious and compassionate •Large scale change is half evangelism and half science. It pays to communicate and write well. Book Suggestions: •Love 2.0 by Barbara Fredrickson•The Advantage by Patrick Lencioni •Multipliers by Greg McKeown and Liz Wiseman•Everybody Matters by Bob Chapman and Rajendra Sisodia 

We wanted to start by saying thank you to all our listeners for their feedback and the comments over the past two years and everyone who has played a role in helping us launch and produce this podcast. This marks our 50th episode of Leading the Rounds and we couldn’t have asked for a better guest!Today we have the Vice President of Performance Science at WHOOP, Kristen Holmes. Kristen drives thought leadership by engaging with industry leading researchers and partners to better understand performance data across high stakes verticals. Before joining WHOOP in 2016, Kristen was a 3x All American, 2 x Big 10 Athlete of the year at the University of Iowa competing in both Field Hockey and Basketball and recently inducted into the Hall of Fame Class of 2021 and was a 7-year member of the U.S. National Field Hockey Team.Kristen was then Head Field Hockey Coach at Princeton University where she was one of the most successful coaches in Ivy League history, having won 12 league titles in 13 seasons and a National Championship.Kristen blends her academic and applied background in athletics, coaching, performance technology, psychology, and exercise physiology to drive research, partnership, and product development initiatives to strengthen WHOOP as a leader in Human Performance.Please enjoy this wonderful discussion about health optimization, WHOOP’s work with front line healthcare workers and insights into maximizing human performance.Welcome to Leading the rRounds!Questions We Asked: How did you transition from a player to a coach and leader? Did you feel like creating team buy-in was something you could do naturally or have to learn? What did you learn as a player and coach that has helped you now as vice president of performance at WHOOP? What behavior have you found is most correlated with performance and health? What are the biggest barriers to performance in front line healthcare workers? Can you lead us through some breath work? Have you studied cold immersion for autonomic health? How can a resident physician optimize their sleep in a state of chronic sleep debt? What is your goal with bringing WHOOP to healthcare? Quotes and Ideas: If you want to perform at your best, you have to know your physiology and what your body needs to be at its best. For an athlete, it’s often not the 2 hours of training that determines next day training capacity, but what the athlete does within the other 22 hours of the day. We will be much better as a society if we can understand our physiology and how we modulate stress. Stability of sleep cycles may be the most important metric for health and recovery. Leaders who are underslept lead teams who report poor psychological safety. Managers rated with higher psychological safety bring in an average of 4.3 million dollars more of revenue each year. Breathing protocol for decreasing sympathetic drive “the physiologic sigh”: Two inhales followed by a longer exhale You can see the benefits of cold immersion with only 12 minutes of exposure per week. Tips for better sleep: Keep your sleep environment cold, dark, and quiet Avoid nigh time mealsAvoid alcoholKeep a regular sleep schedule and nighttime routine Avoid blue light before bed Book Suggestions: Awareness by Anthony De Mello Waking Up & Making Sense by Sam Harris Tools of Titans by Tim Ferris Thinking Fast and Slow by Daniel Kahneman 

Douglas Johnston, MD, is Vice Chairman, Program Director, and staff cardiac surgeon at the Cleveland Clinic. He attended Dartmouth College where he was a Presidential Scholar, earning his degree in Anthropology and Classical studies with Honor and Distinction. In the process he performed field research in tuberculosis among refugee communities in India. Dr. Johnston then went on to complete his medical education at Harvard Medical School, where he was a Harvard National Scholar.Dr. Johnston completed his clinical training in general surgery at the Massachusetts General Hospital in Boston. He was awarded the Edward D. Churchill Fellowship, the American College of Surgeons Resident Research Scholarship, and an NIH National Research Service Award for his research in the immunology of heart and lung transplantation.Dr. Johnston then completed his training in Thoracic and Cardiovascular Surgery at the Cleveland Clinic, including a focused fellowship in endovascular surgery and additional training in advanced 3-dimensional imaging techniques. He joined the cardiac surgery staff in 2008.Dr. Johnston is the author of numerous articles and abstracts published in leading scientific journals. His research interests include high risk aortic valve surgery and interventions, hybrid approaches to complex cardiac disease, and transcatheter interventions for valvular heart disease. He is a member of the American College of Surgeons, the International Society for Heart and Lung Transplantation, the International Society for Minimally Invasive Cardiac Surgery, and the Society of Cardiac Computed Tomography.An avid outdoorsman, Dr. Johnston enjoys hiking and sailing with his family during his time away from the hospital.Questions We Asked: Where in Cleveland do you hike and sail? Did you always know you wanted to be involved in leadership? What type of qualities do you look for in your team? Why doesn’t everyone define leadership? What makes a good leader in the operating room? How do you develop calm in stressful situations? Where do you draw the line with emotional behavior in the OR?How do you recover from a leadership mistake? What advice would you give to yourself at the beginning of training looking back now? Favorite book and hike? Quotes & Ideas: “No matter what specialty you are in, you have teams of people working towards a common goal.” “The best leaders are those who develop other members of the team to be leaders” “Traditional residency training doesn’t address this [leadership]” “A good leader will have the awareness to know the pulse of the room, but won’t try to control everyone.” “When you achieve a state of flow, it’s probably leadership that led to that.” “The best leaders I’ve seen are people whose energy level goes down in a crisis.” As a medical student, be the quiet professional Book Suggestions: Turn This Ship Around by L. David MarquetThe No Asshole Rule by Robert L Sutton 

John Abramson served as a family physician for 22 years. And was voted “best doctor” numerous times. He is a Harvard Medical School faculty member, where he currently teaches health care policy. He transitioned to litigation as a consultant to the FBI and Department of Justice  and served in many trials against big pharmaceutical companies. Dr. Abramson has appeared on more than 65 national television shows and podcasts, including the Today Show, the Joe Rogan Experience, Dr. Oz Show, Lex Friedman and now LTR. His writing has been published in places like the New York Times, LA Times and he is the author of the national best-selling book Overdo$ed America.Recently he published his second book Sickening and we are so grateful to have him here today to talk about how lack of transparency in pharmaceutical trials is impacting the healthcare system and what you as a future leader need to know about it.Questions We Asked: How did you transition from a family physician to litigation and writing work? What inspired you to write your second book, Sickening? What are a few examples of pharmaceutical case trials that have impacted patients? How can doctors learn about how drugs are marketed and what the data shows? Should there be a governmental body that vets clinical trial data? How should physicians decide which drugs to support and give their patients?How do we incentives caring for the patient? What advice would you give your younger self? Book Suggestions? Quotes & Ideas: Peer reviewers only get to see the submitted data instead of the raw data. This allows for cherry picking of data to prove effectiveness and maximize profits, not improve health. Most medical journals profit from sending reprints to pharmaceutical companies which creates an incentive to make the pharmaceutical drugs look good. Milton Freedman’s 3 roles of government, “It should provide for military defense of the nation. It should enforce contracts between individuals. It should protect citizens from crimes against themselves or their property.”US healthcare is alone in allowing commercialization permeate the healthcare system from drug advertisements to device sales and more The US healthy life expectancy has decreased from 38th in the world to now 68th in the world The system is designed to allow commercial interests to maximize drug companies profits instead of maximize the ability of physicians to deliver quality care Book Suggestions: Overdo$ed America and Sickening by Johnathon Abramson How Markets Fail by John CassadyPhishing for Phools by George AkerlofBetrayal of Trust by Laurie Garrett 

Dr. Cam Patterson is a renowned cardiologist and healthcare administrator who currently serves as chancellor of the University of Arkansas for Medical Sciences (UAMS).Patterson previously held numerous academic and clinical appointments at the University of North Carolina, including as physician-in-chief at the UNC Center for Heart and Vascular Care and executive director of the UNC McAllister Heart Institute.He was previously senior vice president and chief operating officer of New York-Presbyterian in New York.Over the course of his career, Patterson has received more than $60 million in grants from the National Institutes of Health, the American Heart Association and the Centers for Disease Control and Prevention and has published over 300 peer-reviewed articlesHis residency, including a year as chief resident, was conducted at Emory University Affiliated Hospitals. He was a research fellow at the Cardiovascular Biology Laboratory in the Harvard School of Public Health and a clinical fellow in cardiology at The University of Texas Medical Branch at Galveston, Texas, where he joined the institution’s faculty in 1998.His wife, Kristine Patterson, M.D., is an infectious disease specialist who is an expert in treating menopausal women with HIV. They have three children Celia, Anna and Graham.We hope you enjoy this episode where we discuss starting a new role as a leader, leading a medical system, and establishing an organizational vision. Welcome to Leading the Rounds! Questions We Asked: How did you come to be the chancellor of University of Arkansas Medical? Was there something that surprised you about becoming chief resident? How were you able to create a culture in your organizations? How do you go from planning to implementation as a leader? How are you able to see problems as opportunities? How do you keep a pulse on your entire organization and know when to step in? What do you use to guide decision making with limited information? As a leader, how do you decide what challenges to take on first? When do you work to create buy-in first vs making unwavering decisions? What advice would you give someone interested in leadership? Quotes & Ideas: “You can create an environment where everyone complains to you, or one where everyone is understanding and happy.”  “Culture eats strategy for breakfast” “Our goal is to help UAMS make Arkansas the healthiest state in the region.” “As a leader, there should be moments where you have nothing to do, otherwise you’re doing someone else's job.” “If you make a bad decision, move on fast and start making some good decisions.” “Sometimes you have to trust your gut, and your gut works best when you have a strong moral compass.” “Leadership is a job that should not have a reverse gear… The reason why you make a change is because there was a problem in the first place.” “If life and work isn’t fun then is it even worth it.” “You will be infinitely more happy finding and promoting the careers of people around you, than promoting your own career.” Book Suggestion: Music is History by Questlove 

Dr. Benjamin M. Scirica is a cardiovascular medicine specialist and associate professor of medicine at Harvard Medical School (HMS). He is the director of quality initiatives at Brigham and Women’s Hospital’s (BWH) Cardiovascular Division and a senior investigator at the Thrombolysis and Myocardial Infarction (TIMI) Study Group, where he is director of the Electrocardiography Core Laboratory.Dr. Scirica received his medical degree from HMS. He completed an internal medicine residency and a cardiovascular disease fellowship at BWH. He also completed a research fellowship in cardiovascular disease with the TIMI Study Group at BWH and received a master’s degree in public health from Harvard School of Public Health. Dr. Scirica is board certified in cardiovascular disease.His clinical and research interests include assessing novel therapeutic agents and developing electrocardiography and cardiac biomarkers. As director of quality initiatives at the Cardiovascular Division at BWH, he leads projects to improve delivery of care and inter-disciplinary communications. At the TIMI Study Group, Dr. Scirica’s research focuses on improving risk stratification and cardiovascular disease treatment. He has authored over 100 peer-reviewed publications.We hope you enjoy this episode where we discuss disruptive innovations, change implementation, and teambuilding. Welcome to leading the rounds. Questions We Asked: Tell us about your NEJM article “Disruptive and Sustaining Innovation in Telemedicine: A Strategic Roadmap”?How do we build sustainable systems to use innovative technology? Have we been able to effectively evaluate telemedicine as a healthcare media? What is your company CardioCompass? What have you learned about leading diverse interprofessional teams? What are your favorite books? Quotes & Ideas: Disruption theory by Clay ChristensenThe Innovator's Dilemma Cardiocompass In order to create an innovation, you need to release a minimum viable produce and then refine and improve it based on feedback and inefficiencies“What’s the job that needs to be done” As a leader, “think out loud and let people into your thought process.”“It’s almost impossible to over communicate, especially virtually.” Book Suggestions: Books about Abraham Lincoln 

Brian Ferguson has spent his career working in high-performance organizations, as well as learning from leaders and decision-makers in US national security, the military, and technology. He has used those experiences to build  Arena Labs , healthcares first performance platform.Brian is also a Partner + Co-Founder of the Liminal Collective, a unique company human performance focused company “enabling humanity’s boldest endeavors.” Liminal is currently working in civilian space travel, deep sea exploration, and the digital future of cyberspace. Before founding Arena Labs & Liminal Collective, Brian served in the military as a Navy SEAL Officer. Prior to joining the military, he was a Presidential Appointee in the Office of the Secretary of Defense, and worked in the White House managing Intergovernmental Relations Brian serves on the Boards of GenNext, Seatrec, and The Honor Foundation. He lives in Nashville, Tennessee and is most proud of being a great father to his daughter.We hope you enjoy this episode where we discuss leadership as a Navy Seal, wearable devices, and high performance medicine. Welcome to leading the rounds! Questions We Asked: Tell us about your time as a Navy Seal and how that has affected you and your outlook on life? How have you been able to build mental fortitude? How did you become involved in medicine and surgery? Tell us about the name of Arena Labs and how the idea started? What is high performance medicine? What does Arena Labs track and how does it use the data? How do you use wearables to improve performance? What are the programs Arena offers? What can performers do in the macro or micro scale to improve performance? What makes a good surgical time out? Book Suggestions? Quotes and Ideas: “[Military training] forces you to push up to your limit and then go a little further… and when you do that daily, you become a different person.” “Mindset is trainable” “From what I’ve seen, surgical residency and other residency are way more demanding [than the navy seals]”Tools to improve your performance : Be aware of your stressors and learn how to react Improve your energy management People in medicine are service archetypes: they do hard things, help people, and make an impact on the world "It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly." -Teddy Roosevelt There is a difference between endurance and performance. Endurance is repeated stress without recovery. Performance is repeated stressors with adequate recovery which leads to growth through hormesis. Non-Sleep Deep Rest Protocols “Don’t let your first time be your first time.” In an acute stress situation, use two inhales through the nose and then one exhale out of the mouth to try to slow your heart rate down “Is the surgical timeout an obligation, or an opportunity to improve team chemistry and performance.” Does it tap into the aspirational? Does it improve collegiality? Book Suggestions: Tribe by Sebastian Junger Atomic Habits by James Clear Nassim Taleb books 

Joel Bervell is a third year Ghanaian-American medical student at Washington State University. Joel graduated from Yale University, where he served as an elected member of Yale student government, and director of a longitudinal mentorship program based in low-income neighborhoods. He completed a Masters in Medical Science at Boston University and spent a year working as a clinical research assistant at Providence Hospital. At Washington State University, Joel served as Medical Student Council President and the co-founder and president of a chapter of the Student National Medical Association. He is also the founder and director of the Coug Health Academic Mentoring Program, a mentoring program dedicated to increasing the number of underrepresented students interested in medicine. He has been invited to speak to national organizations such as the U.S. Food and Drug Administration, Clinton Foundation, Network of the National Library of Medicine. He has also spoken on well-known media outlets including Good Morning America, NPR, YahooNews and WebMd. He currently is working with the World Health Organization’s Digital Communications Team with a collection of health professionals combating the spread of misinformation on social media about COVID-19, and on a Diversity, Equity and Inclusion project with the VA Hospital systems.Joel is committed to fighting health disparities in medicine through education and regularly shares topics about racial disparities/ biases in healthcare and other industries on his TikTok and Instagram (@joelbervell). Joel has been named by TikTok as the top 2021 “Voice for Change,” was featured by TikTok as one of 10 “Changemakers” on their inaugural Discover List, named as one of ten recipients of the 50K MACRO x TikTok Black Creatives Grant, and was a nominee for the AdColor Awards. He is the recipient of the National Medical Association’s Emerging Scholar Award. Joel has served in an advisory role on the boards of multiple organizations including the National Student Response Network, Hope in A Box, and the Ron Brown Leaders Network Council.Welcome to Leading the Rounds!Questions We Asked: How did you get started using media platforms to promote change? How have you been able to manage social media with being a 3rd year medical student? Have you always been comfortable speaking in public? How have you been able to use your voice as a medical student to affect change?How have you felt being a young professional speaking to experts?  Have you struggled with imposter syndrome when speaking out for change? What are biases that we see in medicine? How do we discuss genetics vs race in medicine? What is your outlook with our generation in terms of eliminating health disparities? What advice would you have for trainees who want to create change? Quotes & Ideas: Use social media as an extension of yourself. Be true to who you are. Medical students can make an impact on changing what we are taught in medical school Medical students have been instrumental to rethinking pulse oximetry, eGFR, and diversity in medical imaging Levels of bias in medicine: Medical education- Risk factors Systematic biases- Race based medicine, disease equations, etc. Educational materials- Dermatology textbooks Book Suggestions: Between the World and Me by Ta-Nehisi CoatesAtul Gawande books The Color of Law Richard RothsteinShoe Dog by Phil Knight How to be an Anti-Racist Ibram X. Kendi

Intro: Dr. Lauren Weber graduated from the University of Florida in 2003 and was commissioned into the U.S. Navy prior to attending medical school at the Uniformed Services University of the Health Sciences.She graduated medical school and departed to attend the Aeromedical Officer course. There she completed flight and aeromedical training in order to earn her wings and become a Navy Flight Surgeon. She received the Boeing Rescue Award for the first long range MEDEVAC in an Osprey.After returning from deployment, Dr. Weber finished her training, was Chief Resident, then completed Cardiovascular Fellowship Program and stayed on to served as the Associate Program Director for the Cardiovascular fellowship program, Director of Echocardiography and Director of Advanced Cardiac Imaging. Dr. Weber has been a student of leadership and followership, and was awarded the Lieutenant General Claire L. Chennault Award as the physician who most closely emulates the General's prominent personality traits: Innovation, Fairness, Teaching Effectiveness, and Leadership. She has given over half a dozen lectures and workshops on topics related to followership.Dr. Weber is now practicing as a non-invasive Cardiologist for Confluence Health in Washington. In this episode we discuss her time as a flight surgeon and how followership can lead to successful leadership. Welcome to Leading the Rounds. Questions We Asked: Tell us about your time as a navy flight surgeon? What training did you have to prepare you for military trauma? What is your advice for learning technical skills? How have you helped your trainees jump into challenging opportunities? What advice do you have for people who are afraid of failure? Can you tell us about your idea of followership? Do you think followership is the way to become a good leader? How can somebody be a good follower? What advice would you give to yourself at the beginning of your training? What books have made an impact on your life? Quotes and Ideas: “Look out for folks who are interested, but quiet… and give them an opportunity.” “Look at being wrong as an opportunity to relearn something or learn something completely new.” “As a leader you sometimes have to make the unpopular choice… not necessarily what’s easy.” 1988 Robert Kelly article In praise the Followers in HBR Chaleff’s Follower Archetypes: Individualist: The pessimist. Rarely accepting of new ideas and willing to challenge the group and leader. High challenge, but low support. Resource: Get work done, but don’t spur change or challenge the leader. Low challenge and low support. Implementer: Implement change, but often go along even if they thing change isn’t working. High support but low challenge. Partner (The Ideal Follower): Will work with the leader to come up with change ideas and challenge them if needed. Collaborate with the leader. High challenge and high support. “I have yet to come across a situation where someone is being an excellent follower and no one knew about it.” “Opportunity lies where responsibility has been abdicated” -Jordan Peterson “We are building a toolkit for leadership and followership our whole medical careers.” Book Suggestions: Think Again by Adam Grant The Courageous Follower by Ira Chaleff Embracing Followership by Allen Hamlin Athena Rising by David Smith and Brad Johnson 

James L. Madara, MD, serves as the CEO and executive vice president of the American Medical Association and adjunct professor of pathology at Northwestern University.Dr. Madara has helped sculpt the organization’s long-term strategic plan. He also serves as chairman of Health2047 Inc., the wholly-owned innovation subsidiary of the AMA, created to overcome systemic dysfunction in U.S. health care. Prior to the AMA, Dr. Madara spent the first 22 years of his career at Harvard Medical School, receiving both clinical and research training, serving as a tenured professor, and as director of the NIH-sponsored Harvard Digestive Diseases Center. Following five years as chair of pathology and laboratory medicine at Emory University, Dr. Madara served as dean of both biology and medicine, and then as CEO of the University of Chicago Medical Center, unifying the university’s biomedical research, teaching and clinical activities. Dr. Madara then served as senior advisor with Leavitt Partners, a health care consulting and private-equity firm founded by former Health and Human Services Secretary Mike Leavitt.Throughout his career, he has published over 200 original papers and chapters and has served as editor-in-chief of the American Journal of Pathology and as president of the American Board of Pathology.Dr. Madara is consistently named one of the nation’s 50 most influential physician executives and on the nation’s 100 most influential people in health care. Some of his notable awards include the MERIT Award from the National Institutes of Health, the Davenport Award for lifetime achievement in gastrointestinal disease from the American Physiological Society, and the Mentoring Award for lifetime achievement from the American Gastroenterological Society.Welcome to Leading the Rounds!Questions We Asked: What led you to be CEO of the American Medical Association? How did you develop the three arcs of the AMA? What are some targeted things AMA has done to improve physician workflow? What is the goal of Health2047?What does the future of medical education look like? How can medical trainees become involved in innovation in healthcare? What are some book suggestions for medical leaders? Quotes & Ideas: AMA’s Three Strategic Arcs: Improving physician satisfaction by removing obstacles that interfere with patient care; Driving the future of medicine by reimagining medical education, training and lifelong learning and by promoting innovation to tackle the biggest challenges in health care; and Improving the health of the nation by leading the charge to prevent chronic disease and confront public health crisesDr. Madara’s AMA Startup Health2047 AMA launches Silicon Valley integrated innovation company, Health2047How the AMA works to support medical trainees: AMA announces new online education hub to support lifelong learning, Accelerating Change in Medical EducationThe three legged educational stool: Clinical Science, Basic Science, and Health Systems Science Establish your own personal guiderales. Dr. Madara’s include: always take the high road and don’t mistake a dropped ball for a conspiracy Book Suggestions: Nudge by Richard H. Thaler Thinking Fast and Slow by Daniel Kahneman

Intro: Scott Tillema is an FBI trained hostage negotiator and active law enforcement officer.  Scott teaches organizations how to use the power of life saving negotiation principles to enhance their work. He has developed a powerful model for safely resolving crisis situations, which is now being recognized and adapted by the private sector for use in sales, communication, influence, and leadership. He was invited to the most famous speaking stage in the world, TED, to share his approach to negotiation. His talk, "The Secrets of Hostage Negotiators" has amassed over one million views. We hope you enjoy this episode where we talk about stress inoculation, reading people, and effective communication.Welcome to Leading the Rounds! Questions We Asked: How did you become involved in hostage negotiation? What are the biggest challenges in being a hostage negotiator? What are things that helped you go from training to practice? How do you effectively communicate with someone very different than yourself? How do you judge if a conversation is moving in the right direction?What is your strategy when a negotiation is not working? What is the longest negotiation you have been a part of? What tips do you have for reading body language and voice inflection? What would you tell yourself if you could go back to the beginning of your career?Quotes and Ideas: The people that are effective communicators are curious about those they are communicating with, and work to find a common bond. Hostage Negotiation Framework: Understanding: Try to understand the situation Timing: Actively listen before making requests Delivery: How you speak is just as important as what you say Respect: Mutual respect drives good negotiation “We make our decisions based on emotion, not because we are using reasoning and logic.” When a negotiation moves from a monologue to a dialogue, it is moving in the right direction. FBI Behavioral Change Stairway Model Paul Ekman Resources on Micro Expressions Logotherapy: a therapeutic approach that helps people find personal meaning in life. “We feel empowered when we have a purpose, vision, and mission.” Scott’s Mission, “To inspire people of all backgrounds to be great negotiators.” Advice to younger self, “Don’t be afraid.”Book Suggestions: Hostage at the Table: How Leaders Can Overcome Conflict, Influence Others, and Raise Performance by George Kohlrieser Beyond Reason: Using Emotions as you Negotiate by Roger Fisher 

Dr. Ely is the Grant W. Liddle Chair in Medicine, Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine and co-director of the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University Medical Center. He is also a practicing intensivist with a focus on Geriatric ICU Care.  Dr. Ely’s research has focused on improving the care and outcomes of critically ill patients with ICU-acquired brain disease His team developed the primary tool by which delirium is measured in ICU-based trials and clinically at the bedside in ICUs worldwide.  Dr. Ely has over 400 peer-reviewed publications and recently published a highly acclaimed book titled Every Deep Drawn Breath. All net proceeds from his book are going to patients and their families.Despite his many accomplishments he will be the first to say that his most amazing accomplishments are his three daughters, Taylor, and twins, Blair and Brooke. We hope you enjoy this episode with @weselymd where we discuss clinical research, creating change, and humanism in medicine.  Questions We Asked: How did you become involved in clinical research? How do you “live at the edge of mystery”? How do you lead a large research lab effectively? How do you create buy-in to change clinical practice once you have made a discovery? What do you mean by “malignant normality”? How have you been successful in changing people’s minds? How have your relationships inspired you in your work?Was your passion for story the reason for writing EDDB? What does every person is a world mean to you? How has the pandemic affected your practice in medicine? How do we keep medicine human? How will technology influence our ability to maintain humanism? What are some books you would suggest to medical trainees?Quotes & Ideas: Rules for designing a clinical research project: Study what you have a lot of Create a study where either answer matters As a leader, one of the most important goals should be maintaining a human connection with everyone in your team. Malcolm Gladwell’s Tipping Point idea of Mavens, Salespeople and Connectors Malignant Normality: we tend to think the way we do things is the best way to do things We need to use the power of story to change peoples minds Cada Persona Es Un Mundo, “Every Person is a World” “Sometimes a kind of glory lights up the mind of a man. It happens to nearly everyone. You can feel it growing or preparing like a fuse burning toward dynamite. It is a feeling in the stomach, a delight of the nerves, of the forearms. The skin tastes the air, and every deep-drawn breath is sweet. Its beginning has the pleasure of a great stretching yawn; it flashes in the brain and the whole world glows outside your eyes.” by John Steinbeck in East of Eden Everything in medicine comes down to “Humility, Glory and Wonder” “If I think it’s just my job to take care of the MATTER, then I am missing ⅔ of that human being.” -Wes Always ask patients, “what matters to you?” Book Suggestions: My Own Country & The Tennis Partner by Abraham vergheseIn Shock by Rana Awdish Crossing to Safety by Wallace Stegner Arrowsmith by Sinclair Lewis I Know Why the Caged Bird Sings by Maya Angelou