Latest / Becker’s Healthcare Podcast / How Dual Training Is Advancing Complex Cardiac Care with Dr. Mohammed Imran Aslam

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How Dual Training Is Advancing Complex Cardiac Care with Dr. Mohammed Imran Aslam · Becker’s Healthcare Podcast

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  - Welcome to the Becker's Cardiology and Heart Surgery
• 1:00
  - podcast. I'm Mariah Taylor, assistant editor, and I'm
• 1:03
  - thrilled to be speaking with Mohammed Imran Aslam,
• 1:07
  - director of acute mechanical circulatory
• 1:09
  - support and director of Robert Kung Interventional Heart
• 1:12
  - Failure Clinical and Research Fellowship Program at Tufts
• 1:15
  - Medical Center. Thank you so much for joining
• 1:18
  - me today. I'm really excited to learn more
• 1:20
  - about your very rare dual certification.
• 1:23
  - But before we dive into that, I would
• 1:25
  - love for you to introduce yourself and tell
• 1:26
  - us a little bit about your background.
• 1:29
  - Thanks so much. Yeah. Really excited to join
• 1:30
  - you and appreciate the time.
• 1:33
  - So, yeah, as mentioned,
• 1:35
  - my role at the Tufts Medical Center is
• 1:37
  - the director of acute mechanical circulatory support. And,
• 1:41
  - as we'll talk about more,
• 1:43
  - dual certification in interventional
• 1:45
  - cardiology and heart failure, transplant cardiology, I'm also
• 1:48
  - fortunate enough to be the director of the
• 1:50
  - interventional and heart failure fellowship,
• 1:52
  - on the clinical and research side.
• 1:55
  - And so,
• 1:56
  - really,
• 1:57
  - you know, with the dual certification of interventional
• 1:59
  - cardiology and advanced heart failure and transplant cardiology,
• 2:03
  - my clinical,
• 2:05
  - role spans both. But most of my clinical
• 2:08
  - time is spent,
• 2:09
  - being an interventional cardiologist in the cath lab.
• 2:12
  - So that spans from,
• 2:14
  - complex coronary disease,
• 2:16
  - interventions,
• 2:17
  - chronic total occlusion,
• 2:19
  - interventions,
• 2:21
  - mechanical circulatory support, obviously, is my role
• 2:25
  - the shock team director here.
• 2:27
  - And so that includes extracorporeal membrane oxygenation or
• 2:30
  - ECMO, cannulations,
• 2:32
  - decannulations,
• 2:33
  - you know, placement of any other mechanical circulatory
• 2:36
  - support devices,
• 2:37
  - in the cath lab that's available.
• 2:40
  - And then we're also, you know, on the
• 2:42
  - side of, the,
• 2:43
  - the heart failure transplant side. I round on
• 2:46
  - the transplant service
• 2:48
  - about a month out of the year.
• 2:50
  - And that is most of my clinical,
• 2:53
  - footprint, so to speak.
• 2:55
  - And I do have some clinic as well,
• 2:57
  - which is fairly curated for,
• 3:00
  - heart... Advanced heart failure patients as well as
• 3:02
  - patients with complex coronary disease,
• 3:04
  - that need, interventions.
• 3:06
  - And so that's where my clinic,
• 3:08
  - really,
• 3:09
  - lies in the space of. And,
• 3:11
  - I think, on their research side, not to
• 3:13
  - get too much into that, but,
• 3:15
  - also, I have a a lab, in the,
• 3:18
  - MCRI, which is under Tufts, which is a,
• 3:20
  - like, your cardiology research institute,
• 3:22
  - focused on kind of translational research,
• 3:25
  - sort of bench to, bench to bedside, but
• 3:28
  - also some large animal models of of heart
• 3:30
  - failure,
• 3:31
  - and and again, very relevant to my clinical
• 3:33
  - practice. So,
• 3:34
  - kind of a longer way to explain what
• 3:36
  - what I do, but just in a nutshell,
• 3:38
  - that's kinda what I do on the research
• 3:40
  - and and then, clinical side.
• 3:42
  - That's such an excellent
• 3:44
  - introduction to all of this because across health
• 3:46
  - care, it seems like dual certifications are pretty
• 3:49
  - uncommon, but then the dual certification you have
• 3:52
  - is especially rare. So as you already said,
• 3:54
  - you're in interventional cardiology, and you also work
• 3:57
  - in advanced heart failure transplant cardiology.
• 4:00
  - Tell us a little bit more about what
• 4:01
  - motivated you to pursue both of these subspecialties,
• 4:04
  - and how did you make it happen?
• 4:06
  - Yeah. No. Of course. Great question. I think,
• 4:09
  - it's a it's a long story, but I'll
• 4:11
  - try to be, not too,
• 4:13
  - not too,
• 4:14
  - long with it. But,
• 4:16
  - you know, to start off, my my interest
• 4:18
  - in in medicine really started to,
• 4:20
  - in... On the research side, really to understand,
• 4:23
  - kind of
• 4:25
  - why we do what we do and and
• 4:26
  - to, to innovate. And, it started from there.
• 4:29
  - And then when I became,
• 4:32
  - a trainee as an intern and as resident,
• 4:34
  - I realized my,
• 4:36
  - love for critical care and cardiology,
• 4:38
  - which... And when you take care of sick
• 4:40
  - patients in the cardiac intensive care unit,
• 4:43
  - almost all of those patients have heart failure,
• 4:45
  - if if not all of them. And all
• 4:46
  - of those patients will also require some sort
• 4:48
  - of procedural
• 4:49
  - intervention for them, whether it's surgery or minimally
• 4:52
  - invasive advanced therapies,
• 4:54
  - to, to be, utilized or deployed for those
• 4:57
  - patients. And so what I realized is that
• 4:58
  - I really enjoyed caring for those patients,
• 5:01
  - where you can... Where someone comes in, quite
• 5:03
  - ill, on death's doorstep, so to speak, and
• 5:06
  - then, you're able to maneuver them out of
• 5:08
  - that,
• 5:10
  - kind of the the,
• 5:11
  - the the unfortunate situation that they're in into,
• 5:15
  - recovering or whether it's that, as a bridging
• 5:17
  - to that recovery or whether it's bridging to,
• 5:20
  - an advanced therapy as we call it, whether
• 5:22
  - that's heart transplant or a permanent heart pump
• 5:24
  - or LVAD,
• 5:25
  - and see them walk out of the hospital,
• 5:27
  - that's truly,
• 5:28
  - a pleasure and joy to see. I think
• 5:29
  - there's nothing quite like it. And so I
• 5:31
  - realized I really enjoy being a part of
• 5:33
  - the... Those sorts of patient,
• 5:35
  - caring for them in the hospital. And so,
• 5:37
  - the the types of cardiologists that care for
• 5:40
  - those are critical care cardiologists,
• 5:42
  - obviously, but also heart failure transplant cardiologists and
• 5:45
  - interventional cardiologists. And,
• 5:47
  - I wanted to,
• 5:49
  - you know, think about how can I participate
• 5:52
  - in the care for these patients as much
• 5:53
  - as possible because I enjoyed it so much?
• 5:56
  - And that's kind of how I came to
• 5:57
  - the conclusion that, the best way for me
• 6:00
  - to do that was to,
• 6:01
  - certainly be a advanced heart failure cardi... Transplant
• 6:04
  - cardiologist, which, are the type of cardiologists that
• 6:06
  - obviously care for patients that have advanced heart
• 6:08
  - failure and are critically ill and need,
• 6:11
  - transplant or,
• 6:12
  - permanent heart pump or LVAD or or some
• 6:14
  - sort of, other therapy to recover.
• 6:17
  - And I really enjoyed being part of their
• 6:19
  - care, but what I realized is I also
• 6:21
  - really enjoyed doing the the things, you know,
• 6:23
  - the the actual mechanical work of of, fixing
• 6:27
  - those patients,
• 6:28
  - on the procedural side, and that... That's where
• 6:30
  - it became to me,
• 6:32
  - a no brainer to do both. Obviously, as
• 6:34
  - you mentioned, this is not something that's common.
• 6:36
  - And so, as, you know, really everything in
• 6:39
  - life, but particularly in medicine, it's really important
• 6:42
  - to have, role models and and mentors to
• 6:44
  - help guide you. And so I was fortunate,
• 6:47
  - very fortunate enough to have somebody who had,
• 6:51
  - walked that path prior to me,
• 6:53
  - and Naveen Kapoor, who had actually trained at
• 6:56
  - the same institution that, I was at years
• 6:58
  - earlier,
• 6:59
  - and had,
• 7:00
  - let let some sort of a a blueprint,
• 7:02
  - so to speak, of how to pursue that.
• 7:04
  - And so that's why I ended up pursuing,
• 7:06
  - dual,
• 7:07
  - kind of, a training, as a, fellow,
• 7:11
  - at an institution I was at at the
• 7:12
  - time, which was at at Johns Hopkins.
• 7:15
  - Amazing. That's such a great story, and it's
• 7:18
  - so cool to hear just how people end
• 7:20
  - up where they are and what they're capable
• 7:22
  - of doing. Now that you've been in practice
• 7:24
  - for a bit, what are some of the
• 7:25
  - advantages of dual certification
• 7:28
  - in practice and patient care, and are there
• 7:29
  - any disadvantages?
• 7:32
  - Yeah. Great question. I think so. There's,
• 7:35
  - certainly, the advantages are
• 7:37
  - what I initially
• 7:38
  - kind of perceived as as, the advantage when
• 7:41
  - doing dual training is that you'd be able
• 7:43
  - to,
• 7:44
  - really be somebody in the cath lab or
• 7:46
  - or the procedural,
• 7:48
  - kind of suite where you are an interventional
• 7:51
  - cardiologist doing the procedure that is,
• 7:54
  - also knowledgeable in how the patient in front
• 7:57
  - of you,
• 7:59
  - is being currently cared for or the trajectory
• 8:01
  - they need to take in order to get
• 8:03
  - to,
• 8:04
  - what is for them,
• 8:05
  - the endpoint, whether that's recovery or or heart
• 8:07
  - transplant, etcetera.
• 8:09
  - And so knowing where the patient comes from,
• 8:11
  - where they are, how they're being cared for,
• 8:13
  - and where they need to go is a
• 8:15
  - great advantage when you are a proceduralist.
• 8:17
  - You know, if you think about the cath
• 8:19
  - lab in general, you've got a lot of
• 8:20
  - complex patients that run through the cath lab
• 8:22
  - that need procedures, whether it's a stent, whether
• 8:24
  - it's a valve,
• 8:25
  - whether it's something that needs to be fixed
• 8:27
  - in their arteries and their legs because they're
• 8:29
  - having,
• 8:30
  - you know, lack of blood flow to their
• 8:32
  - leg, or whether it's heart failure. And you
• 8:34
  - have, interventional cardiologists who are invested in all
• 8:37
  - of these patients where, in the cath lab
• 8:39
  - such as, peripheral interventional,
• 8:42
  - you know
• 8:42
  - cardiologists who are particularly interested in those sorts
• 8:45
  - of interventions or whether you have cardiologists that
• 8:47
  - are interested in structural or valve interventions those
• 8:50
  - are what you call the structural cardiologists.
• 8:52
  - And you have coronary cardiologists obviously those are
• 8:54
  - you know all interventional cardiologists do coronary work
• 8:57
  - but what you really lack in the cath
• 8:59
  - lab is a, you know, a interventional cardiologist
• 9:02
  - who... Who's invested in the heart failure patient.
• 9:05
  - Even though, as I mentioned, all of our
• 9:07
  - patients really do have heart failure. And so
• 9:09
  - that's where the advantage is that you have
• 9:11
  - that investment, that knowledge,
• 9:13
  - and that understanding of complex hemodynamics that despite
• 9:17
  - all interventional cardiologists participating in acquiring hemodynamics in
• 9:20
  - patients,
• 9:22
  - the, kind of the training behind how to
• 9:24
  - think about those hemodynamics, how to apply them
• 9:26
  - to the patient outside the cath lab as
• 9:28
  - well as in the cath lab is something
• 9:29
  - that you acquire, during your training as an
• 9:31
  - advanced heart failure doctor, and that is something
• 9:33
  - unique,
• 9:34
  - and a very clear advantage to me.
• 9:37
  - And it... You you speak the languages of
• 9:39
  - both, subspecialties and are able to bridge that
• 9:41
  - gap. So I think that's, again, a very
• 9:43
  - clear advantage and something that,
• 9:46
  - I I really enjoy on a day to
• 9:47
  - day basis.
• 9:48
  - And, you you know, I'm a very positive
• 9:51
  - about this dual training. I think it's great.
• 9:53
  - But with everything in life, there are also
• 9:55
  - disadvantages. And I think, the disadvantages
• 9:58
  - are,
• 9:59
  - that whenever you're doing something that's,
• 10:02
  - dual training,
• 10:04
  - it can be difficult for, institutions or hospitals
• 10:08
  - to understand how best to, utilize you or
• 10:10
  - deploy you because it's not something that's commonplace.
• 10:14
  - And so it could be a challenge to
• 10:15
  - find,
• 10:16
  - where you fit in in a particular division,
• 10:20
  - and how they see you,
• 10:23
  - kind of how much time that you would
• 10:25
  - spend in each sub specialty, so to speak,
• 10:27
  - how that fits with what you want to
• 10:29
  - do and why you decided to do the
• 10:31
  - dual training to begin with and how that
• 10:32
  - fits with what the institution needs. So it's
• 10:34
  - a lot of, kind of what you think
• 10:36
  - you wanna do and how how the institution
• 10:38
  - or hospital thinks that that they need to
• 10:40
  - wield you. And I think,
• 10:42
  - certainly with interventional heart failure, but with any
• 10:45
  - dual training, there really needs to be some
• 10:47
  - sort of understanding and consensus of how best
• 10:50
  - to utilize,
• 10:51
  - those who have trained,
• 10:53
  - in in both subspecialties,
• 10:56
  - as well as, I think,
• 10:58
  - what what seems to me obvious, but certainly
• 11:00
  - to others who don't, do this or think
• 11:02
  - about this is, that there is a value,
• 11:05
  - in doing a training for both of these,
• 11:07
  - because I think that that is the first
• 11:09
  - hurdle I noticed,
• 11:11
  - trying to convince others that there is a
• 11:12
  - value to do this, and this wasn't,
• 11:15
  - seemingly just an excess of training for no
• 11:17
  - reason,
• 11:18
  - which I think, sometimes,
• 11:20
  - is is an unfortunate reality that you have
• 11:23
  - to convince others.
• 11:25
  - But I think,
• 11:26
  - to distill it down into is really the,
• 11:28
  - make... Making sure that the value is clear,
• 11:31
  - and the value added to the institution or
• 11:33
  - hospital, and then how best to deploy,
• 11:36
  - you... Needs to also be cleared. So I
• 11:38
  - think that can be disadvantageous because those are,
• 11:40
  - the hurdles that you have to,
• 11:42
  - really,
• 11:43
  - clear before you can,
• 11:45
  - practice and and take it,
• 11:47
  - kind of, take full advantage of the of
• 11:51
  - the of the positives of training in in
• 11:53
  - both, interventional and heart failure.
• 11:56
  - Amazing. That's such a great overview of just
• 11:58
  - the good and the bad of having that
• 12:00
  - dual certification. And I wanna dive into something
• 12:03
  - a little bit more that you mentioned kind
• 12:04
  - of in the beginning, And that is that
• 12:07
  - at most hospitals,
• 12:08
  - right, it takes two physicians to treat the
• 12:10
  - patient, but you can do kind of both
• 12:12
  - roles. And so there's a lot of obvious
• 12:14
  - advantages that come with that for both the
• 12:16
  - hospital and the patients. You only have to
• 12:18
  - see one person instead of multiple.
• 12:20
  - But I'm curious for you and your practice,
• 12:23
  - do you miss having that collaborative effort with
• 12:25
  - another physician?
• 12:27
  - Yeah. Again, great question because I think, you
• 12:29
  - know, when you're taking care of such complex
• 12:31
  - and fragile patients,
• 12:33
  - you know, you know, there's never one person
• 12:35
  - just taking care of them. It's always,
• 12:39
  - a group of people that are caring for
• 12:40
  - them. If if I, if you recall, one
• 12:43
  - thing I mentioned earlier was that when you're
• 12:45
  - taking care of these really sick patients is
• 12:47
  - that,
• 12:48
  - it's a group of people including interventional cardiologists,
• 12:50
  - heart failure cardiologists, which obviously I'm dual training,
• 12:53
  - but also critical care cardiologists. Right?
• 12:55
  - You can't train absolutely everything, and you really
• 12:58
  - need
• 12:58
  - a full team to...
• 13:00
  - A full complement of a team to help
• 13:02
  - help you care for that. So I'm constantly
• 13:04
  - communicating with, collaborating with other types of cardiologists,
• 13:08
  - whether that's cardiologist focused in imaging, whether that's,
• 13:11
  - cardiologist focused in the critical care aspect of
• 13:14
  - it. Even though I do a lot of
• 13:15
  - that critical care, there's still aspects of it
• 13:17
  - that,
• 13:18
  - are, definitely,
• 13:21
  - more sub, subspecialized
• 13:22
  - that, I benefit from my colleagues who who
• 13:25
  - have trained in in that. And then even
• 13:27
  - on the heart failure side, when we are
• 13:29
  - thinking of deploying therapies such as transplant or
• 13:32
  - Elevate or permanent heart pumps,
• 13:34
  - that's never something... A decision that's made by
• 13:36
  - one person. It's always made by, as a
• 13:38
  - committee.
• 13:39
  - And so you're always speaking to other heart
• 13:41
  - failure cardiologists as well. And whenever you've got
• 13:43
  - really complex cases in the cath lab, it's
• 13:45
  - also very common that you speak with other
• 13:47
  - interventional cardiologists as, you know, your colleagues together.
• 13:50
  - So there's... You're never,
• 13:52
  - you're never by yourself just because you're dual
• 13:54
  - trained. You're you're more,
• 13:57
  - you know, I think you're better trained certainly
• 13:58
  - and able to to handle things and,
• 14:01
  - and think about things, in ways that you
• 14:03
  - wouldn't have been able to otherwise. But you're
• 14:05
  - certainly not,
• 14:07
  - you know, you're certainly not avoiding,
• 14:10
  - collaboration or communication
• 14:12
  - because you have that dual training. So...
• 14:15
  - Excellent.
• 14:16
  - I'd also love to hear a little bit
• 14:17
  - more about how your dual certification improves your
• 14:20
  - relationship with patients. So do you find that
• 14:23
  - because of your certification, you have a stronger
• 14:25
  - relationship with patients or that you can help
• 14:27
  - make their experience a little bit better?
• 14:30
  - Yes. I think,
• 14:32
  - definitively, the answer to that is yes because,
• 14:34
  - and this spans from inpatient to outpatient care
• 14:37
  - is that when I'm inpatient and I'm rounding
• 14:39
  - on the transplant service and caring for patients,
• 14:41
  - and I'm talking to them about a procedure
• 14:43
  - they need, etcetera.
• 14:44
  - Frequently, when I'm on service, my preference is
• 14:47
  - to do the procedures for my patients.
• 14:50
  - And, again, that's a personal choice that I
• 14:51
  - make, but I do enjoy that, and that's
• 14:54
  - why I did get into the old dual
• 14:56
  - training
• 14:57
  - pathway. And so, it definitely helps with with
• 15:00
  - that,
• 15:01
  - that relationship because,
• 15:03
  - I'm the doc who's seeing that patient day
• 15:05
  - to day in the morning and coming by
• 15:07
  - and rounding on them and then say, okay.
• 15:08
  - Well, I'll see you in the afternoon when
• 15:09
  - I'm gonna do this procedure.
• 15:11
  - And so, you know, when the patient comes
• 15:13
  - to the, Procedural Suite, you know, it's it's,
• 15:16
  - it's a it's a comfort for patients because
• 15:18
  - they are already,
• 15:20
  - you know, connected with the physician who's there
• 15:23
  - doing the procedure versus when they meet somebody
• 15:25
  - who they haven't seen before,
• 15:26
  - as excellent as that person may be, it's
• 15:28
  - still new to the patient, and so there's
• 15:30
  - a comfort there that's afforded.
• 15:32
  - And that's something I've definitely noticed over the
• 15:34
  - years, and really enjoy being a part of.
• 15:36
  - And and then when it expands to the
• 15:38
  - outpatient part of it, it also very clear
• 15:40
  - because,
• 15:41
  - I take care of patients who may or
• 15:43
  - may not need transplant, for example, or or
• 15:45
  - LVAD,
• 15:46
  - but, are
• 15:48
  - being managed,
• 15:49
  - via whether it's complex interventional procedures, etcetera, that
• 15:53
  - I'm performing on them.
• 15:54
  - And so I'm able to see them in
• 15:56
  - clinic, from the procedural standpoint, you know, to
• 15:59
  - discuss and counsel them on whether or not
• 16:01
  - we should proceed with a certain procedure, obviously
• 16:03
  - perform the procedure, and then, and then see
• 16:06
  - them in clinic afterwards from the procedural aspect,
• 16:08
  - but also from managing their heart failure medically.
• 16:11
  - And so they only had to see one,
• 16:13
  - physician from that perspective. So that helps helps
• 16:16
  - to,
• 16:17
  - consolidate,
• 16:18
  - care and, and, again, form that relationship with
• 16:21
  - the patient, from,
• 16:23
  - from beginning to end, which is something that
• 16:25
  - I, really enjoy doing on the second.
• 16:28
  - Amazing.
• 16:29
  - Now at the beginning, we talked a lot
• 16:31
  - about how having a dual certification of pretty
• 16:33
  - much any type is pretty rare. But I'm
• 16:36
  - sure there's a fair amount of listeners that
• 16:38
  - are cardiologists. They're looking at maybe getting dual
• 16:40
  - certified, and I know there's a lot of
• 16:42
  - hospital leaders listening in on this. So what
• 16:45
  - advice do you have for cardiologists who want
• 16:47
  - to pursue a dual certification? And then what
• 16:49
  - advice do you have for hospitals on how
• 16:51
  - to best support their dual certified physicians?
• 16:55
  - Yeah. Very, very good question. I'll start with
• 16:57
  - the advice to those who wanna pursue.
• 17:00
  - I think, you know, when I would... Wanted
• 17:02
  - to pursue this, of course, there are some
• 17:04
  - who are supportive and others who are, you
• 17:06
  - know, I don't wanna say not supportive, but
• 17:08
  - more neutral. Right? And I think at the
• 17:10
  - end of the day,
• 17:11
  - you...
• 17:12
  - If if if you find that you need
• 17:15
  - a certain skill set to best care for
• 17:18
  - a patient population
• 17:20
  - and you... We feel that you need to
• 17:22
  - acquire skill set a and b, then I
• 17:24
  - I recommend you go,
• 17:26
  - obtain that skill set.
• 17:28
  - And I think for me, that was... I
• 17:29
  - want to be, kind of a master of
• 17:31
  - hemodynamics,
• 17:32
  - and, being able to
• 17:35
  - provide provide procedures for,
• 17:37
  - for my patients and,
• 17:39
  - as well as care for them from before
• 17:41
  - and after. And so for me, that meant,
• 17:43
  - this is the true dual training that I
• 17:45
  - I needed to do to do that.
• 17:47
  - And I think
• 17:49
  - you just have to
• 17:50
  - be be understanding
• 17:52
  - that,
• 17:53
  - there are extra
• 17:55
  - skill sets that sometimes you have to acquire
• 17:57
  - if you have to do... If you want
• 17:58
  - to do x, y, and z. And so
• 18:00
  - I think those, whether it's critical care cardiology
• 18:03
  - and
• 18:04
  - combination with heart failure cardiologist, because that's another,
• 18:07
  - dual training that,
• 18:09
  - those who are interested in my field certainly
• 18:11
  - can gravitate towards and and that that would
• 18:14
  - make sense for,
• 18:15
  - for those who want to be primarily in
• 18:17
  - the ICU, for example, but those who wanna
• 18:19
  - be primarily in the procedural,
• 18:21
  - aspect like I am, it makes sense to
• 18:23
  - do this dual training. So I think my
• 18:25
  - my advice and summation really is do the
• 18:27
  - training that you feel like you need to
• 18:29
  - in order to take best care of your
• 18:30
  - patients. Because at the end of the day,
• 18:31
  - that's what matters is taking care of your
• 18:33
  - patients,
• 18:34
  - in in the best way you... That you
• 18:36
  - can.
• 18:37
  - And just because it's something that is a
• 18:39
  - path that's less, pursued or certainly has not
• 18:42
  - been in the past.
• 18:43
  - I think don't let those in the past
• 18:45
  - who who have done it a certain way
• 18:46
  - convince you that, oh, they'll... This is okay.
• 18:48
  - Just do it just do it this way
• 18:50
  - because that's the way that it's been done
• 18:51
  - or that's the way that I did it,
• 18:52
  - and it works out just fine,
• 18:54
  - because medicine evolves. And and if anyone who's
• 18:57
  - been in medicine understands that, that medicine has
• 18:59
  - to evolve, and you can't just keep doing
• 19:01
  - things the same way that has been done
• 19:03
  - because that's the way that it's been done
• 19:05
  - or there's dogma. And so you you do
• 19:07
  - what you need to do in order to
• 19:08
  - take best care of our patients, and that
• 19:09
  - means to change your thought and and realize
• 19:12
  - that maybe something that we did in the
• 19:13
  - past was not the best, and now we
• 19:15
  - are able to do something better. So that's
• 19:17
  - my advice to trainees. Don't let someone tell
• 19:19
  - you what you can't do, and do what
• 19:20
  - you got... Need to do. And I think,
• 19:22
  - to transition into,
• 19:24
  - you know, how hospitals can best take care
• 19:26
  - of this is alluding to something that I
• 19:27
  - mentioned earlier, in the podcast, which is that
• 19:30
  - people need to understand the value of dual
• 19:32
  - trainees rather than being afraid of dual trainees,
• 19:35
  - and not knowing how... Whether it's a fear
• 19:37
  - because you don't know how to deploy them,
• 19:38
  - whether it's fear because it's going to threaten
• 19:40
  - a particular,
• 19:42
  - subspecialist because,
• 19:44
  - classically or colloquially, a certain subspecialist have only
• 19:47
  - done a certain thing.
• 19:49
  - And, you know, there's the whole concept of
• 19:52
  - getting grandfathered into,
• 19:54
  - you know, doing certain things, whether it's,
• 19:57
  - you know, heart failure cardiologists who are, you
• 19:59
  - know, grandfathered into doing procedures in the cath
• 20:02
  - lab, etcetera,
• 20:03
  - without receiving formal training.
• 20:05
  - I I think it's really important that institutions
• 20:07
  - understand that formal training is is, and
• 20:11
  - is important and can be very valuable.
• 20:14
  - And dual training is very valuable. And I
• 20:17
  - think,
• 20:18
  - number one one, understanding that there is value
• 20:20
  - there, so that when these,
• 20:23
  - candidates come across your, table, so to speak,
• 20:26
  - you are,
• 20:27
  - keen to be,
• 20:29
  - you know, keen to that... The concept,
• 20:31
  - as well as the potential value. And then
• 20:33
  - understanding,
• 20:34
  - you know, institutionally how you would utilize someone
• 20:37
  - with that skill set,
• 20:38
  - having a discussion amongst the division and the
• 20:41
  - division leaders, the stakeholders as to how someone
• 20:43
  - like this would be deployed,
• 20:45
  - and how they could be formally integrated
• 20:47
  - into the system rather than
• 20:49
  - just kinda,
• 20:50
  - kind of a, well, we have somebody who
• 20:52
  - does both things, but when they're here, they're
• 20:55
  - only gonna do mostly this one thing and
• 20:57
  - not the other thing.
• 20:59
  - Because that that ends up wasting,
• 21:01
  - you know, that person's training because they train
• 21:03
  - to do something else, and then they're not
• 21:05
  - being utilized to do that. And that can
• 21:07
  - be, certainly discouraging for the... That individual person,
• 21:11
  - but also
• 21:12
  - really just a a lack of, you know,
• 21:14
  - use of a appropriate skill set and
• 21:17
  - inability to operate at the full kind of
• 21:19
  - end of your, you know,
• 21:21
  - full full end of your license if if
• 21:23
  - you're dual trained in something,
• 21:25
  - and then you're pigeonholed to do one thing
• 21:27
  - alone. So, I really think it's important for
• 21:30
  - leaders,
• 21:31
  - institutions, hospital systems to understand
• 21:33
  - value and how to integrate people formally rather,
• 21:36
  - rather than, try to pigeonhole people into,
• 21:40
  - kind of, these prior roles, which have been
• 21:42
  - done, classically for years,
• 21:45
  - when caring for these patients because,
• 21:47
  - you know, our ability to care for these
• 21:49
  - patients, whether it's via interventional techniques or surgical
• 21:53
  - techniques, etc,
• 21:54
  - it has has been evolving, is only going
• 21:57
  - to continue to evolve, and the best way
• 21:59
  - to care for these patients is to,
• 22:01
  - modulate how we,
• 22:03
  - care for for those patients, how we train
• 22:05
  - to care for those patients.
• 22:07
  - And that's just a reality of of of
• 22:08
  - how we,
• 22:10
  - best care for this very complex,
• 22:13
  - patient population.
• 22:15
  - That is some really great advice across the
• 22:18
  - board. So thank you for that, and thank
• 22:20
  - you for being here. This is such a
• 22:21
  - unique position to be in, so I really
• 22:24
  - appreciate you sharing your experience, sharing
• 22:27
  - your advice and expertise,
• 22:29
  - and being willing to talk about it on
• 22:30
  - the podcast today.
• 22:32
  - Yeah. Thank you so much. It's been really
• 22:33
  - wonderful to talk about it. Something I'm very
• 22:35
  - passionate about. I hope people always consider,
• 22:38
  - you know, going into dual training, for whatever
• 22:41
  - it is that they feel that they need
• 22:42
  - to do to best care for patients because
• 22:44
  - that's why we're in this.
• 22:46
  - Absolutely.