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Leadership & Career Pathways for Antimicrobial Stewards · The SHEA Podcast

• 0:05
  SPEAKER_01: Welcome to our Leadership in Management podcast series brought to you by the Society for Healthcare Epidemiology of America, SHA, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:21
  SPEAKER_01: I'm Dr.
• 0:22
  SPEAKER_01: Jessica Howard Anderson, Assistant Professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine and the co-director of antimicrobial stewardship at Emory University Hospital Midtown.
• 0:33
  SPEAKER_01: I will serve as your moderator.
• 0:34
  SPEAKER_01: She is excited to launch this episode of the podcast series entitled Leadership and Career Pathways for Antimicrobial Stewards.
• 0:41
  SPEAKER_01: Our discussion today will explore the different career opportunities for individuals interested in antimicrobial stewardship.
• 0:48
  SPEAKER_01: In addition, we'll learn how to advocate for and advance stewardship positions at your institution and elaborate on leadership and management skills necessary for antimicrobial stewards.
• 0:57
  SPEAKER_01: I'm very happy to introduce our speakers today.
• 1:00
  SPEAKER_01: First, we have Dr.
• 1:01
  SPEAKER_01: Daniel Lavorsi.
• 1:02
  SPEAKER_01: Dr.
• 1:02
  SPEAKER_01: Lavorcy is an infectious diseases physician who practices at the University of Iowa Hospital in the Iowa City VA.
• 1:09
  SPEAKER_01: His research focuses on improving the evaluation of antibiotic use and optimizing the implementation of stewardship activities.
• 1:16
  SPEAKER_01: Hi Dan.
• 1:17
  SPEAKER_00: Hi Jessica, thanks for that introduction.
• 1:19
  SPEAKER_01: Thanks so much for being here.
• 1:21
  SPEAKER_01: So next we have Dr.
• 1:22
  SPEAKER_01: Erin McQuery, Clinical Assistant Professor within the University of Pittsburgh's Division of Infectious Diseases, and the Director of Infectious Diseases Improvement and Clinical Research Innovation for UPMC.
• 1:33
  SPEAKER_01: She has led system-wide implementation of multiple infectious diseases and antimicrobial stewardship initiatives and published numerous peer-reviewed manuscripts in the areas of antimicrobial stewardship and infectious diseases.
• 1:45
  SPEAKER_01: Dr.
• 1:46
  SPEAKER_01: McQuery is also the host of Breakpoints, the Society for Ivy Pharmacists or SADP podcast.
• 1:51
  SPEAKER_01: So welcome, Erin.
• 1:53
  SPEAKER_02: Hey, thank you so much for having me.
• 1:54
  SPEAKER_02: Very excited to be here as a guest at this awesome panel to talk about a cool topic.
• 1:58
  SPEAKER_02: Great.
• 1:58
  SPEAKER_02: Thanks for joining us.
• 2:00
  SPEAKER_01: And finally, we have Dr.
• 2:01
  SPEAKER_01: Pyle Patel.
• 2:02
  SPEAKER_01: Dr.
• 2:02
  SPEAKER_01: Patel is the system-wide director of antimicrobial stewardship at the Intermountain Healthcare.
• 2:07
  SPEAKER_01: She is passionate about improving antimicrobial stewardship nationally and internationally and is a voting member of the Presidential Advisory Council on Combating Antimicrobial Resistance.
• 2:17
  SPEAKER_01: Hi, Pyle.
• 2:17
  SPEAKER_01: Welcome.
• 2:18
  SPEAKER_03: Hey Jess, I'm glad to be here as well.
• 2:20
  SPEAKER_01: Great.
• 2:21
  SPEAKER_01: Well, thank you all for joining us today.
• 2:23
  SPEAKER_01: So to kick off our discussion, I'd like for each of you to tell us a bit about your jobs and the pathway you took to get there.
• 2:30
  SPEAKER_01: Dr.
• 2:31
  SPEAKER_01: Lavorcy, would you like to kick us off?
• 2:33
  SPEAKER_00: Sure thing.
• 2:34
  SPEAKER_00: So I would say that I got to where I am today through a very um nonlinear path.
• 2:39
  SPEAKER_00: So when I was a fellow, I had a lot of different interests.
• 2:42
  SPEAKER_00: I wasn't entirely sure what I wanted to focus on.
• 2:44
  SPEAKER_00: And my first job out of fellowship was uh doing infection control.
• 2:47
  SPEAKER_00: And it didn't take very long for me to realize that that really wasn't what I wanted to be doing.
• 2:51
  SPEAKER_00: I had some opportunities to do stewardship and I realized that I liked that.
• 2:53
  SPEAKER_00: I wanted to get more into research.
• 2:55
  SPEAKER_00: So I ended up coming here to Iowa where I had the chance to um be mentored by someone with sort of a hospital epidemiology stewardship focus.
• 3:02
  SPEAKER_00: And I was able to get a VA Career Development Award.
• 3:05
  SPEAKER_00: And through that award, I was able to continue doing research within the VA and continue to do stewardship.
• 3:10
  SPEAKER_00: And today I'd say my job provides a lot of variety where I still am involved in day-to-day stewardship.
• 3:16
  SPEAKER_00: I also um do a lot of mixed methods research and then spend time doing patient care as well.
• 3:20
  SPEAKER_01: Great.
• 3:21
  SPEAKER_01: Thanks so much.
• 3:22
  SPEAKER_01: Dr.
• 3:22
  SPEAKER_01: Herpreary, tell us about your life job.
• 3:25
  SPEAKER_02: Yeah, I'm smiling because I imagine Pyle will have a similar answer in that I don't think any of us are necessarily where we thought we'd end up.
• 3:32
  SPEAKER_02: And I kind of wish I could go back to little me in pharmacy school and just say it's gonna be okay.
• 3:36
  SPEAKER_02: I actually wasn't even committed to residency training, which for pharmacy would be one of the paths towards being an infectious diseases specialist until I did my first rotation during my fourth year, which in pharmacy school, that's when we go on our experiential rotations and depends on the school.
• 3:53
  SPEAKER_02: Some schools do two years of that, similar to med school, some do one, mine did one.
• 3:57
  SPEAKER_02: And honestly, prior to that, I I went to pharmacy school in Auburn, Alabama, and I was going to stay in Alabama and run an independent community pharmacy.
• 4:05
  SPEAKER_02: That's what a lot of my mentors did.
• 4:06
  SPEAKER_02: 80% of my graduating class went into community pharmacy, which is very admirable, and it was something I was really passionate about.
• 4:13
  SPEAKER_02: I was really involved with the National Community Pharmacy Association, and that was my dream.
• 4:17
  SPEAKER_02: And then I started my fourth year, and my first rotation was an internal medicine rotation at Huntsville Hospital in northern Alabama.
• 4:24
  SPEAKER_02: And it was the first time I'd ever been exposed, really, to interacting with multiple tiers of medical learners on the physician side, nurses, respiratory therapists, what have you.
• 4:34
  SPEAKER_02: It's really my first exposure to being in the hospital.
• 4:36
  SPEAKER_02: And I just absolutely loved it.
• 4:38
  SPEAKER_02: And I was like, oh no, this is what I need to do.
• 4:41
  SPEAKER_02: And it was an internal medicine rotation, but it was all the patients with infectious diseases and really the patients on antibiotics that I was drawn to.
• 4:48
  SPEAKER_02: And then particularly as a pharmacist, the opportunities we had to optimize the patient's care was in stewardship, which I didn't even realize at the time I was doing stewardship, but it was a whole lot of stopping ceftriaxone for ASB kind of stuff, but I loved it.
• 5:02
  SPEAKER_02: I also trained on paper charts.
• 5:04
  SPEAKER_02: So we went up and literally like frost off the drug in the paper chart, which was very satisfying.
• 5:09
  SPEAKER_02: And so then I looked at residencies and pivoted pretty hard in the middle of my fourth year.
• 5:14
  SPEAKER_02: I didn't actually have a lot of time to prepare for residency applications, but I knew I wanted to continue my training to work in the hospital.
• 5:20
  SPEAKER_02: And therefore I looked at residency programs that had ID PGY2 training, the second year specialty training in pharmacy.
• 5:27
  SPEAKER_02: And then I also was really interested in oncology.
• 5:29
  SPEAKER_02: Later in the year, I had an oncology rotation.
• 5:31
  SPEAKER_02: I thought that was a cool population.
• 5:33
  SPEAKER_02: And so I pretty much narrowed my residency application search down to hospitals that had PGY2s and oncology and infectious diseases.
• 5:39
  SPEAKER_02: And I thought I'll figure it out down the line what I ultimately end up in.
• 5:43
  SPEAKER_02: In my PGY1 year, my general year where you go all throughout the hospital, I realized I liked oncology, but I really liked it because they all got really weird infections.
• 5:51
  SPEAKER_02: And it was immunocompromised ID that I was really drawn to.
• 5:54
  SPEAKER_02: So I ended up doing a PGY2 and ID in full disclosure, because I think this is really important to talk about.
• 5:59
  SPEAKER_02: And we don't talk a lot about how our personal life changes impact where we ended up in our careers.
• 6:04
  SPEAKER_02: But I went through a pretty bad breakup in the middle of my PGY2 year, which was kind of after the time course in which we would start applying for jobs.
• 6:13
  SPEAKER_02: And so admittedly, that was very thrown off because of some personal life changes that I didn't anticipate in kind of at the end of my PGY2 year.
• 6:21
  SPEAKER_02: So I ended up staying at the University of Wisconsin in my first job, and I took a half administrative, half clinical role where I was the education coordinator and also an infectious diseases specialist.
• 6:31
  SPEAKER_02: So I did stewardship and I rounded with the consult team.
• 6:33
  SPEAKER_02: I precepted residence, but then I was also responsible for preceptor development and I created one of the first preceptor development programs for residency training within pharmacy.
• 6:42
  SPEAKER_02: I did all interprofessional learning, which got me really engaged with med schools and nursing schools and other things on the University of Wisconsin's campus, which opened a lot of doors.
• 6:51
  SPEAKER_02: And then, of course, I was doing stewardship, which I loved.
• 6:53
  SPEAKER_02: And I loved that job.
• 6:54
  SPEAKER_02: And I, despite the personal things I had been through, I really honestly wasn't looking to leave Wisconsin.
• 6:59
  SPEAKER_02: But then I went to ECMID, which is major infectious diseases conference, of course, in April.
• 7:04
  SPEAKER_02: So I'd been out of residency for, I don't know, nine months or whatever the math is there.
• 7:08
  SPEAKER_02: And I went to that conference, I went by myself and I didn't really know a lot of people in the space, a lot of people that were there.
• 7:14
  SPEAKER_02: And I, you know, I tried to network and I tried to engage, but at the end of the day, sometimes also, and I think this is okay to admit, sometimes you're just kind of tired and you're like, I cannot go to another happy hour.
• 7:23
  SPEAKER_02: I can't, I don't have it in me to talk to humans anymore today.
• 7:27
  SPEAKER_02: And that I hit this wall on like day three of ECMID where I couldn't do it.
• 7:30
  SPEAKER_02: And so also I grew up a big Pittsburgh sports fan and the Penguins were in the Stanley Cup playoffs.
• 7:36
  SPEAKER_02: And all I wanted to do was go watch the Penguins and the Stanley Cup, which in Spain time was it jived with being out late and what have you.
• 7:43
  SPEAKER_02: So I effectively, and for all the, you know, the trainees out there trying to network, I effectively blew off this networking opportunity to go watch hockey.
• 7:52
  SPEAKER_02: And that ended up having me end up with all these Pennsylvania connected infectious diseases physicians and pharmacists, including Neil Clancy and Ryan Shields, who are two mentors today.
• 8:05
  SPEAKER_02: And so I wanted to like not talk to anyone.
• 8:07
  SPEAKER_02: And I ended up in this situation where I was with all these people I didn't know and I had to meet them.
• 8:11
  SPEAKER_02: And then I was like, oh my goodness, are you the Ryan Shields who discovered CEFTAS AV resistance?
• 8:16
  SPEAKER_02: And so then I find myself in a position where I'm talking about work instead of hockey, but that's okay.
• 8:21
  SPEAKER_02: Because in that moment, I found out that in Pittsburgh, they had an open ID pharmacist position, and that led to a job interview.
• 8:28
  SPEAKER_02: So I left that night with submitting an application for that position, flying to Pittsburgh to interview, and was fortunate enough to be offered the job.
• 8:35
  SPEAKER_02: So that's how I ended up in Pittsburgh.
• 8:37
  SPEAKER_02: I do have family in the area.
• 8:38
  SPEAKER_02: So I moved back to Pittsburgh for this amazing opportunity to do research with Ryan, to work at a very transplant-heavy infectious diseases center and to take care of my grandfather.
• 8:48
  SPEAKER_02: And I did that and I would have done that forever.
• 8:49
  SPEAKER_02: I would have stayed in that job and been an ID pharmacist in that kind of classic role.
• 8:54
  SPEAKER_02: And then the pandemic happened.
• 8:56
  SPEAKER_02: And when the pandemic happened, I started trying to figure out what the heck COVID was for my hospital, as we all did.
• 9:01
  SPEAKER_02: But not all of the UPMC hospitals have an infectious disease-trained pharmacist.
• 9:05
  SPEAKER_02: And so I quickly started helping all of our other hospitals with treatment guidelines and things like that.
• 9:11
  SPEAKER_02: And that evolved slowly into the system level role where I ran our COVID therapeutics committee and some of our clinical trials for the system.
• 9:18
  SPEAKER_02: That moved me from the Department of Pharmacy into the Department of Medicine where I now live.
• 9:22
  SPEAKER_02: And I did that system role somewhat unofficially for a couple of years.
• 9:26
  SPEAKER_02: And I realized I really loved it.
• 9:28
  SPEAKER_02: But the job I was doing with COVID, which I'm sure is true for all of us, wasn't actually a real job.
• 9:33
  SPEAKER_02: It didn't exist.
• 9:34
  SPEAKER_02: We never knew it was going to be a thing.
• 9:36
  SPEAKER_02: But what we learned in COVID, the silver lining was wow, we really can function as a system.
• 9:40
  SPEAKER_02: We can take 35 hospitals and connect them and treat our patients in critical access and community sites with the same opportunities as those in academic centers.
• 9:48
  SPEAKER_02: And I just really loved that work.
• 9:50
  SPEAKER_02: I loved getting to talk to everyone at all these different sites and improve the care of patients with infectious diseases.
• 9:56
  SPEAKER_02: So in January of 2022, I wrote my own job description, which was effectively taking what I had done with COVID for two years and putting it on paper.
• 10:04
  SPEAKER_02: And I submitted that to our chief quality officer.
• 10:06
  SPEAKER_02: And I'm fortunate enough that the system said, you're right, this should be a thing and created my role.
• 10:11
  SPEAKER_02: So I wrote my current job description and I wrote the name of the department which I now run, which integrates infectious diseases, care, and clinical research.
• 10:19
  SPEAKER_02: So I have a team that does some clinical trials and then I collaborate with all of our stewardship pharmacists and infectious diseases people across the system to kind of improve and standardize anywhere we use antibiotics.
• 10:29
  SPEAKER_02: So a very windy and weird path, but I wanted to be really transparent about how I came into it and show that to hopefully some listeners that that might be helpful for.
• 10:37
  SPEAKER_02: Thanks, Dr.
• 10:38
  SPEAKER_01: McCreary.
• 10:38
  SPEAKER_01: Yeah, I I love that story.
• 10:40
  SPEAKER_01: That was great to hear, and I think very helpful for our listeners.
• 10:43
  SPEAKER_01: I also really appreciate that you pointed out that our personal life can have a big impact on what career we choose.
• 10:49
  SPEAKER_01: And you're right, we probably don't talk about that enough.
• 10:51
  SPEAKER_01: So, Dr.
• 10:52
  SPEAKER_01: Patel, I'll turn it over to you now.
• 10:54
  SPEAKER_03: Yeah, I loved hearing both Dan and Erin's story.
• 10:58
  SPEAKER_03: And I I what I'll do is I'll tuck, I'll go even back further and I'll go back to college because I think, you know, sometimes we don't know where we're going to end up, but you like start picking up along the way things that you really like or things that you're really passionate about.
• 11:12
  SPEAKER_03: And so I went to college at Johns Hopkins.
• 11:15
  SPEAKER_03: I was like pre-med, but I like really loved learning about public health.
• 11:19
  SPEAKER_03: That was what really like drove me and you know, kind of inspired me to want to become a doctor.
• 11:25
  SPEAKER_03: So I studied a lot of global health as an undergrad, and then I won this award and I got to go to Kenya for a year and live there and do some sort of, you know, now I know what is uninformed research, but I did research for a year there on my own.
• 11:40
  SPEAKER_03: And while I was there, I learned a lot about HIV and how that kind of interspersed into a lot of the things that I was looking at, which was maternal and child health.
• 11:50
  SPEAKER_03: And I was, I was really intrigued by that, thought that was really interesting.
• 11:53
  SPEAKER_03: Came back, went to med school, which was tough.
• 11:56
  SPEAKER_03: I thought med school was really tough.
• 11:57
  SPEAKER_03: I was more of like an English major and undergrad.
• 12:00
  SPEAKER_03: And so now I was like just inundated with all these classes.
• 12:03
  SPEAKER_03: But the only class that I had an easy time with or enjoyed were things like microbiology when we went through infectious diseases.
• 12:10
  SPEAKER_03: So I was gravitating towards ID from an early get-go.
• 12:14
  SPEAKER_03: And so I kind of knew I wanted to do ID fellowship, really enjoyed internal medicine.
• 12:19
  SPEAKER_03: And I think one thing that we always hear, you know, podcasts like these or like TED Talks is like you wake up and you're happy to go to work, right?
• 12:26
  SPEAKER_03: So even in my darkest days as an ID fellow, right?
• 12:30
  SPEAKER_03: You just see all these consults, I would look at the schedule for tomorrow and I would begrudgingly be happy that we were gonna get Dunkin' Donuts and it was like ID conference day, right?
• 12:40
  SPEAKER_03: Like I was like, I know I made the right decision because I'm still happy to go to work tomorrow.
• 12:45
  SPEAKER_03: And that continues to be like a theme, I think, in my career.
• 12:48
  SPEAKER_03: So that's been, I think that's really important to ask yourself at the end of the day.
• 12:52
  SPEAKER_03: And then I really didn't know that antimicrobial stewardship was the field for me really until towards the end of my fellowship beginning of my career.
• 13:00
  SPEAKER_03: So I I do want to tell listeners that it's totally okay that you don't, you know, find that niche early on.
• 13:07
  SPEAKER_03: It can happen later on in life.
• 13:09
  SPEAKER_03: And I feel like I've really been able to get back to those elements that drew me into medicine because now I have a job where I'm able to do, like Dan said, the day-to-day stewardship at my own hospital, at my system.
• 13:22
  SPEAKER_03: And then I also now do some global antimicrobial stewardship work.
• 13:26
  SPEAKER_03: I work on policy for antimicrobial resistance and all of those things I'm really, really passionate about.
• 13:32
  SPEAKER_03: So from the deep dark days of being an ID fellow even to now, I still wake up every day and happy to go to work.
• 13:39
  SPEAKER_03: And I think that's really important.
• 13:41
  SPEAKER_01: Thanks, Dr.
• 13:41
  SPEAKER_01: Patel.
• 13:42
  SPEAKER_01: That was great.
• 13:42
  SPEAKER_01: I might have to steal your quote of begrudgingly be happy to go to work.
• 13:47
  SPEAKER_01: All right.
• 13:48
  SPEAKER_01: So now that we've heard a little bit about each of your jobs, I wanted to ask if there are specific job characteristics that ID fellows or pharmacists should be looking for.
• 13:57
  SPEAKER_01: So, Dr.
• 13:57
  SPEAKER_01: Merquary, do you want to start this time?
• 14:00
  SPEAKER_02: I think so, I'll disclaimer this with like every personality assessment I've ever taken shows that I'm a people-driven person more than a logic-driven person.
• 14:06
  SPEAKER_02: So, like grain of salt, because this is going to vary based on what you value and what you need, right?
• 14:11
  SPEAKER_02: For me, it's a good boss.
• 14:13
  SPEAKER_02: I've worked for amazing bosses and I've worked for suboptimal bosses.
• 14:17
  SPEAKER_02: And I have never been more miserable doing the same work, doing infectious diseases, pharmacy type things than when I had a boss that we didn't see eye to eye.
• 14:25
  SPEAKER_02: They weren't supportive of my goals, they weren't a good communicator, things like that.
• 14:28
  SPEAKER_02: So I think a good boss, someone who fosters your strengths and your goals, who treats you how you want to be treated, is not afraid to give you the constructive feedback that you need to improve on certain weaknesses, but recognizes that really we should be channeling the things we're good at, the things that bring us joy.
• 14:43
  SPEAKER_02: Someone who can give appropriately structured feedback too, even if it's positive feedback, don't just say, you're so good, you know, why?
• 14:50
  SPEAKER_02: What do I do that's good?
• 14:51
  SPEAKER_02: What should I continue to work on specifically?
• 14:53
  SPEAKER_02: I think it's just so, so important.
• 14:55
  SPEAKER_02: And I'd say more important, honestly, than the actual job description.
• 14:58
  SPEAKER_02: Maybe not for fellowship and training, because your job's probably going to be pretty similar no matter where you go.
• 15:03
  SPEAKER_02: But as you move into whatever your first big person role is, attending type role, honestly, job descriptions can be relatively vague, which is an intentional thing on the HR standpoint.
• 15:12
  SPEAKER_02: Just now that I am a boss and I hire people, you should see the job description for pharmacists in most health systems.
• 15:17
  SPEAKER_02: It's wildly vague.
• 15:18
  SPEAKER_02: And that's on purpose.
• 15:19
  SPEAKER_02: You can fill that role with any certain type of person.
• 15:22
  SPEAKER_02: And you need to like go to work and do what needs done for your patients and fit the core things.
• 15:25
  SPEAKER_02: But I think what we all just said in our journeys is that beyond that, there's so much room to ask, where can I get plugged in?
• 15:31
  SPEAKER_02: Where can I collaborate?
• 15:32
  SPEAKER_02: How can I grow?
• 15:32
  SPEAKER_02: What can I learn?
• 15:33
  SPEAKER_02: And you need people to help you do that and someone who's supportive of that.
• 15:37
  SPEAKER_02: Connecting to the program director, connecting to whoever your boss is, someone that is going to listen and foster you and still be tough when you need it is just, I think, invaluable.
• 15:47
  SPEAKER_02: And then the other job characteristic I think I've learned over time is like money to me, at least it money goes so far.
• 15:54
  SPEAKER_02: I'm not necessarily overly driven by financial incentive.
• 15:57
  SPEAKER_02: I don't think anyone in the infectious diseases space is, but your time is so valuable.
• 16:01
  SPEAKER_02: Time is the only thing we're never getting back.
• 16:03
  SPEAKER_02: And so being able to negotiate for how you spend your time, professional development's really important to me.
• 16:09
  SPEAKER_02: I really love attending conferences and meeting people and learning is I love to learn.
• 16:15
  SPEAKER_02: And so I've negotiated and asked over time if I attend a conference, I don't want to have to take PTO for that necessarily.
• 16:21
  SPEAKER_02: If I'm still staying up on my email, I'm off service from patient care standpoint.
• 16:26
  SPEAKER_02: And it is, I work long hours when I'm traveling for conferences because I'll email, you know, before and after the conference events.
• 16:31
  SPEAKER_02: But to have conference time and not have to take PTO and things like that, these are things you can negotiate for along the way.
• 16:37
  SPEAKER_02: So that's something I've learned and looked for as I've moved into different things and worked for different bosses.
• 16:42
  SPEAKER_02: It's something I've learned to ask for.
• 16:44
  SPEAKER_02: Is we might not always be able to negotiate benefits or salary structures because those are might be more rigorous and there needs to be equity, et cetera.
• 16:50
  SPEAKER_02: But you really can discuss earnestly how you spend your time.
• 16:53
  SPEAKER_02: I think that's really important.
• 16:54
  SPEAKER_01: Those are great points.
• 16:55
  SPEAKER_01: Dr.
• 16:56
  SPEAKER_01: Patel, we'll go to you next.
• 16:57
  SPEAKER_03: Yeah, I totally agree with what Erin said.
• 17:00
  SPEAKER_03: I I wish I had asked her for advice before I got my first job.
• 17:04
  SPEAKER_03: But you know, I think that what she said helped me in my first job.
• 17:07
  SPEAKER_03: I had a great boss, you know, I had that flexibility.
• 17:10
  SPEAKER_03: I think what I would add to what Erin said is, you know, some flexibility in your job.
• 17:15
  SPEAKER_03: Like I agree that that job description, you never know what you're gonna do with that.
• 17:20
  SPEAKER_03: But if you have some time in there to work on a passion, build on an interest that you have in the field, if you could try for your for your first job not to be a hundred percent clinical, right?
• 17:31
  SPEAKER_03: And have some time, some dedicated time for something else, I think that is gonna kind of help you get through those dark days and and get back to work the next day.
• 17:41
  SPEAKER_03: So flexibility, I think, is important.
• 17:44
  SPEAKER_03: And I know that they say that it's not important about having like an office or office space, but I must say that in my first job, I had a fantastic office.
• 17:55
  SPEAKER_03: I got to paint an accent wall at the VA, guys.
• 17:58
  SPEAKER_03: I painted an accent wall at the VA.
• 18:01
  SPEAKER_03: That's huge.
• 18:01
  SPEAKER_03: And then I had thick enough walls that I could listen to, like, you know, some music in my office.
• 18:06
  SPEAKER_03: Man, the ambiance just it was awesome.
• 18:09
  SPEAKER_03: So I, you know, everyone has their own thing, but I would say having your own space, because for so long, resident, med student, fellow, you've been sharing your office with like eight other people.
• 18:19
  SPEAKER_03: If you could get some of that grown-up stuff in your first job, that's that's really nice.
• 18:24
  SPEAKER_01: So, Dr.
• 18:24
  SPEAKER_01: Lavorcy, I think the first question to you obviously is did you have an accent wall at the VA?
• 18:30
  SPEAKER_01: And what what other advice do you have to add?
• 18:33
  SPEAKER_00: Gosh, I wish I did.
• 18:34
  SPEAKER_00: Um, the walls in the VA are usually just brown or white.
• 18:37
  SPEAKER_00: So I think an accent wall would have been nice.
• 18:39
  SPEAKER_00: So, no, I I did not have that luxury, but I I would definitely echo what Aaron and Haale have said so far.
• 18:44
  SPEAKER_00: I think one other thing that's important to think about as you're looking at jobs is to make sure that you're going to be in a situation where you can succeed.
• 18:51
  SPEAKER_00: So, this would definitely include things like having protected time to do stewardship, having colleagues who share similar interests to you and who you could perhaps collaborate with, having IT support, you know, that can collect metrics for you, or if you want to do a small QI project that could help collect data for you for that.
• 19:06
  SPEAKER_00: I think a really important thing too is having leadership that supports stewardship at the level of the hospital, but then also within your ID division as well.
• 19:14
  SPEAKER_00: So those are all things to consider as you're interviewing.
• 19:17
  SPEAKER_00: I can't say that every job I've had has had those things, but it's good to have at least most of those things to succeed.
• 19:23
  SPEAKER_02: I'm so glad you said that because I had in my notes and I forgot to say it is be wary of anything that's a split FTE, which is literally all of us because we all wear 17 different hats.
• 19:31
  SPEAKER_02: But when you're if you're getting funding from multiple sources or your job description means you have to do a lot of things, that can be a pro because you're mixing it up and you're engaged and you're plugged in.
• 19:40
  SPEAKER_02: But having multiple bosses means you have 100% of everything, and they're all full-time jobs, let's be honest.
• 19:45
  SPEAKER_02: So just be wary when you take roles that are split FTE.
• 19:48
  SPEAKER_02: Everyone's expecting 100% of you, even if it's a 20% assignment of your time.
• 19:52
  SPEAKER_02: So it can be a slippery slope.
• 19:54
  SPEAKER_02: So just be careful and be protective of how you're spending your time and how that's allocated.
• 19:58
  SPEAKER_01: Yeah, I think that is actually a great segue to what I wanted to talk about next, which is to think about instances where you may have had to negotiate for additional time or for funding related to antimicrobial stewardship.
• 20:11
  SPEAKER_01: And I'm curious if you have advice for trainees or early career faculty about how to demonstrate the value of stewardship, either to your boss or someone in healthcare leadership, as we were just discussing.
• 20:21
  SPEAKER_01: Dr.
• 20:22
  SPEAKER_01: Lavarsi, we will turn to you first.
• 20:25
  SPEAKER_00: So I think it's really important to not do something for free.
• 20:28
  SPEAKER_00: So as I mentioned before, if you're gonna be in a stewardship position, there needs to be protected time to do stewardship.
• 20:34
  SPEAKER_00: Now, with that said, sometimes you might want to expand the program.
• 20:38
  SPEAKER_00: Maybe you want to get more FTEs for doing stewardship.
• 20:41
  SPEAKER_00: And in that situation, you actually might have to do something for free, but only on a pilot basis, I would say.
• 20:45
  SPEAKER_00: So maybe you want to start a new initiative, and that can be done on a pilot basis.
• 20:49
  SPEAKER_00: And if that's the case, you know, you do it for a set period of time.
• 20:52
  SPEAKER_00: I think you would want to track how much time and effort you're putting forward towards that initiative.
• 20:56
  SPEAKER_00: And then you'd want to have some measure of what type of impact that's gonna have on the healthcare system.
• 21:00
  SPEAKER_00: When it comes to asking for more time or more salary support, I think a lot of it's gonna come to cost savings.
• 21:05
  SPEAKER_00: So that's gonna be a big focus of any sort of hospital leadership.
• 21:08
  SPEAKER_00: So whatever form of stewardship you're doing, and if you are gonna be arguing for more support, I think being able to demonstrate that you're gonna be saving the system money in some way is going to be very important.
• 21:17
  SPEAKER_01: Thanks, Dr.
• 21:17
  SPEAKER_01: Laborsi.
• 21:18
  SPEAKER_01: Those are great points.
• 21:20
  SPEAKER_01: Did you get any specific training and kind of how to effectively show cost analyses or how to prove that you can save the healthcare money?
• 21:27
  SPEAKER_01: I know that's often a difficult thing to show in stewardship.
• 21:31
  SPEAKER_00: Yeah, I wish I did, and I agree it.
• 21:32
  SPEAKER_00: It is a it is a hard thing to show because on the one hand, in stewardship, we I think we often say, well, let's not focus on cost savings because antibiotic prices go up and down.
• 21:41
  SPEAKER_00: But when it comes to approaching leadership, you really do need to focus on costs.
• 21:44
  SPEAKER_00: So maybe some of our other panelists have have more experience than I do.
• 21:48
  SPEAKER_01: Dr.
• 21:48
  SPEAKER_01: McCreary, how have you kind of shown the value of stewardship to healthcare leadership?
• 21:53
  SPEAKER_02: I think echoing some of those themes as well.
• 21:56
  SPEAKER_02: In my experience, I think a flaw, particularly amongst pharmacists honestly that we do is we do the work because we're passionate and we care about our patients and we want to and you know we pick up the cross and we just do the work and then we've done it all.
• 22:09
  SPEAKER_02: And then we go to our bosses and say, look, we did all this.
• 22:12
  SPEAKER_02: Can't we get another person or look what we did?
• 22:14
  SPEAKER_02: And they're like, yeah, look what you did with what you have.
• 22:16
  SPEAKER_02: Keep doing it.
• 22:17
  SPEAKER_02: Right.
• 22:17
  SPEAKER_02: And so I have found and in slowly evolving that is you want to make the case to your boss first and then their boss and then whomever else needs to sign off on it.
• 22:26
  SPEAKER_02: And if it's a collaboration, make sure everyone's at the table up front.
• 22:29
  SPEAKER_02: So for example, right now we're trying to do a system thing with blood cultures.
• 22:33
  SPEAKER_02: And I had to get quality, finance, micro, infection prevention, and stewardship at the table, right?
• 22:38
  SPEAKER_02: Because it and that's true, it impacts all of those people and you have to show all of those teams how you're going to enhance their teams and show value.
• 22:45
  SPEAKER_02: But get everyone together, make your case with some pilot data you have from work you're already doing and ask, basically make your ask up front and then you go do the work before you get a yes.
• 22:54
  SPEAKER_02: And then once you've done it, then you come back and say, okay, I did it.
• 22:57
  SPEAKER_02: I we saved one day length of stay because we implemented a rapid diagnostic and now can we have another pharmacist to respond to the rapid blood culture phone calls or something like that.
• 23:06
  SPEAKER_02: So you have to do the work usually before you end up getting the resource, but you have to make the case for why you're doing the work first so that when you turn around and ask for the resource, they're prepared for it.
• 23:14
  SPEAKER_02: You've made the case for it.
• 23:15
  SPEAKER_02: And I think we that's what we've been working on more.
• 23:18
  SPEAKER_02: And I've honestly my boss is my boss is the chief quality officer right now.
• 23:21
  SPEAKER_02: So she's been really exceptional in coaching me through this and how you show ROI for a massive system and that's been really helpful.
• 23:28
  SPEAKER_02: But I think you do have to do the work first and then and then as you show that then you can move on and we've and we've been able to expand in that regard.
• 23:36
  SPEAKER_01: Great points.
• 23:37
  SPEAKER_01: Dr.
• 23:37
  SPEAKER_01: Patel, I know you recently took a new job so any insight?
• 23:41
  SPEAKER_03: Yeah you know one thing I've been learning from my colleagues here at at Inner Mountain is they have really they've done a fantastic job with stewardship.
• 23:49
  SPEAKER_03: But then they take that value and really show it, showcase it, show that, you know, if we were to fund this position, you know, here is the exact you know things that you would get in terms of value for patient care and all of those things.
• 24:04
  SPEAKER_03: And that really can help you build a business case.
• 24:07
  SPEAKER_03: And the other thing that I've seen is they've really aligned what the system, what the healthcare system's goals are for the next year with antimicrobial stewardship goals.
• 24:16
  SPEAKER_03: And so if your goal is to make an impact, let's say for me for example, I'm going to try to make an impact in outpatient primary care stewardship this year.
• 24:25
  SPEAKER_03: And that's also a goal for the system that's going to be a lot easier to try to get resources or you know show the value of the resources that we have when those two align.
• 24:34
  SPEAKER_03: So I think that can be hard in different systems, but if you can get your goals to align with the hospital's goals, I think that could be really helpful.
• 24:42
  SPEAKER_01: Great.
• 24:43
  SPEAKER_01: Next I'd like to ask what leadership or management skills you all have found useful in your career.
• 24:48
  SPEAKER_01: And if there are any specific training courses or programs you'd recommend to those interested in antimicrobial stewardship.
• 24:54
  SPEAKER_01: Dr.
• 24:55
  SPEAKER_01: McQuery, why don't you start us off?
• 24:57
  SPEAKER_02: Sure.
• 24:58
  SPEAKER_02: I think and this is actually something I learned too with my first job that I didn't realize you could ask for these kinds of things.
• 25:05
  SPEAKER_02: And as soon as I asked I realized the people are very eager to send you if you're engaged.
• 25:09
  SPEAKER_02: Most health systems have some kind of resource in learning and development or HR where you can get some training.
• 25:15
  SPEAKER_02: And so I've tried to take advantage of a lot of this getting to know myself and then down the line getting to know the people I interact with in my team.
• 25:22
  SPEAKER_02: I'm a big fan of the disk assessment I think amongst the workplace assessments you can take to understand who you are, how you work, how you like to communicate, how you like to be communicated with I think that's been the most powerful tool all of my co-residents and I took it on day one of residency.
• 25:37
  SPEAKER_02: And it anything that happened in residency that you were like, oh this member of the team is doing XYZ thing, it helps you reframe that and say, oh, it's just because this is their disc personality and I understand exactly why they're saying this when I would have said this.
• 25:48
  SPEAKER_02: And that's been a really productive professional team thing for me.
• 25:51
  SPEAKER_02: I also am a big fan of the strengths finder assessment if you're looking into those.
• 25:55
  SPEAKER_02: I think knowing the differences between leadership and management are actually very important.
• 25:59
  SPEAKER_02: So I think we lump them together a lot but I think being a leader and being a manager are distinctly different skills.
• 26:04
  SPEAKER_02: And I think understanding those nuances and understanding what your role is.
• 26:08
  SPEAKER_02: Are you supposed to be managing?
• 26:09
  SPEAKER_02: Are you supposed to be leading are you supposed to be doing both in some way I think often where leaders run into problems is when they're supposed to be leading and in fact they're managing.
• 26:19
  SPEAKER_02: And then that can cause a lot of dysfunction on the team and a lot of personal stress for that leader.
• 26:23
  SPEAKER_02: So I think that's something really helpful.
• 26:25
  SPEAKER_02: The other thing I would think everyone needs to go through is a course on giving and receiving feedback because it's an art and I think it's an important thing to practice.
• 26:32
  SPEAKER_02: And then I mean of course I think everyone should have unconscious bias and diversity and inclusion training annually in different capacities to continue to be able to relate all across the workforce and diversify your teams.
• 26:44
  SPEAKER_02: Thanks.
• 26:44
  SPEAKER_01: I think that distinction between leadership and management is really interesting.
• 26:48
  SPEAKER_01: That's something I thought a lot about so I appreciate that point.
• 26:51
  SPEAKER_01: Dr.
• 26:51
  SPEAKER_00: Lavorcy, I'll turn to you next yeah so a couple things that have been helpful to me in my career.
• 26:56
  SPEAKER_00: So one thing that comes to mind is really trying to be diligent about setting aside time every week to catch up on journals and just to educate myself there's so much new information out there and things are changing so quickly I think it's it's it's helpful to have that sort of dedicated time and to be very protective of that time.
• 27:12
  SPEAKER_00: And I think something that everyone else needs and no matter what type of career path you take is mentorship.
• 27:17
  SPEAKER_00: So in the case of my career one reason I came here to Iowa was to have mentors for research but I've also had mentors for other aspects of my career people who are more senior than me who've done who've done stewardship or people who are just more experienced ID clinicians, you know people I can go to and talk about my career path and get input on things and um so I think that's something everybody needs and I think when you're looking for a new job that's one thing that you should sort of be thinking about as you go around interviewing people at that new job is okay which people here could be potential mentors for me and would would that person and I work well together.
• 27:46
  SPEAKER_01: Dr.
• 27:47
  SPEAKER_01: Patel, any additional skills or maybe courses or programs?
• 27:51
  SPEAKER_03: I do have a couple of recommendations.
• 27:53
  SPEAKER_03: So first of all we have that the IDSA antimicrobial stewardship curriculum we have the the basic level and then we have an advanced level and we've really tried to talk about leadership, mentorship and stewardship in the advanced curriculum.
• 28:06
  SPEAKER_03: So if you're an ID fellow this is a great time to ask your program director to you know fork up what$200 or something for you to get some of these skills in that second year of your fellowship.
• 28:16
  SPEAKER_03: So I think that's really really a good resource and that's from IDSA.
• 28:20
  SPEAKER_03: And then when you start your job, you know, I agree with Aaron I think you know asking for things like going to a leadership course you know every other year or every couple of years can be really helpful.
• 28:31
  SPEAKER_03: One thing that I went to was that double AMC has a leadership course for women and they have I believe an early career and a mid-career course.
• 28:40
  SPEAKER_03: And even for people later on in their career there's all sorts of leadership courses for wherever you are on your career path.
• 28:47
  SPEAKER_03: So I think that's really important.
• 28:49
  SPEAKER_03: And then IDSA other professional societies also have leadership courses.
• 28:53
  SPEAKER_03: The IDSA has a leadership institute which several of your colleagues have gone to Jessica from from Emery and I'm going to try out this year.
• 29:00
  SPEAKER_03: So if anyone wants to hear how it is, please ask me in like five months.
• 29:03
  SPEAKER_03: But I think that it's really important to go to these because you forget I went to the AMC course a couple of years ago and I forgot, you know, I forgot some of those important things.
• 29:12
  SPEAKER_03: And so each time it reminds you and it kind of reinforces some of those things that you can really use on your stewardship team just like you guys are talking about in your daily life that can help make things a lot easier for everyone around you.
• 29:25
  SPEAKER_01: Thanks Dr.
• 29:26
  SPEAKER_01: Patel we'll follow back up with you in five months for sure.
• 29:29
  SPEAKER_01: But I'm also really glad that each one of you touched on sort of different skills and different courses to take as well.
• 29:36
  SPEAKER_01: As we conclude the podcast I just wanted to ask if each of you all have final thoughts you'd like to share with our listeners.
• 29:43
  SPEAKER_01: And Dr.
• 29:43
  SPEAKER_01: Patel start with you first.
• 29:45
  SPEAKER_03: I think one thing that I tell a lot of my mentees is you know it's really important to not just have that shallow network, right?
• 29:54
  SPEAKER_03: So there's like the shallow network of you meet someone once and then like that's the end.
• 29:58
  SPEAKER_03: I think a lot of what Dan is talking about too that mentorship it can really be a lateral mentorship as well.
• 30:04
  SPEAKER_03: Like for me, my co-fellows have served as peer mentors for me as I've moved from different job to job and I have been really really lucky to develop these really important peer mentorship relationships within the field of stewardship, which I think is really important.
• 30:19
  SPEAKER_03: So I think what I would say is you know invest in those relationships.
• 30:22
  SPEAKER_03: They're probably going to be more than just your colleagues they're going to be your friends.
• 30:26
  SPEAKER_03: And as I look at the group here today, you know, I I think of all of you as friends my first year on the job, Dan was one of the only people doing stewardship research in the VA.
• 30:35
  SPEAKER_03: So I reached out to him, you know, tried to understand more about the field that we were both in.
• 30:40
  SPEAKER_03: I think that's really important.
• 30:42
  SPEAKER_03: So I would say it doesn't have to be super formal, but this these informal relationships, I would invest in them, they become deeper and deeper each year and they can be really helpful along the way.
• 30:52
  SPEAKER_02: Thanks, Dr.
• 30:53
  SPEAKER_02: McQuery?
• 30:54
  SPEAKER_02: I'd co-sign mentorship and in that a peer community and just networking in general I the world is really really small.
• 31:01
  SPEAKER_02: So as you move throughout your career if you want to try opportunities or look for a job in a new space or a new institution or even within your institution, I mean I don't think I do anything without asking like 10 people about it first.
• 31:12
  SPEAKER_02: And again I'm more of a people person and maybe I ask too much but I think getting the opinions of others leaning on others there's always someone who's going to know someone who's done it before or who works there or who's had a similar job and asking them to reach out on your behalf and connecting them I mean similar to what Pyle just said and reaching out to Dan I've cold called I cannot tell you the amount of people in the ID community and they all are probably listening and laughing being like oh yeah I remember when Aaron as a student sent me this random email but the most notable is when I emailed Jason Newland as a resident and said can you teach me pediatric stewardship and he was probably like who are you?
• 31:48
  SPEAKER_02: But he did and he got me connected with his whole pediatric stewardship network and I learned so much from him.
• 31:54
  SPEAKER_02: So I think that that is something that you should just continue to lean into and take advantage of.
• 31:59
  SPEAKER_01: That's amazing.
• 32:00
  SPEAKER_01: Dr.
• 32:00
  SPEAKER_01: Lavorcy, any final thoughts?
• 32:02
  SPEAKER_00: So one thing I've been um surprised by in my career is just the the multiple opportunities to sort of reinvent myself and to redefine my career path like I think back to when I decided to do internal medicine, you know, that was just that that career path opened up many more different options for me.
• 32:15
  SPEAKER_00: And then when I decided to do infectious disease the same thing there was multiple career paths within infectious disease.
• 32:20
  SPEAKER_00: And even within stewardship I mean stewardship is a fairly narrow field but I feel like within stewardship there's so many different ways that you can take your career.
• 32:27
  SPEAKER_00: So I guess one point I would leave the listeners with is just if you're proactive and and and you have a sense of what you want to do with your career, there's plenty of opportunities to help redirect and reinvent yourself as time passes.
• 32:37
  SPEAKER_00: So take advantage of those.
• 32:38
  SPEAKER_00: And I'll also put in a plug for Shay I think we would talk about peer networking Shay is a great opportunity for that and some of the most worthwhile stuff I've done over the past few years has been through different Shea committees that I've been part of.
• 32:50
  SPEAKER_01: Wonderful.
• 32:51
  SPEAKER_01: Well thank you Dr.
• 32:52
  SPEAKER_01: Patel, Merquery and Lavorsi for such a fantastic conversation today.
• 32:56
  SPEAKER_01: We appreciate you joining us you can find more educational content like this podcast on Shay's online education center, Learning CE at www dot learningce.shay hyphenon org.
• 33:09
  SPEAKER_01: This concludes today's episode of the Leadership Management series.
• 33:13
  SPEAKER_01: Thank you for tuning in