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Hat Collecting with Paul Wojciechowski · Style Points

0:11
My name is John Crow, and you are listening to
0:13
Style Points. Today on the podcast, I'm sitting
0:16
down with my mentor and colleague, Dr. Paul Wojciechowski,
0:19
to talk about the many hats you wear in academic
0:22
medicine. Before we get there, I'll hand it over
0:25
to my co -host, Nate Moore, to introduce this
0:27
month's RSI. Thanks, John. I am so happy to introduce
0:31
Dr. Sarah Miranda, one of our interns. She may
0:34
have gone to Florida for med school, but memories
0:36
of warm biscuits and cornbread from working as
0:38
a cracker barrel waitress brought her back to
0:40
the Midwest, and we're glad she's here. She will
0:43
be diving into all the different neck manipulations
0:45
people sometimes ask for during intubation. Tell
0:48
us more, Sarah. Thank you, Dr. Moore. Today,
0:51
I want to talk about the difference between cricoid
0:54
pressure and external laryngeal manipulation,
0:57
and specifically the burp maneuver. what the
1:00
evidence says about them, and why we often ask
1:03
for one when we might actually mean the other.
1:06
So frequently in the ORs, someone will be intubating,
1:10
whether it's the medical student or the attending,
1:12
and they'll ask for pressure. And it's important
1:15
to clarify the clinical context about where they're
1:19
asking for pressure and why they're asking for
1:21
pressure. So cricoid pressure, is also known
1:24
as the Selick maneuver, was first described back
1:27
in 1961. And it involves applying posterior pressure
1:32
frequently with several pounds of force to the
1:35
cricoid cartilage, which sits just below the
1:37
thyroid cartilage. The theory is that pushing
1:40
the cricoid cartilage back against the esophagus
1:42
would compress it against the cervical spine.
1:45
and prevent regurgitation of gastric contents
1:48
during rapid sequence intubation and would thus
1:51
theoretically reduce the risk of aspiration pneumonia.
1:54
So the classic indication for cricoid pressure
1:57
is aspiration prophylaxis in high -risk patients
2:00
undergoing rapid sequence induction, such as
2:04
those with a full stomach, a trauma, bowel obstruction,
2:08
or pregnancy, for example. For decades, this
2:11
maneuver was considered standard during RSI,
2:13
but when researchers started studying it a little
2:15
bit more carefully, the evidence became a little
2:18
bit less convincing. The largest randomized controlled
2:20
trial examining this question was in 2019, known
2:24
as the IRIS trial. The IRIS trial randomized
2:27
more than 3 ,400 patients undergoing rapid sequence
2:30
induction to either cricoid pressure or a sham
2:34
maneuver. The result? There was no significant
2:37
difference in aspiration between the groups,
2:39
although unfortunately the cricoid pressure group
2:42
did experience more difficult laryngoscopy and
2:45
slightly longer intubation times. Another challenge
2:48
to the original theory comes from imaging studies
2:51
that looked at airway anatomy. These studies
2:53
show that the esophagus is frequently positioned
2:56
lateral to the cricoid cartilage rather than
2:58
directly behind it, meaning cricoid pressure
3:01
may not actually compress the esophagus as reliably
3:04
as originally thought. There is, however, some
3:07
anecdotal evidence to support that documentation
3:10
of cricoid pressure during RSI could be protective
3:13
in situations where litigation is involved. Ultimately,
3:16
it seems like it comes down to individual practice
3:19
patterns, as there's not a lot of evidence to
3:22
support that it's necessarily helpful or harmful.
3:25
Now I want to talk about a maneuver that is pretty
3:27
popular in the ORs, and it's used to improve
3:30
airway visualization. This is external laryngeal
3:34
manipulation. or ELM. More specifically, I want
3:37
to talk a little bit about the BURP maneuver,
3:40
B -U -R -P. So first things first, BURP stands
3:44
for backward upward rightward pressure. So what
3:48
exactly does that mean? That means that you are
3:51
manipulating the thyroid cartilage, generally
3:55
backwards towards the bed, upwards towards the
3:59
patient's head. and rightward. The key detail
4:02
though here is that the pressure is applied to
4:04
the thyroid cartilage, not the cricoid cartilage
4:07
necessarily. Unlike cricoid pressure, burp is
4:11
not intended to prevent aspiration. The purpose
4:14
is to improve the laryngoscopic view by repositioning
4:18
the larynx during intubation. Right, so we want
4:20
to get a better view of those vocal cords. The
4:23
maneuver was first described by Dr. Nill back
4:25
in 1993. And since then, several studies have
4:29
demonstrated that burp can significantly improve
4:32
glottic visualization. One study with about 2
4:36
,000 patients found that applying the burp maneuver
4:39
reduced the rate of difficult laryngoscopy from
4:42
about 21 % down to 6%. So when we compare cricoid
4:46
pressure versus the burp maneuver, the differences
4:49
become pretty clear. Cricoid pressure is about
4:51
theoretically protecting the airway from aspiration,
4:54
while burp and external laryngeal manipulation
4:57
is about finding the airway in the first place.
5:00
And the confusion happens because in real clinical
5:03
practice, someone might ask for cric pressure,
5:06
and that frequently becomes shorthand for any
5:09
manual neck manipulation during intubation. So
5:13
the next time someone asks for pressure, it might
5:16
be worth clarifying exactly what they want, because
5:18
sometimes they want theoretical aspiration prophylaxis
5:21
during RSI situations, or sometimes they just
5:24
want a better view. Paul Wojcicki, thank you
5:32
for joining us. Thank you, John. I appreciate
5:34
you having me. So the title of this episode,
5:38
Hat Collecting, that's something that I chose
5:41
pretty specifically for you. A lot of us in the
5:45
department will say, well, I wear a lot of different
5:48
hats in reference to all the different roles
5:50
that we have through the department. I consider
5:53
myself to be somebody who wears a lot of hats.
5:56
Although I don't think that I have very many
5:59
hats compared to you. You are the chief hat collector
6:03
in the department, and I don't actually think
6:07
it's particularly close. Before we get into all
6:11
of that, though, I want to ask you, One of my
6:13
favorite questions that I ask to all of my guests,
6:15
which is my dinner question. Sure. If you could
6:18
go out to dinner with anybody, and it could be
6:19
somebody from the past or even from fiction,
6:22
who would you invite to dinner and why? It without
6:25
a doubt would be Benjamin Franklin. Really? I
6:29
thought he was an incredibly, what I've read
6:31
about him is incredibly wise guy who knew things
6:35
and could think about things and analyze things
6:37
in ways that other people never thought about.
6:40
And that's. a trait in people I really appreciate.
6:44
Would you ask him his opinion on how you run
6:46
the schedule? See if there's any optimizations.
6:48
I think that part he would probably not have
6:51
an opinion on. He may have an opinion on, you
6:55
know, the state of affairs of the world and maybe
6:57
this country too. Yeah. I think that would be
7:00
really interesting. I have gotten a few people
7:03
who have mentioned founding fathers and I, I
7:06
think that those are really interesting ones.
7:08
Yeah. Lincoln would be one of the ones that I.
7:11
would pick out for myself. Absolutely. You could
7:12
throw George Washington in there too. Basically
7:15
the whole cast of characters from Hamilton, I
7:18
think would probably be appropriate. Yeah, absolutely.
7:22
Okay. Excellent. So when you think about all
7:26
the different hats that you wear on a day -to
7:28
-day basis, what are the hats that you wear the
7:31
most often? Which are the ones that you identify
7:34
with the most? Spend a great deal of time. It's
7:44
really faculty development, and that crosses
7:47
a lot more with the schedule than people think.
7:51
What people like to do, what people are wanting
7:56
to do, two different things, and how we can help
8:02
facilitate that. That's a big job. And it's different
8:08
than the mechanics of just putting some assignments
8:11
in a box and making sure that everything is filled
8:14
and the schedule is made. The thoughtful nature,
8:20
the way you treat each individual is I think
8:25
the most important part. And the hardest part
8:28
of the job is when people don't think you think
8:32
about it. They don't think you care. They don't
8:34
think you are doing things thoughtfully. But
8:37
indeed, a thought goes into just about everything.
8:41
So that would be, you would say, the vice chair
8:45
of education hat that you wear that does the
8:47
most with faculty development or is it a blend
8:50
of things? Yeah. You know, specifically my job
8:53
description there as vice chair of education
8:55
does not include a heavy dose of faculty development,
9:00
but that's what it has turned into. And part
9:03
of that is being chair of the APRT committee.
9:07
Sure. That's where the role of vice chair of
9:12
education, the education part, and the promotion
9:16
part, and being a faculty advocate or a developer,
9:22
helping one further their career, they all kind
9:27
of meld into one specific place. Can you define
9:31
APRT? for our listeners. Yeah, sure. So every
9:35
department in the College of Medicine has a committee
9:38
called the Appointment Reappointment Promotion
9:40
and Tenure Committee, APRT. And that committee
9:43
is responsible for every person that's hired
9:45
and has an academic appointment for reviewing
9:47
their CVs, dossiers, and approving that initial
9:51
appointment. And then also anyone who is going
9:55
for promotion, reviewing those dossiers, making
9:59
sure that All the CVs are appropriate for the
10:03
academic level. What's different about the way
10:09
I approach our committee, and there is some significant
10:14
disagreement in the College of Medicine with
10:16
my method, I choose to use it more as a faculty
10:20
development piece. Because I think faculty development,
10:22
my time here at UC, is the one thing that is
10:24
sorely lacking. And so I've used the APRT committee
10:28
as a vehicle to do so. I also that way I can
10:32
meld the schedule to make some of those things
10:35
happen. It's all always with chair approval and
10:39
sort of the understanding of limited resources
10:41
and the needs of everybody else. But that is
10:44
where ultimately where I can really make a difference
10:48
in somebody's career, help put them on a trajectory
10:50
that they want to be on. That committee, the
10:54
functions of that committee are simple. It's
10:58
very well defined in the college medicine guidelines,
11:01
but taking it one step further and asking someone,
11:05
okay, so you want to get promoted, but the question
11:08
is how do you want to do that? Which way do you
11:11
want to do that? Because there's not one prescribed
11:13
way in the old bias of thinking about I just
11:17
need to publish X number of papers. I just need
11:20
to sit around in a cold, dark room and write.
11:24
That's not accurate. That doesn't apply to –
11:28
the academic world in 2026. Would you say that
11:31
starting a podcast would be something that would
11:34
be more applicable in 2026? It's sort of funny
11:37
and ironic because as I recall, I had the light
11:41
bulb and then you took it and ran with it, which
11:43
I think is great. I think is awesome. This has
11:46
turned into an amazing vehicle for our department.
11:50
And the kudos goes to you because that idea,
11:54
that light bulb moment was merely that. But that's
11:58
my best – that's what I enjoy most is having
12:03
younger faculty, colleagues really take an idea
12:09
and really run with it and make a career out
12:11
of it. It's a really cool thing. It's the part
12:13
– money is money, but really watching people
12:18
grow, that's the part about academic medicine
12:21
that I never really appreciated. uh, initially
12:24
in my career, but now appreciate pretty heavily.
12:27
That's the reward. So let's take a step back
12:32
and go closer to the beginning of your career.
12:35
I was just looking at, uh, the plaque out there.
12:39
You were chief resident here back in, uh, 1948.
12:43
Was it not quite that old yet? It was some time
12:50
ago, uh, but it's still on the plaques and that's
12:52
good. Since then, what did your career look like?
12:59
Yeah, I mean, I wouldn't even back it up a step.
13:02
You know, I went to medical school at the University
13:05
of Cincinnati, graduated in 2002. I matched in
13:08
the surgery and I really thought I was going
13:10
to be a general surgeon. Trauma and critical
13:12
care were interesting, probably where I had my
13:15
most sort of inspirational moments. But I found
13:20
within a year of being in surgery that the operating
13:22
part was kind of cool but not what I could see
13:27
myself doing for the rest of my life. And I thought
13:29
somewhat respectfully to my colleagues and more
13:32
importantly patients that that was – having that
13:35
level of enthusiasm was probably not a way to
13:38
start a career. So I shifted to what I thought
13:41
was really a better option, which was doing critical
13:46
care. It's funny because anesthesia, I rotated
13:49
anesthesia in January of my fourth year of medical
13:51
school. Never really thought about it before
13:54
then, but probably would have thought about it
13:56
had I rotated it earlier, which is the little
13:58
piece of advice to medical students is really
14:01
dig in and rotate in as many areas as you can
14:04
so that you understand where there is. But for
14:07
me, it was a natural. fit to go and stay in the
14:10
operating room, take care of patients. You know,
14:12
in the operating room, there's a lot to be said
14:14
about that. It's like critical care. It's just
14:16
on a very, you know, smaller scale. And then
14:19
it was pretty natural to do a critical care fellowship.
14:21
But I'll be honest with you, when I started anesthesia
14:24
after two hard years of surgery, I didn't think
14:27
I would ever end up in academics. Why not? Didn't
14:31
think I was that person. Never thought about
14:33
it. Never, ever thought I would be a program
14:37
director. Certainly never thought I'd be a vice
14:39
chair of education. Never consider the fact that
14:43
I would get into this tangled web of doing a
14:45
schedule. Those were not remotely, even in the
14:49
corner of my mind, that I would be doing at this
14:53
point. This is all somewhat I would call accidental.
14:57
And that is really the interesting part about
15:00
one's career, which is why I take the faculty
15:03
development piece of my current role so seriously.
15:08
Because I got lucky. I found good people. I found
15:12
a pathway that largely was by luck. Now I would
15:20
prefer to have people have sort of some of that
15:23
thoughtfulness, maybe that vision, understand
15:25
who they are, and help them get to where they
15:28
need to be again. It sounds terrible. I'm not
15:33
a terribly money -driven person. Making a good
15:36
living is great and I like to be comfortable,
15:38
but the satisfaction of the job is coming from
15:41
that piece. And that comes as you're hearing
15:44
from that early part where I didn't think I had
15:46
significant influence. But I do remember even
15:52
Annie Friedrich, Steve Lisko, those guys sitting
15:56
me down and saying, hey, what do you want to
15:57
do with your life? And they kind of helped give
15:58
me that guidance. So thank goodness I had those
16:01
guys and Bill Hurford to hire me for my first
16:05
job. I owe them a lot for everything. But it
16:10
still didn't make any sense to me that I would
16:12
be doing the things I'm doing now. I imagine
16:16
so. So was being chief resident your first real
16:18
foray into academic leadership? Did that set
16:21
off something for you? A hundred percent. A hundred
16:24
percent. And it really hadn't, ironically, much
16:27
to do with. the direction of the residency at
16:32
that point. We were still, I don't want to say
16:35
fledgling, but we were still in the sort of formative
16:39
stages. We were still in that stage where, you
16:41
know, if you look at it, the residency didn't
16:46
look when I started or even kind of when I finished
16:50
what it looks like right now. And so that did
16:54
inspire me. Once I became a chief, I kind of
16:56
knew that that's something that I was going to,
16:57
you know, at least explore. It may not pan out,
17:01
but I had two fellowships in between. I had already
17:05
kind of decided. I was a deal between my wife
17:07
and I. She said, we can stay in Cincinnati. You
17:09
can do two fellowships. Set a deal. And that
17:12
was a pretty easy deal for me. So I worked out.
17:16
But yeah, I mean, that's where I figured out
17:19
that, you know, being a part of the residency
17:21
was a really neat thing. And again, it had everything
17:24
to do with helping people achieve their goals.
17:27
It really didn't. It's not much fun. There's
17:31
really not a lot of fun in schedules and block
17:35
schedules and discipline and letters of deficiency
17:40
and all those sorts of things that come along
17:42
with being a residency, APD, PD, if you can't
17:47
get the reward on the back end, which is why
17:49
for me graduation is one of the best days of
17:51
the year. That makes a lot of sense. I remember
17:55
when I was chief resident, considered myself
18:00
to be very motivated to affect change within
18:04
our department. And I took on a bunch of different
18:07
initiatives and some of them were successful
18:10
and are still in place today. Others, I had to
18:15
have a sit down with my program director at the
18:17
time who said, this is a bad idea and you should
18:20
stop trying to do this. And I'm sure that he
18:24
was probably right. It is interesting. But I
18:30
think for me as well, it was seeing that you
18:34
could affect change for people and help make
18:37
a group of people's lives all better. That sort
18:41
of marriage of efficiency and helping people
18:45
together is really what I think propelled me
18:48
towards academic leadership as well. Yeah. I
18:51
mean, you know, it starts with, you know, anesthesiology
18:54
being such a cool branch of medicine. That's
18:58
the first part of it. And the rich history of
19:01
patient safety in there, there's a heck of a
19:04
lot to get behind. You know, it's really not
19:07
hard to think about doing this and what we do
19:10
and doing it well and helping people. The hardest
19:14
part about it is if everything goes super well,
19:17
you generally don't get a pat on the back. That's
19:19
sort of the expectation. It's kind of like the
19:21
airplane flight. Like when the plane lands, everybody's
19:25
like, okay, great. Where am I going next? You
19:27
know, you don't thank the pilot for making sure
19:29
you got from point A to point B safely. Yeah,
19:31
you don't get applause. No, you usually take
19:33
it for granted. They only get applause when,
19:35
you know, something bad happens or something
19:37
like that. Same thing with anesthesia. It really
19:39
is. You know, you really don't get a lot of applause
19:41
and a pat on the back. And I think that's one
19:45
of the hardest things for trainees and others
19:47
to realize is that day to day we grind it out
19:50
and we land those planes every single day very
19:54
safely. And the only time we ever hear anything
19:57
about our practice, generally speaking, is when
19:59
something bad happens. So the chief resident
20:03
hat was perhaps the first hat that you collected.
20:06
It was. What happened after that? What were the
20:09
other ones that you started to collect? How did
20:11
that all develop? Yeah, it was interesting. I
20:13
had a little bit of a break there. So I had two
20:15
years of fellowship. I did critical care first
20:16
and then did cardiac here and great experiences.
20:20
Small fellowships, a lot of individual attention,
20:23
could really understand and think about it. What
20:26
was very nice, Dr. McCodd was my program director
20:29
for cardiac. Dr. Lisko was my program director
20:32
for critical care. They gave me a lot of latitude
20:35
to understand the mechanics of putting some schedules
20:38
together. Dr. McCodd and I worked actually pretty
20:41
close together. putting together a sort of didactic
20:44
piece that really helped. And so that helped
20:47
give me perspective on, you know, what it's like
20:51
to think about an educational program. So that
20:54
was a little bit of a jumping off point. And
20:57
then the residency was at a, again, at a crossroads.
21:00
Those who may be listening may not remember,
21:04
but Dr. Lawrence had taken over the residency.
21:08
Kind of really with Dr. Lowe. late 1990s, early
21:14
2000s. And we were a program that still had citations.
21:18
We were the program that still had, you know,
21:20
less than a full accreditation up until our site
21:24
visit in 2010. And so that's kind of where I
21:26
entered the picture. I started as faculty in
21:28
2009. I was officially named APD in July of 2010,
21:33
but had really started helping him out in that
21:36
year proceeding. And we had that site visit,
21:38
and I remember... having that site visit and
21:41
i remember the details of it to this day it was
21:43
over in that classroom right across the the hall
21:45
from us here and uh and we were so overjoyed
21:49
when we received full accreditation without citations
21:52
or afis or anything like that uh it's an afi
21:55
areas for improvement sorry yeah the lingo gets
21:59
goes quick um but that that was a real you know
22:04
moment where we got out of the hole and then
22:07
we could start looking at the residency and all
22:10
of our programs and innovate. And if you really
22:13
think about it, the training environment you
22:15
see now at UC is not the same training environment
22:17
that was present then. We had a chronic pain
22:21
fellowship. We did not have a critical care that
22:24
started in some years before my time, but that
22:29
was pretty new. We did not have an OB fellowship.
22:32
Cardiac had just started when I was a resident
22:34
here, so we didn't even really have a cardiac
22:36
fellowship. And so you really look at everything.
22:39
Regional wasn't even heard of. The thought of
22:42
having a regional fellowship was, you know, I
22:44
think very small and premature and very few places
22:48
had anything like that. So we were a very different
22:51
place at that point. And I think I'm very proud
22:55
of what we've grown into. It's not been easy.
22:57
But now you look at our training environment,
22:59
it's a big one. We're up there with, I think,
23:03
from quality of anybody in the country. I put
23:06
our residents and trainees up against anybody
23:08
that way. So that's kind of where things started
23:10
with me is that site visit in 2010 and jumping
23:13
off and being an APD. So you became APD and then
23:19
later you became program director. And you started
23:22
also accumulating a lot of other. committees
23:26
and other leadership. How did that all go? What
23:29
was the trajectory there? Well, again, it's a
23:32
little bit by accident. If you look at most of
23:34
my career, it's by accident. I didn't have enough
23:39
thought to put together to think that this would
23:45
all go somewhere. And again, I have to attribute
23:48
a lot of my success to my mentors, including
23:51
Dr. Lawrence, who did get me involved in the
23:53
Ohio Society of Anesthesiologists. And that really
23:56
stuck because it just so happened that 2010 was
23:59
kind of a big year. That's the first time I attended
24:01
as a delegate, the House of Delegates. And that,
24:05
I'll be honest with you, I was bored. I really
24:09
didn't like it the first time. And it kind of
24:12
speaks to the collecting of hats, our theme here.
24:15
Sometimes you have to give something a try before
24:18
you discard it. I really was bored. I was like,
24:22
man, I do not know if this is for me at all.
24:25
And then I kept getting invited, kept getting
24:27
invited, went back a couple times, and then it
24:30
started to get interesting once you understand
24:31
it. It was big. It was overwhelming. And so,
24:35
yeah, that was the point I started collecting
24:38
different roles, which was, OK, APD of the residency.
24:44
Then I got involved in OSA. Admittedly, my track
24:49
was pretty fast to president of the Ohio Society.
24:52
That happened in six years. That's pretty fast.
24:58
But that was a part of it. And then I got involved
25:02
in some other committees. I was on an SCCM committee,
25:05
Psychic Critical Care Medicine, for a while.
25:07
That didn't pan out. If you look at my CV, I
25:09
was there for a while. It just wasn't my thing.
25:12
And I tried a few other things. So I guess that's
25:15
the common theme in this whole discussion is
25:18
you're not going to love everything and you're
25:21
not going to keep everything. But you got to
25:22
try lots of things. It's like food. I'm not a
25:25
very, um, diverse, I don't have diverse tastes.
25:29
Let's just put it that way. I think that's a
25:31
pretty kind way to put it. That's a widely known
25:35
thing too. I think, I think, I think my young
25:38
children have approximately the same palate as
25:40
you from pretty close. Probably. I don't get
25:44
very adventurous at all, but my career, I've
25:48
taken the completely opposite approach. That's
25:51
true. I've, uh, I've tried lots of things and
25:53
there are some things that I said no thank you
25:55
to. But other things have stuck and it's where
25:59
I found good people and where I found places
26:01
where I thought I could make a difference. The
26:03
Ohio Society was a big part of that. That has
26:06
been a huge springboard for me into the other
26:10
hats I've collected in ASA now. And so yeah,
26:14
I mean everything starts but you got to kind
26:16
of stick with it. And the biggest thing that
26:18
happens these days. I would really want to convey
26:22
to others and try to convey to my colleagues
26:25
who are starting their careers is you got to
26:28
stick with it. It doesn't just happen in a year.
26:30
It doesn't happen in two. Sometimes it doesn't
26:32
happen in three. You know, I was APD. I became
26:36
program director in April of 2017. So I was,
26:39
you know, APD and effectively APD getting started
26:43
maybe in call it December of 2009 for. almost
26:47
seven years, what is that, eight years before
26:49
I ever had a chance. And I just was happy to
26:54
be a program developer, happy to be part of it.
26:56
I knew at that point after I got three or four
26:58
years in that I wanted to be a program director
27:00
at some point. And the same thing goes with OSA.
27:06
And the same thing goes with ASA is like you
27:08
really had to stuck with it. Like it wasn't all
27:11
roses at first. I get to do lots of fun stuff
27:14
now, but it didn't start that way. I'm going
27:16
to ask a selfish question for me as an APD now.
27:21
What were some of the biggest transition points
27:25
or changes that you had to go through mentally
27:28
when you shifted from being APD to PD? What was
27:32
that like for you? Yeah, it's a giant leap because
27:36
you go from being an APD where, you know, I was
27:40
pretty close with the residents, could really
27:44
come talk to me. They felt like, you know, that
27:47
was, I was a good person, a safe person to come
27:52
to. And all of a sudden somebody flips that switch
27:54
and you become their boss. Boy, oh boy, oh boy,
27:57
everybody approaches you in a very different
27:59
way. You know, joke around and try to make it
28:02
even now. Like, oh, it's like come to the principal's
28:04
office. I'm like, it's not the principal's office.
28:06
It's just, you know, yeah, you come and talk
28:09
to me and, you know, it's 10. It tends to be
28:11
about serious things. It doesn't always have
28:13
to be about serious things, but it tends to be
28:14
about serious things. So that was the hardest
28:19
part is you really become the boss. And whether
28:22
you like it or not, whether you acknowledge it
28:25
or not, it is reality because in the end you
28:28
have the ultimate authority to say, yes, someone
28:30
can move on in their career or someone can't.
28:32
And after that level of investment of medical
28:35
school plus some residency, that is a very, very
28:40
– big task i can look back across my career and
28:48
it's easy for me to point towards things that
28:50
i might have done differently or mistakes that
28:54
i might have made there's there's a whole lecture
28:58
that i've given before that's basically entitled
29:02
things that i would have done differently um
29:05
what What kind of advice like that do you have
29:09
about things that you picked up that maybe that
29:13
you wish that you hadn't or the reverse, things
29:16
that you wish that you had done maybe earlier
29:19
that you didn't quite get to? I think on the
29:25
side of things you should do is get involved
29:28
in your professional organizations. Get outside
29:32
of your institution. The easiest thing to do.
29:35
is to focus and your chair will love you because
29:37
you'll do all kinds of great things inside of
29:40
your department. The hardest thing to do is go
29:42
outside of your department and do things in other
29:45
professional organizations. And as I described,
29:48
like my first house of delegates, I was underwhelmed.
29:51
It was not fun. I thought, wow, this is great.
29:54
You know, Ohio society paid for me to go to San
29:58
Diego, but I was bored. I didn't think that there,
30:02
I was like, I don't know if this will continue.
30:04
And I thought about quitting on multiple occasions.
30:09
That is part of my advice though is get outside
30:12
of your department, number one. Number two, stick
30:15
with it. Give yourself a timeline. Ironically,
30:21
in a different way, I gave myself a timeline
30:23
in academic medicine because I wasn't sure that
30:25
academic medicine was for me. I gave myself five
30:27
years. I said I'm going to do this for five years.
30:31
And at the five -year mark, I'm going to sit
30:33
down and I'm going to make a decision whether
30:35
this is a place for me to be or this is a place
30:37
for me to go someplace else. So I wasn't even
30:39
sure at first. Everybody looks at me now and
30:41
they're like, oh, you had to be certain this
30:43
is what you're going to do. And I'm like, that
30:44
couldn't be further from the truth. I was as
30:47
uncertain as anybody else, if not more. And you
30:52
have to put a timeline to it. You have to give
30:54
it a couple of years. You have to really get
30:56
to know some people and figure out whether that's
30:58
a place for you. Biggest piece of advice is just
31:02
get out of your department. Go to your professional
31:04
organizations. Meet people in your areas. Find
31:09
out how you can get involved. And then get involved.
31:14
And try it out. And don't quit right away. Give
31:17
it some time because you never know how it's
31:19
going to develop. And as I said, I couldn't see
31:22
the forest for the trees and many of the things
31:24
I had done. Now it's pretty easy for me to see.
31:26
But at then, who knew? And it's not easy being
31:32
a person in the family. I had little kids at
31:34
that point in time. You bring that part into
31:36
it for people. My wife even said to me recently,
31:40
and it was actually a little telling and maybe
31:42
even a little hurtful, but I think she was being
31:43
honest in the best possible way. She's like,
31:45
yeah, you were away a bunch when they were little,
31:49
and it was hard. And I acknowledge that, that
31:52
that was – she made that sacrifice. And that
31:57
sacrifice is part of where things are right now
31:59
and what we're at and the opportunities I may
32:02
have in the future. So you really have to stick
32:06
with it. And it comes at a sacrifice. It comes
32:08
at a sacrifice for your family, your department,
32:11
for you personally. You know, having to prepare
32:15
for these meetings, having to do things. There's
32:18
no non -clinical time for that. You know, if
32:21
you look at my current life. I probably have
32:24
one to two ASA meetings at night, they're Monday
32:27
through Thursday a week. And that there's no,
32:32
you know, that's because I want to do it. There's
32:34
no pay. There's no compensation. There's no,
32:36
there's nothing associated with that. That is
32:38
purely the cost of being involved, but it's also
32:41
being a good steward of the specialty now and,
32:44
and helping, you know, move the specialty forward.
32:47
So let's talk about some of your involvement
32:49
in ASA. What are, what are some of the things
32:51
that you do there? So my biggest role is I'm
32:56
on the board of directors. So I am the alternate
32:59
director from the state of Ohio. So kind of the
33:02
second in charge. Basim Abdomalek at Cleveland
33:05
Clinic is our current director, who's done a
33:08
great job. And again, for me, I've been very
33:09
lucky to have great mentors. He's been a great
33:11
mentor to me. He has taught me a lot. I learned
33:14
a great deal from many people in OSA. And so
33:18
that is my primary role. attend the board meeting
33:21
we meet three times a year i'm headed off there
33:23
next weekend and the goal there is to be ready
33:30
in case he needs me but also be ears for the
33:34
ohio society and what issues are coming up at
33:36
the board level so i can report back but also
33:40
to make sure that the interests of anesthesiology
33:44
are being protected to be completely fair So
33:50
what kind of things do you talk about or do just
33:55
zooming out in a board meeting for the ASA? Wow,
34:00
it comes in so many different directions. There's
34:03
a ton of it that is financial and talking about
34:06
being good stewards of the resources that all
34:08
the dues give us. There's a great deal of talk
34:12
about advocacy. There's also practice considerations.
34:18
There's payment considerations. There's structural
34:23
considerations of how we interact with one another
34:26
and what committees and how we interact with
34:29
the component societies. And so being still –
34:32
having a large role in OSA helps me at ASA because
34:37
I really can see both sides of things. And it
34:42
also helps. I'm on three ASA committees. Being
34:47
pretty heavily involved in those because it lends
34:49
some perspective. The issues that come up there
34:51
often come up at board meetings. So multifactorial
34:56
issues, it kind of depends on what is the emergency
35:00
or the flavor of the moment. That's what we address.
35:05
So I want to move to another one of your hats
35:08
that I find interesting, which is that of being
35:12
the DIO. When I was a resident, I... don't know
35:16
that I knew what a DIO was for the duration of
35:19
my entire residency. I'd love your take on explaining
35:23
what it is that a DIO does and then how you got
35:28
to do it. Yeah, that's an amazing question because
35:31
you'll be floored that I didn't understand in
35:36
my training either for a point what a DIO was,
35:40
nor did I really care. But then at some point
35:43
in time – and it took – certainly in surgery,
35:46
I didn't know, didn't care, even in the early
35:48
parts of my anesthesia residency. But that's
35:50
where, again, by pure accident, I got involved
35:53
in GME here. So I was one of the resident representatives.
35:57
What is GME? Graduate Medical Education. And
36:01
our Graduate Medical Education office here got
36:03
involved in – Graduate Medical Education got
36:06
involved in just being a resident representative.
36:09
It wasn't even – I don't think – turned RAC,
36:12
which is our resident advisory committee at that
36:14
point. And then I kept showing up. So one of
36:17
the common themes you're hearing is, is when
36:19
you do something, you got to keep showing up.
36:21
You got to actually just, and sometimes you sit
36:23
there and you're like, I don't know why I'm here.
36:25
This is really boring. I'm just sharing my internal
36:27
thoughts. There are moments in time where I'm
36:29
like, man, this is a waste of my time, but I'm
36:31
going to go ahead and fulfill the obligation.
36:33
And then all of a sudden it got more interesting,
36:35
you know, after a period of time. And then you
36:39
look at it, and when I was a fellow, the person
36:42
who was – work hours were a big item at that
36:46
point in time. I volunteered myself to head up
36:50
the work hours committee, and that was right
36:52
out of fellowship. And our DIO at that point,
36:55
Dr. Philak, who's our just recently retired dean,
36:57
I think somewhat reluctantly but agreed to let
37:00
a fresh new trainee – I mean he'd been out of
37:03
residency for two years but just was getting
37:05
out of fellowship – head up work hours. And that
37:10
was a big moment because that set me on my trajectory
37:12
in graduate medical education because I kept
37:16
showing up. Again, same thing for OSA and ASA.
37:19
I just kept showing up. I picked a couple of
37:21
things and I kept showing up. And it worked out
37:26
really well because all of a sudden you keep
37:28
showing up, you keep showing up, and I got asked
37:31
to do more things in graduate medical education.
37:36
Unfortunately got involved in a lot of discipline
37:38
stuff and so got to understand the standard terms
37:41
and conditions and what that contract looks like
37:42
and had read one. At that point didn't even realize
37:45
when I was a trainee that that's what I was signing.
37:47
Had no idea what was in it. Sort of admit some
37:51
of maybe my negligence and naivete at that point.
37:54
But it was really, really interesting to get
37:57
involved in the deeper parts of graduate education
38:01
and understand the nuts and bolts of how. Yeah,
38:04
at a program level things work, but then at a
38:06
bigger institutional level. And so what you learn
38:09
is a DIO is a person that's in charge of that
38:11
whole enterprise for the institution. And you
38:14
can have small sort of programs that have a DIO,
38:20
designated institutional official, for one residency
38:25
program or two residency programs, every place,
38:28
hospital, sponsoring. place that has graduate
38:31
medical education has a dio what you understand
38:36
is you can also be dio really big places and
38:38
we're not the biggest but we're a pretty big
38:40
place when i was the io here we had 650 trainees
38:45
that i was in charge of helping them get through
38:48
their careers and that was interesting the story
38:52
is an interesting one because i was asked to
38:54
do it and volunteer to do it and i um I think
38:59
it's fair to say at this point I was asked to
39:01
do it and I reluctantly, very reluctantly agreed.
39:04
Matter of fact, put it off for several weeks
39:08
before I gave them an answer and wasn't even
39:14
sure I wanted to say yes. And it was hard because
39:17
it actually speaks to the residency here. I'd
39:20
just become a program director. I mean I'd been
39:22
a program director for just a short period of
39:23
time. So that happened. I became a program director
39:26
in April of 17. And I was asked to be DIO in
39:30
November of 18. So I really had not been program
39:33
director for much more than about a year and
39:35
a half. And it was a big job to be, because at
39:40
that point in time, and I don't even, pains me
39:42
to even think about it, I was doing our faculty
39:44
schedule, program director, and I was the DIO.
39:48
And so any clinical work I was doing was spent.
39:52
Saturday and Sunday nights in the ICU, and then
39:54
I would move on during my work week and do purely
39:57
administrative work. I would never change it,
40:00
but it was valuable, but it was also quite challenging.
40:07
I remember one time we were at the OSA meeting,
40:13
and this was a long time ago. I don't know if
40:15
you'll remember this, but I made some joke about
40:19
you being 110 % FTE non -clinical. It was close
40:27
to the truth. And I think you maybe took a little
40:34
bit offense to that because I think that your
40:37
concept was that I was saying you don't do any
40:39
critical work at all. But that's not really what
40:43
I was trying to say. It was more that I was just
40:46
astonished how many non -clinical responsibilities
40:50
that you had accumulated because it seemed frankly
40:53
ridiculous to me it and to be fair it really
40:56
was but again it tells you a lot about my career
40:59
which has been a lot of purely accidental you
41:03
know if you look at the scheduling part just
41:04
separate that part out you know our previous
41:08
schedule had left we had three persons including
41:12
my current program director who had agreed to
41:15
do the schedule and then in january of In 2017,
41:21
we signed a contract with QGenda. And my whole
41:24
role in the schedule was merely just to get the
41:27
QGenda platform up and going. And those guys
41:30
were supposed to be the schedulers. Oh, really?
41:32
100%. I never, ever agreed to be the scheduler.
41:36
But what happened is those guys left. And Mike
41:42
was left holding the bag. And all of a sudden,
41:47
he just couldn't do it any longer. And that part
41:52
is – that's a big part of the story because all
41:56
of a sudden, if you think about it, as I put
42:00
in the timeline together in April – I can laugh
42:04
about it now. It wasn't funny then. In April
42:06
of 2017, Dr. Lawrence left, and I became program
42:09
director. I was in the middle of putting Cugenda
42:12
together for this project, and then I find out
42:14
in May. that Mike no longer is going to do the
42:16
schedule. I begged and begged and begged him
42:19
and Angie Friedrich to please do the June 2017
42:22
schedule because I couldn't do it. I just had
42:26
too much on my plate. And I took over and the
42:28
first schedule I made was July of 2017. I never
42:31
intended to do that. It just sort of fell on
42:34
my lap. I was sort of the last person standing
42:37
at that point. And so then you put that, those
42:40
two items together and it was like, wow, that's
42:42
a huge job. That's a big deal. And then you throw
42:45
the DIO thing in my lap. And again, I won't divulge
42:49
too much of the details. I think that some of
42:50
it is still private. But I was approached to
42:55
take the job in 2018. And I don't know if I was
43:00
the only person, but I was the person who was
43:02
probably the most available, which is odd, and
43:06
the person who they thought could do the best
43:08
job. And so all of a sudden – In November of
43:11
2018, I was, you know, I was program director.
43:17
I was running the schedule for this department,
43:19
which quite frankly was only about, you know,
43:22
between 50 and 60 faculty at that point. So it
43:24
isn't anywhere near what it was right now. So
43:26
it was actually something that could be handled.
43:29
And then all of a sudden it was a DIO, not to
43:32
mention the fact in 15, 16, I had also been,
43:34
or 16, 17, I'd been the Ohio society president.
43:37
So I just passed that up. So those were some
43:40
big years for me and they – and all of a sudden,
43:43
a lot of the things I've been doing for the previous
43:45
five years or so before that kind of all materialized.
43:49
It crystallized in one sort of short period of
43:52
time and I did have a lot of jobs. And to be
43:55
completely fair about it, I've spent the last
43:56
eight years or so shedding as many of those jobs
44:00
as I possibly can. Because you get the experience
44:03
and it's great and being a DIO was – Something
44:08
I would never – I don't regret and I'm really
44:12
glad I did. But boy, oh boy, was it interesting
44:15
at times. So tell me a little bit more about
44:18
what a DIO does. What's the day -to -day like?
44:22
What sorts of examples – obviously without getting
44:25
into specifics. But what would be an example
44:28
of something that would fall under your plate?
44:32
And to be completely fair about it, it's not
44:34
as much fun as everybody would think it is. You
44:36
really end up dealing with a lot of issues. The
44:39
budget is a big one. So the finances for graduate
44:41
medical education and making sure the finances
44:44
are in line is a huge part of that job. The other
44:47
big part of the job was making – was discipline
44:49
and making sure that everybody stays in line.
44:54
So the issue would be that a resident would be
44:58
in some sort of – Big trouble that would be something
45:04
that exceeds the bounds of even the program director's
45:07
responsibility. And then it comes to the DIO.
45:10
Is that right? Absolutely. So what would be an
45:13
example of something like that? Well, you have
45:15
instances where you have residents that get in
45:17
trouble with the law. Sure. And that becomes
45:19
an institutional concern then, especially if
45:22
things show up in the news or things like that.
45:25
Thankfully, there went, I can't recall an instance
45:27
that. It occurred during my time there, but there
45:30
were other things where residents will sort of
45:33
run afoul of things and, you know, some not by
45:35
their own doing, some by some bad choices. And
45:40
your job is to really help them through that
45:42
and to walk a very, very tight line between the
45:47
institutional person. You're technically their
45:49
employer. You're their boss. That's the hard
45:52
part about being program director and chair and
45:54
everything like that. You know, the DIO is technically
45:56
the person who employs all of those residents.
45:58
They sign that contract, their signature on there,
46:01
you know, puts everything together. And that's
46:04
a really difficult thing because you ultimately
46:06
have to be the authority and the person who's
46:09
responsible for discipline. That was a big part
46:12
of it. You know, the other part of it, which
46:14
is sort of fun, is looking at some of the resources
46:16
and the learning environment and doing some of
46:19
those things to help. programs out, help them
46:22
be more successful, help the residents, medical
46:26
students and other trainees have a good experience.
46:30
You're not specifically responsible for medical
46:32
students or others, but the crossover is only
46:35
natural and, you know, makes perfect sense in
46:38
some ways. You have to think about when a medicine
46:40
team is, you know, four residents plus, you know,
46:43
an attending plus, you know, three medical students.
46:47
only give them a room that's big enough for the
46:49
four residents and the attending, then you've
46:50
excluded the medical students and then that's
46:52
a problem. So you really do have to think about
46:54
the overall picture. And that's part of being
46:57
a good steward for the College of Medicine as
46:59
well, is really thinking about the student's
47:01
experience. When I think of all of these roles
47:06
that you've held and what you do now, I think
47:10
of you in a way as the chief mentor of the Department
47:15
of Anesthesiology. Would you say that that's
47:19
relatively accurate? Yeah, I don't know if you'd
47:22
use the word chief, but I guess by a lot of these
47:25
experiences that I've kind of been telling stories
47:27
about, it's kind of good to go down memory lane.
47:30
I do have some significant amount of knowledge
47:34
and sort of things I did right and things I did
47:37
wrong that I can help convey to folks and, again,
47:43
help them along in their career. You know, not
47:46
one size doesn't fit all. And some are go -getters
47:50
and they do it on their own. But others, you
47:52
know, need a little bit of help. And, you know,
47:55
it's interesting because one of the biggest questions
47:56
that's always come to me is how did you do all
47:58
that stuff? And it's not a simple answer because
48:01
it's like you just have to go outside of your
48:04
shell a little bit. You got to connect with people.
48:07
You got to show up. And sometimes you got to
48:09
show up and you got to stay when it really is.
48:12
So it's a couple of times. It's really boring.
48:15
It was really, you don't understand what your
48:16
place or what your role. And all of a sudden
48:19
you'll wake up one day and you'll be in charge
48:22
of it. And you'll be like, wait a minute. You
48:24
know, it was only a short time ago that I thought
48:26
this was really a, you know, useless endeavor.
48:31
One thing that I've learned over time in my hat
48:35
collecting is that people often look up to leaders,
48:40
whether it's the chief resident or the program
48:43
director things like that they think wow that's
48:46
such a cool position of leadership it must be
48:50
really neat to be that guy but when you actually
48:54
get to some of these positions you realize what
48:57
the job description is is much more of a service
49:01
-oriented endeavor you're really doing the nitty
49:07
-gritty work the filling out of the paperwork
49:10
the dotting the i's the crossing the t's that
49:14
enables everything to function and a lot of that's
49:17
pretty invisible it is and it's not really all
49:20
that fun you know you really as a program director
49:24
the accreditation piece is huge and you end up
49:27
filling a lot of a lot of paperwork that's not
49:29
a lot of fun now you can you can turn it on its
49:32
head a little bit and that's where you know i
49:34
figured out because i man i do not like paperwork
49:38
i really don't like paperwork But I figured out
49:42
how to have some fun with it. And one example
49:45
of that is how we do our annual program evaluation.
49:48
So that came up during my time as sort of I think
49:52
maybe APD into PD, somewhere in that time frame,
49:55
that concept of having a program evaluation committee.
50:00
And I thought, wow, how can we make this fun?
50:02
Because I could invite a whole bunch of different
50:03
people. I can invite some residents. To be fair
50:06
about it, all that would do is just disenfranchise
50:08
people. the people who weren't invited to be
50:10
like, why didn't I get invited? Why am I, you
50:12
know? So I thought, well, forget that. Let's
50:15
just have everybody. Let's invite everybody.
50:17
And whoever shows up are the people that want
50:19
to be there. Residents required to be there,
50:22
but faculty, other, hey, if you want to show
50:26
up, great. That was fun because every year I
50:29
got to hear what we were doing well. And I also
50:34
heard about the things that we can improve on.
50:36
And so I really. used that as my springboard
50:38
into filling out all the, you know, the web ads
50:40
paperwork for ACGME, the, the annual program
50:44
evaluation for the, you know, GME office. And,
50:48
and then I looked forward to how we were going
50:50
to do, you know, achieve those goals, make those
50:55
changes in the program. It makes doing that paperwork
50:57
a little bit more fun. Some people don't view
50:59
it that way, but it's kind of really how you
51:02
view it. That was one way that I looked at and
51:04
said, yeah, you know, even though I'm, mostly
51:06
a paperwork pusher in a lot of ways and a disciplinarian
51:09
and I get to do all the fun stuff that's not
51:11
so fun. Those are the ways you can kind of turn
51:14
it on its head a little bit and have fun with
51:16
it. It's not all, you know, oh, this is really
51:19
terrible because it makes it sound like being
51:21
a program director is a bad job. It's not a bad
51:22
job. It's just a hard job. And the cool part,
51:25
again, is you get to see residents at the very
51:27
beginning of their career and you watch them
51:30
and you help them and you see them at the end
51:33
when they graduate and it's incredibly gratifying.
51:36
And there's no extra pay. There's no anything.
51:38
There's no personal gain other than the satisfaction
51:40
of knowing you helped somebody get somewhere.
51:45
You mentioned earlier that you were trying to
51:48
shed some of these roles now. What do you think
51:53
is the right time to step down from a role? Yeah,
51:58
it's an interesting question because that was
52:00
the real question for me as a program director.
52:04
In a lot of ways, and this sounds maybe a little
52:08
selfish, but I felt a little cheated because
52:10
I'd been a program director for a year and a
52:12
half. And then all of a sudden they asked me
52:15
to be DIO. Well, being DIO and program director,
52:18
the two, I didn't feel like I could, you know,
52:21
we did a great job. I had great APDs, people
52:24
who stepped up and helped me, but I felt like
52:27
I didn't have the sort of the bandwidth, the
52:31
mind. the thinking capacity to really put all
52:35
of my creative efforts into the residency. And
52:38
then COVID hit and it was even worse. And then
52:42
by that time it was, you know, close to 2022.
52:45
And boy, I really, I thought all about it. Maybe
52:50
I should hang on, be programmed for a little
52:52
bit longer. Maybe I'll get some of that satisfaction.
52:54
I can think about it, innovate, do things. But
52:57
to be completely fair about it, it was time to
53:00
make a change. And, you know, Mike Howershark
53:04
was the right guy. And he was ready for it. And
53:07
it was a good time for him. And it was a good
53:11
decision. It was a hard decision, but it was
53:12
a good decision. And, you know, if you had asked
53:15
me to stay on for program director for another
53:16
couple years, I would have easily agreed to do
53:19
that. But in retrospect now, it was a good time
53:23
for him to take the program. He's done a great
53:26
job. He's really, really, really taken a different
53:28
tact on some things. And but, you know, I have
53:31
some regrets that I didn't get, you know, my
53:33
full sort of experience that way. I didn't get
53:37
to do all the creative things and other things
53:39
I really thought that I and dreamed that I was
53:42
going to do at that point. At that point, you're
53:44
all in and you really want to, you know, you
53:47
want to make a you want to have a bang up experience
53:50
and you want to make a difference. One thing
53:53
that I was thinking of and quickly Googled while
53:56
you were talking about this is. The city of Cincinnati,
54:01
where we live, is named after Cincinnatus, who
54:06
was very briefly a dictator in Rome. And interestingly,
54:14
Rome was in a battle with another large fighting
54:21
force, and Cincinnatus was summoned from his
54:24
plow to assume complete control over the state.
54:28
He achieved a swift victory in 16 days, according
54:32
to this Wikipedia article. And then he relinquished
54:35
power and its privileges and returned to labor
54:38
on his farm. And the whole civic virtue of Cincinnati
54:45
is based on the idea of relinquishing power.
54:48
I just think that that's a really cool philosophy
54:53
to have a city named after. One of my – probably
54:58
my downfalls as a leader is sort of knowing when
55:03
to say when. It's sort of interesting. It's been
55:04
easy in some ways. It's been more difficult in
55:07
other ways. I look at some of the projects I've
55:09
had ongoing. I still do work hours for GME. I
55:13
mean that's been going on now for – we're going
55:17
to approach 17 years. There's not been another
55:20
person who's sort of been on – had their finger
55:22
on the pulse of work hours here. Even through
55:25
my time as DIO and everything else, I have stayed
55:28
in charge of work hours. You know, if anyone
55:31
ever decides that they're passionate about that
55:33
and wants to take it over, I'd be happy to give
55:37
that along. And, you know, you look at our department
55:40
schedule and how that is such a big project and
55:45
where we've come from and where we are now. You
55:50
know, I think there's still some things to be
55:52
done. And eventually someone's going to have
55:55
to take the torch and do it. My goal is not to
55:59
be the permanent anything, permanent vice chair
56:03
of education, permanent scheduler, permanent
56:05
this, permanent that. That never has been the
56:08
goal. But one of the things that's hard for me
56:11
is when I think there's still things to be done.
56:14
And that's how I kind of view scheduling. That's
56:17
how I view certainly the vice chair of education.
56:22
unfinished business there. If you could go back
56:26
in time and give yourself advice back close to
56:31
the moment where you started collecting hats,
56:33
what would that advice look like? Probably to
56:46
be more present in the development of the faculty
56:58
side of things in the institution, in our department.
57:04
I look at it now and I think some great things
57:07
have happened. I was so heavily involved in the
57:10
residency and the development there, but really
57:13
getting involved with more faculty development
57:16
pieces because, again, I do think, and they may.
57:21
Not that I say this, but I do think that's one
57:23
of the things that we're pretty sorely lacking
57:25
at UC is true faculty development pieces. I also
57:32
think it's one of the greatest things about being
57:33
here because there's a ton of opportunity because
57:35
it's almost a blank slate. You can almost write
57:37
your ticket to what you want to do. But I also
57:40
think that's very hard because the path to writing
57:43
that ticket is challenging. And as you've kind
57:47
of heard my story, my story is, boy, I got lucky
57:49
a lot. I bumped into some good people. On the
57:54
GME side, I would be remiss if I didn't mention
57:57
Amy Bunger, who was really, really, really incredibly
58:02
influential in my development as a GME person.
58:09
And so I've really had a lot of luck in bumping
58:15
into great people to get me involved in these
58:17
things. to me, shouldn't be the norm. The norm
58:23
should be more of, you know, really investing
58:27
in our faculty and paying attention to what they
58:29
want and what they want to do. I think there
58:32
is probably, you know, the sum of all of those
58:34
parts is going to be one thing. The whole has
58:40
a potential to be much greater than the sum of
58:42
all of those parts, because I think if you ever
58:44
get anybody, everybody swimming in close to the
58:47
same direction. Boy, we could be a real powerhouse
58:51
academic place. Lastly, what kind of style points
58:56
do you want to share with us today? So points
58:59
of personal preference that have really brought
59:02
you success across your hat collecting career.
59:05
And you've given us a ton, but maybe just to
59:09
sum up. Yeah, no, I think the biggest things
59:11
are, you know, if I were to advise someone now,
59:15
kind of look at what buckets of your. your career
59:18
that you have you know what what what makes you
59:20
what are you interested in what you're passionate
59:22
about in the clinical bucket you know what are
59:24
you what are you thinking about what are you
59:26
passionate about in education you know are you
59:29
passionate about anything in administration are
59:30
you passionate about anything in scholarly work
59:32
are you passionate in faculty development mentoring
59:35
what are the things that you're most passionate
59:37
about Pick those things and go after them. Go
59:40
do them. Don't be caught in the quagmire of somebody's
59:44
going to come to me and ask me to do these things.
59:46
That's not going to happen. You're going to have
59:48
to put yourself out there. You're going to have
59:50
to find those accidental people in your life
59:55
that will make a difference. Like I said, there's
59:58
been many great ones for me. And to be completely
1:00:01
fair about it, you really have to put yourself
1:00:03
out there. It's going to cost something personally.
1:00:06
It's going to cost something professionally.
1:00:08
but it leads to a great career. I think that's
1:00:13
the reward of academic medicine is you get to
1:00:15
do some other things other than clinical care
1:00:17
because clinical care is very rewarding. You
1:00:20
do a good job, but the other parts are also equally
1:00:24
as rewarding. Paul, thank you so much for joining
1:00:27
us. Thanks, John. I appreciate it. Thanks for
1:00:32
joining us for another episode of Style Points.
1:00:35
If you enjoyed the show, please consider leaving
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us a rating or a written review. It's the best
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way to help other people find the podcast. If
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you didn't enjoy the show, just toss it in your
1:00:46
closet with the rest of the hats that you never
1:00:48
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1:00:57
We're all done.