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#068 - Dr. Alvaro Proaño MD



Hello Friends 👋


Daphna and I are very excited to bring on the podcast this week Dr. Alvaro Proaño. Alvaro recently completed his residency at Tulane University and is a rising fellow at the Children's Hospital of Philadelphia. This episode is an excellent opportunity for our community to hear pediatric residents' challenges during their NICU rotation. Alvaro also spoke to us about his work on Twitter and how trainees and neonatologists can leverage social media for a variety of purposes.


Enjoy!

 

Bio: Alvaro is a pediatric resident at Tulane University and an incoming neonatology fellow at Children's Hospital of Philadelphia. He is from Lima, Peru where he learned medicine in a resource-limited setting. He created two bots that keep the #neoTwitter community connected and informed. These bots are @neo_papers and @neo_twiter. The former pulls published papers from PubMed and tweets them, and the latter retweets posts related to the #neoTwitter community.


 

The transcript of today's episode can be found below 👇

Ben 0:46

Hello, everybody. Welcome back to the incubator podcast. Dafna. How are you?


Speaker 3 0:51

I'm doing I'm doing great. I'm, again, still on vacations.


Ben 0:58

So for once, I get to say, I just came back from vacation. Went to the south of France, went back home, South family, it was phenomenal. The reason? I mean, people know that you are part time. But the reason I'm not on vacation as much as you are, is because my wife is a cardiologist, as I've always seen, what an awful Oh my God.


Speaker 3 1:25

You know what, I'm glad we're talking a little bit about vacation. Because I, I saw some tweets this week about people skipping their vacations and stuff. And, you know, I used to do that. And it really catches up with you. I just think it's, this is a good plug, too. You don't have to go anywhere. But take some time for yourselves, you know, doesn't have to be over the summer. It doesn't have to be fancy. Just take some time away. That being said, We've been recording or writing every day. So don't do that.


Ben 2:02

But that's that's passion project.


Unknown Speaker 2:05

passion project. Alright, shall we but


Ben 2:09

to our credit, we did postpone the Neo review podcast. So


Unknown Speaker 2:15

we're begrudgingly


Ben 2:18

we're back. I mean, but the content we've never sacrificed content. So tomorrow, we'll have a series of episodes, discussing GBS and some of the new guidelines. And we talk to the famous doctor popolo. Am I pronouncing that correctly? I should ask her. But we're going to talk to her. She's going to be on the podcast. So I think this is going to be a great week to talk about a very common issue in the newborn nursery in the NICU. So stay tuned. We have great episodes that we've recorded. We have today's episode, obviously is very exciting. We have Dr. Avro fanaroff coming up. So yeah, a lot of great, great content. So we're very and and we're not responsible for this content. We're very thankful for people making the time and coming on the platform to share their experience their stories, so thank you, to everybody. So today, we are still in July. It's growing fast. But we're still in July. So we're still focusing on training and trainees. And we have today with us, Dr. Avro Pro Annual, who is a Twitter superstar. He is he Well, at the time that we recorded this episode, he was a resident, a pediatric resident at Tulane University. He has since graduated from residency, congratulations Alvarado and is now a neonatology Fellow at the prestigious Children's Hospital of Philadelphia. ovvero is from Lima, Peru, where he learned medicine in a resource limited setting. And his work is already very significant, and something that we've both benefited tremendously, mostly on social media. He has created two bots, which are basically robots on social media that basically post any content that is tagged with the hashtag new Twitter in order to keep people connected and informed. Those bots are available at the following handles at Neo underscore papers. And at Neo underscore Twitter. The former polls published papers from PubMed and tweets them and the ladder retweets posts related to the hashtag news new Twitter community. So without further ado, please join us in welcoming Dr. Avro perennial. ovvero thank you so much for being on the show with us. How are you today?


Alvaro Proano 4:48

I'm doing well. Thank you for inviting me. It's quite an honor.


Daphna 4:54

Honor czars that are Yes.


Ben 4:56

Yes, the honor is out is ours and you're ready. You ready? wasn't exactly what we're trying to do here at the incubator, obviously, we recently had the series of legends of or giants of neonatology and we talked to all these very famous people. But the goal of the incubator, which is why it's also called the incubator is to, is to showcase a little bit some of the talents that are coming down the pipe from from residency from fellowship and, and showcase the good work that these people are doing. So. So yeah, no, thank you for coming on. You are a What are we gonna say? Like a B list celebrity on Twitter, or a list? Celebrity? Yeah, a list.


Daphna 5:38

Especially on via Twitter.


Ben 5:40

I know. I know. And so for many of our audience members, you will be very well known. But for the people who may not know who you are, can you tell us a little bit about yourself where you're from and what you're up to these days?


Alvaro Proano 5:54

Yeah, so my name is Alberto. I'm from Peru, Lima, Peru. Born raised there, my whole family's there. And I, after finishing high school, I was doing mathematics, I thought it was going to be a mathematician and computer scientist. I went to Rochester for a couple years after that. And then I wanted to do medicine. And then when I wanted to do medicine, I stumbled upon some obstacles in the US, because they told me that table to get loans will be able to like apply, I needed the money like that, as an international, I needed the four years of medical school, the tuition to be able to run by so. So I had to say, I had to make a decision. What should I do? I mean, I don't have the money. And I think there were only like two programs in the country that could otherwise work. So I decided maybe I should, you know, try another route and go home. So I went home. And it was hard, because a lot of people want to do medicine back in Peru too. And I applied to my university University at the time, no idea in order to pay to unlock it. And thankfully, I got in, it's a seven year program. And then after I finished, I didn't know if I wanted to stay in Peru come to the US. But then I saw like a lot more research. I was starting to do more research, thanks to global health, like people from Hopkins were doing global health in Peru. And I started to get connected. And I decided I wanted to come to the US. So my wife and I, she's also a physician. We both couples match here at Tulane, and we're very happy. And, and then during the road, I kept thinking, what what, what else should I do? And then I decided to do an ontology. So I'm going to NICU. That's that's my


Ben 7:39

story. And you'll be starting your NICU fellowship at a chop in July.


Alvaro Proano 7:43

That is correct. Yes, I'm going to chop in July. And I, I the whole interview was virtual that I finally visited a couple of weekends ago. And it was it was great to see the place where I'm going to be training in the next three years. Yeah.


Ben 7:56

Congratulations on that. What is your wife? What is your wife doing is she also in pediatrics?


Alvaro Proano 8:01

know she's an internal medicine, she likes the adults. She and she will be a hospitalist.


Ben 8:08

So it's exactly the same scenario. I was in the same scenario as you I was in pediatrics, my wife internal medicine. And yeah, now she's decided to pursue a career in cardiology. So I relate to your I relate to your familial situation,


Daphna 8:26

the plight of a to physician hassles.


Ben 8:28

But let me ask you something, I want to go back to this to this epiphany that you had as a mathematician that you were going to pursue medicine, right. I mean, mathematics is so is so intellectually sophisticated. And I'm wondering, what, what went through your head that you like, no, mathematics is not doing it for me. I want to pursue medicine?


Alvaro Proano 8:50

That's a great question. I think that mathematics is so different than medicine. Someone recently asked me or maybe a few years ago asked me. So you went from the most precise type of science, there could be to the most imprecise science that could be that now we talked about p values, confidence intervals, nobody knows what really works, because everything is different for every person. There's a lot of questioning about pee hacking and all that. And then math, I really liked math, because it was just pure, like, you know, you had to prove formulas. You knew the formula, and if it was that, that was that. But the problem, I guess, I wanted to get back to society. As I kept, I was doing metal, I was doing math, and I was doing computer science. I was really I was programming I was it was doing well. But a lot of my classes were starting to get geared towards like businesses and started getting geared towards or the math was starting to get geared more towards like just being a professor not just towards being a professor. So I felt I wanted to do something more active in society. I felt I wanted to give back to society in a more active role. So that's why I started thinking about what should I do? What should I do? And then my dad is a pediatrician. So I really never wanted to follow his footsteps. I wanted to do my own, my own my own thing. And, and I don't know, I just, I felt medicine was perfect for me. My dad, actually, he, he told me, okay, so you're sure you want to do PVS you want to sure you want to do medicine. So come back to Peru, do some volunteer work in the hospital, and he sent me to GI and he sent me to the ID sis service. And after I saw, like, I don't remember a lot of scopes. He was like, so you still want to do this? And I was like, I fix Yes, I do. And, and okay. And then, you know, it was difficult for my family to because I had a full ride at Rochester, and they were helping me and it was difficult to help me be in the US and then come back to, like, just zero. But, you know, that's what I wanted. I wanted to follow my dreams. I also thought about finishing that career first, but I just didn't want to delay my dreams. My dream of being a doctor.


Ben 11:06

Did you was were you married at the time when you made that decision was


Alvaro Proano 11:10

No, I was single. I was single.


Ben 11:15

It's a very difficult decision, right? Because you're basically vanquishing all the safety nets that you've built for yourself, right, you have a career you have you have, especially in a field that has a ton of opportunities, and you decide to just press the reset button and take all the chances all over again, even though you could say that your background in mathematics was going to play out and be a strength but it's it must have been very scary. It's interesting how you it's I'm interested in the way you're portraying this right, you're saying my family was really afraid. But you're you're saying this in this in the way where they were concerned for your future. But it seemed like you had no doubt that this was going to work out for yourself. So that's that's kind of interesting is that?


Alvaro Proano 12:01

I was afraid of course, I was afraid I didn't know if I was gonna get in. And the first question I got in the interview in Peru was so you, you went to program, a great program, you're doing this and two years later, you're baiting out? How do we how don't we know that you're gonna not do the same here. And I was like, because I've matured and that this is what I want to do. And


Ben 12:21

because I'm here today, yes, this alone should tell you that I'm motivated.


Alvaro Proano 12:26

And it was I don't know. And it was it was great, actually, to be back home. And I had a lot of different experiences I had a lot of we, our curriculum is very focused on tropical medicine. So I learned a lot about tropical medicine, public health, I was able to do like rotations in other places, too. I did a rotation in Brazil, I did a rotation in Sweden, and all that I think helped me later because that just gave me more knowledge about about medicine in the world.


Daphna 12:54

That's super cool. We actually do a little bit of Tropical Medicine down here in South Florida. We could use that expertise. But you know, we talk a lot about on the podcast about, like people who reinvent themselves, right? And it's like a scary thing to do. And I wonder why some people like you are willing to take the leap and reinvent yourself when, and maybe other people have such a hard time with it.


Alvaro Proano 13:28

I think, at least for me, I I look for happiness. So I think that will I was I wanted to be I wanted to be a doctor, that's what was gonna make me happy. I feel that for other people being a mathematician is the exact thing to do. So, for me, I just wanted to follow my my dream. And it was very, it was a very difficult decision at that time. I wasn't I'm not sure I I'm also a little I guess I like to make big decisions. And I I I trust myself, but I'm I'm also scared every time I make it like that. But since then, yeah, it's difficult. It's difficult. It was very difficult, because some people told me what have you don't get in what will happen later. And I was like, I don't know. I mean, if I don't get it, maybe I'll just finish this first, but I felt I was gonna get it and I felt that was gonna really try. And I'm grateful that it happened. And I learned about Twitter in med school. So a lot of things are playing out that.


Daphna 14:30

Yeah, it's funny how our experiences kind of set us up. I wonder because I think there are lots of people in medicine who are on happy. And, you know, you're just finishing or you're just starting your fellowship training. And I think you will encounter a lot of people who are unhappy for one reason or another. And medicine really, is this opportunity where people can keep reinventing themselves and So anyways, I hope I think you will inspire people to reinvent themselves, which I think is really neat.


Alvaro Proano 15:07

I don't regret any of my decisions. I think that you know, I guess it would have been nice to have more degrees been bachelors mathematics, but I don't that I don't know the degrees don't fill me fill the experiences filled me and I just learned a lot. Being at Rochester going back to Peru doing medicine in Peru. I am so grateful for all the experiences I've had, um, I will do it again, the same way.


Daphna 15:32

Yeah. And it wasn't it wasn't for naught, right? Like, actually, mathematics is actually a really valuable skill in medicine, and especially if you have an interest in research like you do. And your background in computer science, I mean, has really kind of set your path, hasn't it?


Alvaro Proano 15:51

Yeah, I didn't really expect that. I mean, I always think about that speech from Steve Jobs that he gave to Stanford, but like how the dots connect down the road, you cannot connect the dots in the future, you'll just connect them later on. And like, I don't know, I wanted to do research at some point. And then I, I told my mentor about my, my background, and he's like, Oh, no, you'll like this, this this. And I was initially, initially, I was going to actually do a project in like lung ultrasound a few years ago, I'm still interested in ultrasound. But then I ended up doing a project on cough and tuberculosis. And that was, that was very cool, too. So yeah, I don't know, I'm really happy to find my path. And it was hard.


Ben 16:36

Yeah, I think it's it's, it's interesting that in the US, it's, it's become a little bit of what started as good intention became a problem where people now have this this template of like, Oh, you want to go into medical school, you have to major in biology, you have to go volunteer at the hospital, you have to become a scribe. And then you go into medicine, and then you get to medical school, you have to do some clinical research. And then you have to do x. And this is all like this path that's outlined. And it's, it doesn't leave room for people to explore their interest. And you're the perfect example of, yeah, you may start by doing something that seems completely unrelated or a bit distant to the field of medicine. But eventually, it's these. It's these experiences that allow you to do something novel with medicine. I mean, this is you're talking about Steve Jobs and and the commencement speech that he gave at Stanford, but my favorite quote from Ralph Waldo Emerson was, Do not go where the path may lead, go. Instead, where there where there is no path and leave a trail. And I think you exemplify that a little bit by by the path that you've that you've taken. And, and to to talk about ourselves a little bit. Like, I worked with my brothers when they were doing music on helping them produce their, their, their music. And so it gave me some experience doing some audio mixing, which allowed me that to do this podcast.


Daphna 18:00

Ben does all the audio. I can hardly write an email effectively. So Ben is always a tech. So


Ben 18:07

it's a testament to people that pursue your interests, and they will, they will work out, right. And if you like art, maybe you'll become a medical illustrator. Right? There's so many opportunities that people don't think about. So, yeah, I could not, I could not agree with you more.


Alvaro Proano 18:22

And I think medicine is so wonderful, because there's so many, you know, besides there's so many things you can do, you can become a pathologist, you can become a radiologist, you become an intern as you can, you can do anything and there's so many paths. And then if you choose a path and let's say, Oh, you want to try something different, there are more paths, like I think about the future the future is going to be more and more specialties and now that there's more like exploration to space and stuff like that there's gonna be more medical space and who knows like neonatologist, you know, being being on space and stuff like that. Like there's a lot of you. Yeah, there's there's a lot of things that will happen in the next 50 years that


Daphna 19:01

I had not considered that, you know, I think about reinventing myself, but I did not consider a space.


Ben 19:08

The Kennedy Center is two hours.


Daphna 19:11

Maybe, maybe I'll work there but I don't know about doing it. For me, overall, we'll


Ben 19:17

we'll tweet Elon Musk and we'll make sure to get you on that next SpaceX Falcon nine you know algebra one of the reasons why I was very excited to have you on the podcast is because you are not yet and neonatologist. You are a resident and I feel so young


Daphna 19:33

and fresh and


Alvaro Proano 19:36

yes, and that's why I was I was a little scared of being on the podcast.


Ben 19:42

But I think it's very interesting. We've worked with so many of our colleagues and I feel like the way residency is being structured and the role that residents have today is very, very different from even when I was in residency, and it's created a big divide between the attendings and the residence as to the expectations, right? It's like well, back in my day we used to do XYZ and it's like Yeah, dude, it's it's great but like the field has changed dramatically. And there's a lot of pressure on future neonatologist to adapt to a new changing face of residency and expectations. And I think people will benefit tremendously, both in training and both in in who are attending to hear some of your perspective as a resident and some of the things that you guys experienced as residents going through your training, especially in a case like you where you're interested in NICU in order to understand a little bit how we can all get better at didactics. And, and giving people this passion for neonatology that we've acquired as well for residency. And so I guess, for the people who are no longer familiar familiar with residency, how much NICU did you do as a resident?


Alvaro Proano 20:55

So I think I did four months total of NICU and but the requirements two months now. So I had to fight for additional two more for an additional two more months. And I know that in the past, I think people did six months straight, have NICU during their residency. It's not easy to get extra NICU months. And the structure, the way it's structured is for people to explore more more areas. But I guess the difficult part in residency is to know what you want before you apply to fellowship. So you have to try to do those four months before you apply to fellowship. So you really have you know, you're doing four months and 24 months, like not really 36 months. And I think that I don't know the programs have been changing, like some programs expose you to NICU in your first year. So I'm gonna wait until your second year to expose you to NICU. And you know, I guess every program has their has their decision to do that. But in my case, I did it in my first year. And that was very important to me. I had also done NICU in the past, I had done rotations and other institutions and I had done NICU and through, I think that doing in my first year really consolidated me to know Oh, this is what I like. And then after my second month of my NICU rotation, I knew that was what I wanted. I think exposure early exposure is important. But I think that also for attendings to understand that, you know, we're not all, we don't all speak the NICU talk, we don't all understand everything from the NICU early on. And like we are juggling many different things. We're juggling different rotations, where people do things differently in a mock every folder, all the fluids are based on body surface area, and then you go into PQ and everything is you know, you 421421 And the holiday cigar method and then you get and then you go into NICU and everything, start off with a goal and then everything's different than and it's difficult as an intern and then you know, you're I guess the attendings should never forget the residents are there to learn and to know if they're interested and I think if a resident if an attending is passionate about their field, that is that helps. It helps when the attendings hear the residents out, it helps when attendings let the residents percent completely and just just try I think all that really helps and and I think it's easy to forget because you know, as you keep moving on it's a seeing your brain up, I see that there's actually go down I should excavate today and maybe for you know, when you're starting it's not it's not that straightforward.


Ben 23:43

Right? And so for the people who don't understand when you say I my residency program mandated two months, and you did for four, if I understand correctly, because that's something I had to do as well that means that when your your co residents are going on these elective rotations, right and they're going into adolescent medicine, or these rotations that have a very cushy schedule you elect to go into


Daphna 24:07

lightly Benjamin


Ben 24:14

I remember that for I'm saying adolescent medicine because for us adolescent medicine was the elective was in clinic. So it was really sweet. It was like 9am to 5pm. It was it was no right. There was no surprises. You went there in the morning, you had your schedule of patients, you saw maybe a few acute visit majors didn't surprise you. I didn't go that's the whole point. But the point was that you decide when your your friends are going to these rotations that are that are well structured, you go back in the ICU, which means sign out at seven you don't know when you're going to get out and you take on these extra calls in the in the ER and right that's That's the commitment that you're making in order to get a bit more experience, right.


Alvaro Proano 24:55

Yeah, yeah, it was. Yeah, it's different. It's different time you had six we started 16 already so yeah, I had to wake up earlier but I don't know I was I learned a lot and I feel that every I really liked the delivery hospital like every time I saw delivery like I felt like wow this This is wonderful. It's like you're you're able to see for the first time a new person in this world and you are that privileged person that can take care of that person. So I think that that really pushed me forward and then the attendings world nice to me. You know, it was and I worked in two different Nikki's, I worked in a like a level three delivery NICU and also like a level four more like a surgical NICU and that and they were different experiences. But I enjoyed both and both gave me a lot of tools that I later take to Khan, because when I was on the wards, I saw like a neck case, and I had to transfer to the NICU and like, all that, I think, like all that really helped me. Um, yeah, it was my decision.


Ben 25:59

Let me then ask you. So then there's, there's really, I think there's a crisis that's looming for the NICU where we don't let residents experience the NICU enough, because there's a perception that like, how much how important is it for you as a resident to know how to manage a 26 week or on the event, but the problem that this may cause is that you get less and less people who are interested in pursuing the field of neonatology and we will we will create a void where there won't be enough people applying to fellowship. So and one of the things that we can blame on neonatology is that neonatology is very, it's a very recluse type of specialty, right? Yeah, we don't, we don't go to Morning Report. I remember that in residency, right. During one report, the NICU is not there, like we don't interact, interact as much as other specialties. And so I'm wondering, from your experience, what are some of the ways that the NICU could invest a little bit more time in the trainees in order to create a bit more engagement, especially in the context of decreased rotation, decreased exposure and so on?


Alvaro Proano 27:07

I think that simulations are good. And I think that like having neonatologist talking about their experiences in the like, in the backticks would help. Like, you know, I honestly think that I pursued mathematics because I really had a really good method mathematics teacher when I was in high school, so that really made me really like mathematics. I didn't really have a teacher in computer science, I just thought that myself but for, for, for neonatology, like I saw Pete like I saw mentors, and they really helped me. And I think that seeing the passion of others that really motivates you, yesterday, I was walking, I was going to clinic and I saw a medical student, she's like a 30 year medical student now as fourth year medical students, and she was my main med student when I was in the NICU. And she told me, Hey, over, I'm doing my AI in NICU, and I was like, Oh, wow, that's great. And she told me, it's because of you I'd really interested. I was like, Oh, wow. I was really I was I was intrigued. I was like, wow, so like, you know, if people feel your passion, I think if people feel that this is an interesting field that people like, if they understand why you liked the NICU, I think others will also do it. I don't know, I think I think there's a lot of interests. For neonatology, though, like I felt like a lot of residents are interested in in ontology. And it's a it's a very special field. Like seeing as I was saying, like seeing a new baby, being able to hold the ethics in the NICU being working with the families so close. I've never worked with families so close in any other rotation, then that's my personal experience. I don't know if it was bias. But I, I don't know. To answer your question. I think more exposure, I


Ben 28:51

see. It's the only ICU where we don't try to turf the patient to the floors.


Daphna 28:55

Right, that's nowhere to go. Nowhere to go.


Ben 29:00

It's something that used to frustrate me as in the PICU was that as soon as the patient got better, they went to the floors and it's like, hey, like I am just getting to know you just getting I'm just finally getting some satisfaction and now and now this patient has to go in the NICU. It's great. The patients, they don't move until they actually go home. So yeah, definitely, we're gonna say something,


Daphna 29:20

ya know, that that's kind of you were alluding to my question, which was I'm always surprised when faculty that I know are, you know, disappointed when they get bad feedback from residents. And so he wonder, since you're so recent, like, what's the what's the secret sauce? Like? I think it's like, not not so hard to get reasonable feedback from residents. So what are the like definite dues for our faculty members who are listening and some definite don'ts for working trainees


Alvaro Proano 30:01

Wow, that the I never I've never thought about that. But I think that things that, let's say things that attendings, I think should never do is attending should never make the environment hostile they should never make that is no question should be done, you know, maybe like a resident has a question, what's the difference between length and height, you know, and then the you can talk about gravity, you can talk about things like that. And I think like, there's, I think that not making someone feel dumb, no matter where you're in training, I think that's very important. Making sure that it's, you try to make sure that it's as possible, very equity. Promoting environment. I mean, it's very, there's racism in the NICU too. And there's racism in many places of medicine, but I think it's very important for the person leading everything to make sure you know, to say, hey, we're an anti racist environment here. And we, let's, let's make sure everyone's feel feeling is treated equally, and making sure that you know, patients are treated equally, if you feel there's any, if anybody doesn't care, I think that's very important. And listening to your residents, before, like doing things because that, you know, it's very easy for nematology, making rounds, on rounds, just listening to your residents, but also like after rounds, like, let's say something happens, and you know, acutely, you need to make a change, explain to her so now I made this change, like explain your thought process. And I think that that's, that's what residents value a lot. And thinks those are things you shouldn't do. And I think things that you should do, is trying to make neonatology interesting in every single patient, you know, it's very easy, I think, to say, Oh, this just a feeder and grower, and it's not I mean, it's a patient that's also it's feeding, it's growing, but has a family has so much more other things and and make it interesting, every patient should be interesting, the more the the attending is interested in their job, I think it's the more interesting rounds will be and the more interesting the residents will be in. You know, I think that that that's, that's great. That's something like even even bringing controversial evidence about things. Let's say there are a lot of NICUs that use hematocrit instead of hemoglobin and, you know, bring in an article about the differences about word they use them differently, or the threshold that higher versus lower thresholds. And just just talking about the science of the NICU, I think that's that's what makes it a good rotation.


Ben 32:43

Let me let me step on this on this topic, right? Because I think there are two types of residents that walk into the NICU, or maybe three types of residents. And I'm going to be stereotyping a little bit some of the residence, but that's okay. So you're going to have the person who's, who knows they're interested, right? So they're walking in, and they're like, I know, this is a field that I'm probably want to pursue. I think you have the ambivalent resident who walks in and be like, I could see myself doing this, I just have to see if I like it or not. And then you have the resident who walks in as like, I have another passion. I'm just here to do my time and get right. And and I think teaching these three different residents is very different. And it's very difficult. And I am wondering if you could talk a little bit about from the feedback that you have with your co resident. I'm particularly interested in in the latter two categories, the ambivalent and the person not interested. How do we because the we're not here to be? Yeah, we're not here to be. What do we say? proselyte. Right. We don't want to, we don't want to convert everybody, right? We don't want to convert everybody to the NICU. But also, I would like you to learn a few things. So in your experience, how do how to the How to the NICU experience has to be adjusted based on these different personalities that rotate through the NICU from the residency system.


Alvaro Proano 34:06

I think having like an initial gathering and trying to understand what people are trying to get out of the NICU and trying to understand what their what their interests are, like, let's say my friend is interested in hematology oncology. There's him in the NICU. There's you know, there's him in the NICU and trying to ology in the NICU. There's some college D there's gi NICU is such a wonderful field because there's everything and there are people who do all specialize. You know, I recently heard someone in your podcast that neonatology and endocrinology and, you know, I know there's neonatology and cardiology and like neonatology and pulmonology. And there's so many things within the NICU. And even if you go to the other spectrum, adolescent like how does NICU affect adolescent I think just like trying to address their interests, because they're trying to learn, but those two patients when they leave the NICU is a closed environment. But as one of the neonate gets bigger and leaves the NICU, there's a lot of thoughts that neonatologist stopped caring. I don't think that's true. They care, but they don't control them. They don't get to care for them anymore. But I think the NICU rotation, you should be able to help those that will treat these patients later on understand what happens in the NICU with this patients. I think that's what makes it very interesting, because you are seeing the beginning of life.


Daphna 35:31

Yeah, I think you bring up a good point, especially safer colleagues who are going into general pediatrics, well, then we say, Well, who do we send these babies to know who's going to care for this, you know, ELB W. But that's our opportunity, right to change to train, the general pediatrician who will receive babies from the NICU. So I think that's a really valuable point.


Ben 35:58

I want to talk about Twitter, and I want to talk about other stuff. But I want to get I want to continue talking about the residents. Because it's such a source of frustration for so many attendings who are just not, we're just not getting through to creating the spark. And, and I think one of the things that we talk about, especially in the context of training is service versus education, right? It's like, what is the balance? And and in the NICU? It's it's a funny place, because of the attending thing, that service is education. And so, and I don't think it's true, right? I don't think that calling consultants all day and writing notes all day is truly it's educational, but it's not. It's not complete education. And so I wanted to know a little bit about your perspective as a resident when it comes to what constitutes service and what constitutes education is the discussion like you said, on rounds about I love it. By the way, height versus length is just so like the mathematician new is just pouring out now, but but these discussions are interesting, but do they do they fulfill the need for education that the residents have? So I'm curious to see what your perspective is on service versus education? And what these two really look like, today?


Alvaro Proano 37:18

I think you know, someone needs to do the work. So you know, someone needs to do the service. It depends a little bit on how many more hands you have for the residents to help, but there are some services have like two units and like patients who are, the more interesting going into the, into the resident team, I think that's, that's the way it should be. But there should also be a time just to like, time dedicated just for education. I think that's really helpful. Like, okay, so you did your service, you've finished all your tasks, it's 1pm. You went to eat, you came back, you're done with everything in the morning, you're waiting for deliveries, or you're waiting for admits. But let's take an hour and just talk about education. Okay, let's talk about persistent pulmonary hypertension. Let's talk about resuscitation with the intact umbilical cord like, Thanks, Randy, we're not doing here. But it's important signs that we should talk about. And I think that's why I like that's why I think I've gotten more and more into Twitter, because I think that I get a lot of education from different people in the world. And I think that I, I really think that there should be dedicated time for education and in the NICU and NICU is a very wonderful field, I am really happy that I will be able to pursue neonatology. And I know that maybe you know, the future will be different. But I this is the career I chose is the same as pediatrics, and I think you can be burnt out. But if you remember why you came into this field? I think that, I don't know, at least for me, I think that's gonna try to help.


Ben 38:59

Yeah, and I think I want to, I want to I want to emphasize that point, right? It's not really I mean, from what I'm gathering, right? It's not about providing a complete education in neonatology. But it's about sharing what gets you excited with the residents, and then whether that works for them, whether that doesn't work, then then it will be up to them to decide. But obviously, you're talking about evidence based medicine and evidence based practices, but it's about trying to share this love with residents. And I think that's a good framework, in my opinion that you're describing.


Alvaro Proano 39:32

And I think, also letting residents have ownership like, you know, in the NICU in the PICU and words like a little, maybe you want to try you know, instead of one make per kick you want to try point five times to today and you know, and and is it really going to me there's no exact evidence of which one's better you can try it and make it as long as the patient's save and as long as the attending knows about it. I think that letting the rest are when you're weighing narcotics, they're different protocols. But there's no exact way of doing at least I don't know, there's like exact way, but like, it seems like there's no exact way of doing things. And you can, I think, you know, trying and learning while you're trying, while keeping the patient safe. I think that is that makes it more interesting because you are getting ownership and you're trying to be the real doctor for the patient.


Daphna 40:25

I think you bring up another point, which is like valuing the time of the residents and finding this like educational space. And it doesn't have to be like a lot of time, it just has to, it just is comforting to know that somebody thought today like, I'm I'd like to teach them something. And I think that that people get a lot out of that.


Alvaro Proano 40:55

i Sorry, I just wanted to say that also, the other thing that I think is very important for attendance is not to minimize residence at all, because all the residents we are, you know, we are people, but we all have different backgrounds. You know, I was in math in the past, I'm sure there are engineers, I'm sure there were artists in the past. And I think learning a little bit about your residence, and hey, maybe this person is an artist, maybe they can draw things that could be helpful for the families, maybe this person, I think, you know, trying to learn from your residents. And and I think value, I think valuing your residents, because they, you know, what better thing to have a whole team of people trying to learn and trying to help. I think that is a definitely a thing to do for us.


Daphna 41:40

Yeah, I mean, what a great team building skill that is in just, you know, building people up where they already have talent, right? Because all of that is amenable to what we do in medicine in one way or another. And so many of us, like lose those other parts of us when we go into medicine. So I think that's a really a neat tip to say, you know, value what they already bring to the table, which is different than then you have to, to offer maybe as a faculty member,


Ben 42:16

especially today, when when medical students, in order to get to medical school have to get to these long paths where they have to almost have a second career by default that that makes it that makes your point even more valuable, I think.


Unknown Speaker 42:30

Sorry, I cut you off. No,


Daphna 42:32

no, I am. I have one more question. So you're gearing up right for fellowship. So as as somebody who's going to be entering fellowship, I think that's something else we wanted to talk about and leave with our listeners is we're putting you on the spot here, but maybe something that you you wished you had seen you wish you didn't more of or you're feeling like nervous about encountering as a fellow so that people can take that and integrate that into their residency trait work with trainees.


Alvaro Proano 43:06

When I was I remember I was talking to my mentor before I like when I was, you know, trying to do felt like applying for fellowship and I was like, Maybe you should do more CICU maybe I should do more pick you too. And then she told me ever, all you really need to do is more NICU like so then really. And I followed her advice and I didn't work more NICU months and I really like in the NICU. You know, I think just doing NICU months really help and it's exhausting. It's difficult, but you get exposed to so many things. Um, and I think there's, you know, there's no place like the NICU.


Ben 43:42

Yeah, I had, I want to commend my program director, David Ray, who when I was having the same dilemma, towards the last eight months of my residency, he said, Do as much NICU as you can do your calls, and then do as much outpatient and inpatient general pediatrics is like, you need to understand what the pathway looks like for these families, right, because they start in the NICU, but they will go to the outpatient unit, they will go into the inpatient units. And and and it's important for you to remember that and now just to be segmented to the ICU. We're we're coming towards the end at the tail end of the interview, I wanted to talk to you about social media, obviously, and I wanted to devote some time to it. What can you so so for the people who are not familiar with the work that you do, you are very, very active on Twitter, especially in the neonatal sphere of Twitter? Are you involved in any other social media platforms? Or it's just mostly just Twitter?


Alvaro Proano 44:42

Mostly Twitter for academic purposes? I mean, I recently reopened my Instagram to see pictures of my brother's wedding and stuff like that, but I have Facebook because otherwise my mom will probably think I'm not alive but other I have Facebook I have Instagram and But I mostly use Twitter. And I've seen really cool stuff out like in other platforms like it seems like all people are doing educational stuff and tick tock and and I don't know if you consider what's up our instinct or telegram or signal or also social media, but I'm also on those platforms. And I really I like Twitter the most, I think it's very open. I like that, you know, anyone can really join.


Ben 45:25

And so you joined Twitter in 2019. Right. And so I'm wondering when you joined Twitter at the time, did you think this was going to be a professional decision? Or were you just trying to get on social media like everybody else?


Alvaro Proano 45:38

I don't know. i Okay. So the truth is that the truth is that I had to, I had another Twitter account before I used I created Twitter, maybe sometime during medical school, so maybe like in 2009 2010. And when I created Twitter, my first Twitter was like, my personal account, and I would just, you know, hey, my friends, I'm here or something like that, but nobody really replied. And then I did like, I did like a little project about social media for professionals. And they recommend that actually having two different accounts, a professional account and a personal account. So they I did that I had like a professional account or personal account. On my professional account, they started like falling, research stuff. And then I saw I wanted to go into pediatrics. So it started falling pediatricians. And then I wanted to go into Nikki's are volunteers ologists. But then, on that route, I felt it was very hard for me to keep two accounts. And it was very difficult for me, like, I felt like personal and professional lives meshed a lot. So I just deleted my personal account. Yeah. And I went for one. And then I just tried, I don't know, I didn't really try to, it wasn't like my goal to network or it was my goal, just to learn. It was I was there to learn. I felt like it was a good, maybe it was it was easy to join in, it was easy to connect to your phone and just look at what other people were doing. But I got frustrated, because that's why I created new papers because I got frustrated. I think I was a night or something. And I felt like oh, like I have to go to computer or go to my phone and like put like a query and like look for or like put it like MASH. Like I have to like keep doing the same thing to be able to get new articles.


Ben 47:19

Hold on. So can you for the people who don't know what your papers Yeah, back? Can you? Can you tell them? Because there's a lot of people who don't really even understand what could be done with social media. So that's why I don't want to lose anybody in this discussion. So explain briefly, what newpapers is.


Alvaro Proano 47:36

So I created a bot called Neil papers, what that what it does is my question, I guess I created it initially for me, because I said, I make the I spend more time on Twitter than on PubMed. And I want to learn more the newest articles. And if what if I just joined Twitter, and every time I log in, I'm able to see the latest articles. And I was like, Maybe this could happen. And I saw that there were other literature bots, that's what they call them. So what they do is they look for the fee for like the new articles, and they just post a new tweet with every new article. And for me, it has been helpful because, you know, it does, like tweet a lot. But I do like, every now and then I just see things Oh, that's interesting. They're doing that. And I would have not gone into PubMed and looked it up and found that specific thing and it just opens my mind to different things that they're doing in the NICU. I don't know if my query is the best. I mean, I created it myself. I did it while I was on nights. So I I've tweaked it multiple times. No, I have I have the code and I've taken multiple times but I tried to be as broad as possible and it tweets like once a day it starts tweeting everything that's new, and it just starts like every five or 10 minutes just keeps tweeting new new articles.


Ben 48:54

I think I think it's it's it's a bigger deal than you realize because I think from the standpoint of mid career neonatologist and and even more senior neonatologist, there's this fear right of being on social media. It's like I'm going to create an account and then like what am I supposed to do? I don't want to talk to random people. And I think it's it's it's near papers, it's it's we'll talk about near Twitter in a second. But it's these these systems that allow people people to join in and follow newspapers, for example, and just be bystanders in the beginning and just appreciate the volume of information that they could gather from one stream on on Twitter. So I think I think it's huge and that's what I tell people usually is if you don't know what you're supposed to do, go on Twitter, and follow your papers right? I say follow Michael NaVi SF, follow these few accounts and then you will start seeing a little bit of data coming your way and then you can follow more people and then you can then eventually you can interact so I think it represents to me the first step to your to novices introduction to to Twitter.


Alvaro Proano 50:02

Yeah, and I think it has, it has been used more than I had expected I initially created, like, I created as a little game to see if it worked. And it works well. And now I think it's even going to have more followers than I have. Maybe by the end of the year, because it just keeps growing and people keep using it. And it's, it's really, you know, I wish I could make it even better. But I still need to have more time to figure it out. But I really want to keep things free. I want to keep things open because I was a medical student in Peru and it was hard for me to go to conferences. It's expensive. I can I go to conferences, and I think that's why I really liked Twitter, I was it democratizes knowledge, like you're able to see things from anywhere in the world, like right now in New Zealand, they're having this conference and you're able to see their conference, even though you're not there when they had the PHS. I couldn't make it I was I was in the PICU I, you know, you're you're attending virtually at least, I think that all that is very, very helpful as a trainee. And I think Neil papers just adds another layer to this.


Ben 51:14

Does that does that make you at least mildly upset that your papers is going to have more followers than you very soon?


Alvaro Proano 51:20

No, it's exciting. I think it's very exciting. I think it's very precise.


Ben 51:26

You could technically go on your paper and unfollow, like block a few followers just to stay. You know, when, when the ego kicks in? I wanted I wanted all jokes aside, I wanted you also to talk a little bit about Neo Twitter because we talk a lot about new Twitter and I think people Yeah, I think it's still kind of nebulous. I think some people may even think it's a separate social media social media platform. But for for the people who are starting to get interested in social media. Can you tell us a little bit about what's new Twitter? How did that come about and and how people can can leverage that new tool on social media.


Alvaro Proano 52:05

So I think that when I was joining as I joined Twitter, and then I wanted to do pediatric I saw like a common hashtag called Tweety attrition and I follow them but then I wanted to go into NICU and I really didn't find like a hashtag or like a way I could follow all the neonatologist and I was like, All this information is scattered around. Some people use hashtag NICU, some people use hashtag neonatology, some people use hashtag NPM. Some people use like so many different hashtags and phone Well, phone meal. And then like in the in the PICU world, I felt like the peds ICU hashtag was being used. And it's being used a lot. And I felt like wow, that is quite a model. Like just to learn from them. The fact that they have it's organized, and they have people from all over the world connecting. So that's when I think I tweeted about it at some point. Hey, I don't know, I was, you know, it's, it seems might seem that it's that it's easy, but it's not easy to tweet because you know, you're also exposing yourself and but the more you do it, the more comfortable I guess you get and and I tweeted something on the lines of what if we had something like pizza ICU, and it was I there was a lot of controversial because there were some people that said, but there already is for Neo, there's already Neo EBM, and I really didn't want to like collide or clash with with anybody. So but I felt like there were all different things like health equity, equity for babies, that's that's a great hashtag. And nearly BM, that's a great hashtag. But they're all really represented in the end ontology, and there should be like an overlying hashtag. So that's why Neo Twitter, we started like promoting Neo Twitter and Neo Twitter's basically a hashtag that you use. When you post something related to me and ontology on Twitter. That's how I look at it. And you can use other more specific hashtags, but having that umbrella hashtag helps find information.


Daphna 54:08

So you got to break it down for people who are listening who are like, they know what a hashtag is, but they don't know how to use one. Okay, so like, say me like nine months ago.


Alvaro Proano 54:22

So a hashtag is a label. So you use the back of the of the just the hashtag, the pound sign, and then you write something no space in between. The Tic Tac Toe use use the pound sign. In Spanish, we call it mici. So use the pound sign and then you write something next to it. So let's say you pound sign, incubator, and then everyone who uses that pound sign could be related to that conversation. And it's used a lot in conferences. And it's also used by I guess, medical fields. like pizza ICU like, there's, there's one like for urology as well. So near Twitter, the idea was to use that consistently by different neonatal stakeholders to have something that is robust enough that many people are using it. And once you jump into Twitter, you can just follow that or look for that hashtag. And being able to find articles or find information related to neonatology. The only problem with hashtags is that you know, you, you don't decide who labels what. But thankfully, it seems that people it's such a neat che hashtag that just people relate it to me and ontology are using it.


Daphna 55:45

Sounds very helpful, thank you.


Ben 55:49

I'm glad for the people who are hesitant to join social media I want I would like to know if you could break down for them a little bit. You mentioned the opportunities to learn. And, and I think these are obvious, because people post new research, they're posting experiences, they can post pictures, but what are some of the other ways that you've been able to leverage social media? Um, I'm gonna, okay, I'm gonna go on a limb here. I'm gonna just say what I think and, and I apologize in advance, but I feel like I've applied when you apply for fellowship, you were very well known already, thanks to Twitter, which is something that's a little bit counterintuitive, right? When you apply for I remember when we all apply for fellowships, even though we know we're good candidates, you're like, I just hope somebody takes me but I was thinking about your process. And I'm like, I actually spoke to people about you in in several programs, and everybody knew everybody knew about you and knew the stuff you were doing on your Twitter. And I think that's an amazing way for you as a resident to leverage social media to have an impact and, and further your career along. And I am wondering if you could give some practical examples of how that happened, and how that has benefited you. I mean, obviously, you're you're going to chop for fellowship. And I would like to inspire residents and med students to use social media bit more like you to, to propel their career.


Alvaro Proano 57:17

I think social media has more power than we can, that we imagine, I think that there is a lot of hesitancy about using it, because you know, there are things that in social media that may you're not interested, I think that I understand all the cons of social media, there are cons like you know, it can be a use of time it can. There can also be spam. But there are a lot of pros to and the pros are that you are connected with people and I don't know, I don't love the word networking, because I'm not like trying to like, Oh, I'm just network, I'm just trying to learn from others and, and on the way you network on the way like you can act. And I think that it, it can connect you with people from all over the world, like people from Australia, I'm now doing a project with people from Brazil, Canada, CO, UK, Peru, and one of our Peruvian colleagues is in Australia. And we started that project with one tweet. And with that one tweet, we started having meetings, we've now had more than more than a year now that we've been meeting on, on Zoom after that tweet. And we now you know, we're finally have like the manuscript written down and everything. But it's, I think it all started with a tweet, and then new Twitter that started also as a tweet, and I and then we wrote this this, like brief report to the journal parent ontology with Ben. And I think that that, that also shows like, you can connect through Twitter like, and I think that for learners, it's so important. You might not find all the mentors you want in your institution, because you might be a minority. And you might not find that minority being an attending, and you might not feel that connection. But maybe you might find that connection, like I was looking for Hispanic attendees. And I didn't really find that here. So I went to Twitter and I saw a lot of them and I that inspires you to that inspires you there are people who look like you, who also talk Spanish who are doing excellent things. That is that is truly inspiring. And then you can connect for research, you can connect for education, you can learn from others. And then I think the one thing that people don't realize is that you have so much to give also to for others to learn. Like let's say, I didn't want it to go into the NICU. I wanted to go into adolescent medicine and did my NICU rotation and I really liked it, and does it tell your story and I think that's powerful too, and just learning from others. I think social media gives us a voice and and I think that that gives us everyone a voice it doesn't matter if you're an attending to this, no matter what institution you're coming from doesn't matter what country you're coming from. It just gives you a voice.


Ben 1:00:07

I think this is fantastic. Because I think it's the same discussion that we're having with the metaverse, right? People are like, what am I just going to live in the virtual world. And, and it's not the point. And it's the same thing with social media, the point is not to, to replace your interactions and your engagement with digital connections. But the examples you gave where you use this platform to make new connections that then translated into concrete, very much real world progress in the form of research in the form of publications, these are not digital, right. I mean, like you said, these are, these are things that are very tangible. And I think these are a great example, examples for people to follow in terms of you can actually get stuff done. And instead of like you're saying, instead of just roaming the halls of your institution, looking for somebody who's going to want to help you do a research project, and like maybe put you on their research project, or, like the opportunity is there, just roam the timeline on Twitter and find people that you can connect with, and you'd be surprised by how responsive people are on Twitter. I mean, our perfect example is our neonatology review podcast that we started with Dr. Martin broadsky, through Twitter, like we reached out to them and was like, do something together, and it happened. So I think this is this is this is terrific. That's what I'm going to leave you for. You see, I'm leaving you the last question.


Daphna 1:01:24

Ah, that never happens. No, I think I think you totally expressed why we love engaging with our, you know, Neo Twitter community. I feel like for trainees, though, they feel like it is potentially maybe hard to stay in their lane, or will they say the wrong thing? And then and we'll follow them, you know, as they go into their interviews and things like that. So what do you maybe you can tell us like, you know, some safe way for people to like, Wade in the pool before? Before diving right in? And what made you feel brave enough to just start, you know, tweeting and asking questions.


Alvaro Proano 1:02:15

I think the, you know, definitely, if there, you should think about what you tweet, like you should think about twice, because you know, you can delete it. But there's always the you know, footprint, you should also think that it's hard to edit something. But if you have something to say you should say it. And then if there are programs that don't like what you're saying, because that's what you're thinking, I don't know, if you're saying Oh, fam family time is really important. I wish there was more family time and training and their programs who don't like that. Well, that's who you are. And that's in the program. I mean, I think programs should adapt to the reality. And I don't think I think that why was I raised enough? I don't know, maybe a little craziness. I just wanted to tweet and I wanted to express myself initially. And then I don't know why. I guess I just started connecting with people. And everyone seems so nice. And I really have, you know, I've met just wonderful people, including Michael narvi. Amy Kia, been in Nick Bhama. They're all wonderful. And Doug Campbell, like everyone that I've met, that we work together in this paper, it was so easy to to just relate and talk and do projects without knowing each other. And I wanted to give another example I was I was a medical student in Peru. And I think that's why I started using Twitter more. I was a medical student in Peru. And I had done this cough project and TB. And I was like, oh, nobody's gonna read it. It's gonna be like a you know, it got like a Editor's Choice in the in the CID journal. So it was a big deal for me. But I felt like I wanted people to know about it. So I created like a visual abstract, and I spent like, we can make my visual abstract and I was like, I'll just delete this. Maybe nobody will see it, but whatever. I'll put it in. And then I went to sleep. The next day woke up and I had like 40 retweets people in Japan, people in the US and I was like, Oh, my God, people are reading. And then like, my article started getting a lot of accesses. And I was like, Oh, wow, this is really cool. And that


Daphna 1:04:23

was sure, right. It's the future of of getting information out to people.


Alvaro Proano 1:04:29

It eliminates the middleman. You connect directly with people, you connect with other researchers, you connect with other academicians, you connect strictly with people. I think it's a great thing, because you are able to learn from others and yeah, I guess teach others to.


Daphna 1:04:47

And I think, I think once you go and you have a positive experience, it's easy to like stay engaged, even if you're what I call a a lurker. Like even if you don't want to tweet anything, I think You will be positively reinforced by seeing some of the discussion on on Twitter.


Alvaro Proano 1:05:06

And then I do have to say that one day I also tweeted something and then I deleted my app because I was really I don't know, I felt really upset. I had gone to clinic and here in Louisiana, there's a law, that it's really affecting the Hispanic families they are having to use for last names when our customers to use to and it's I don't know, when this was instigated, it was started but I think that I posted something on the lines of Latino families of you know, families are, you should have have two last names. We don't have one listening, we have two last names, some of us use a hyphen, some of us prefer one. And I just explained, that's what I did, I explained and I deleted my my Twitter app, because I was upset how like so many families were just having so many problems in clinic, like making appointments with so many last things that they felt that they didn't really present their child. And my brother, the next day is like, Hey, your tweet is going viral? And like, I don't know, I deleted my app. And I'm like, I go in and they had like, 1000 likes, and I was like, what? And I just felt Wow. So sometimes back when you have to say it's important for others.


Ben 1:06:20

So you did that's what's called in the Twitter world as a post and ghost.


Daphna 1:06:25

That's right. Leaving you comments, people are leaving you comments and you're nowhere to be found.


Ben 1:06:32

But but but that's the thing also that Twitter will make you realize, which is something that we're seeing through the podcast is that the people in the world of neonatology are genuinely good people and and we have so much to share so much in common that the interactions are easy. And like you were mentioning, discussing things with Michael narvi, with Nick badminton, some and Doug Campbell and Andy Kerr, and all these guys. It's like you talk to them. And it says, if you've known them for years, and it's like, I've actually never met you, and the interaction is so fluid that that they will really create this positive feedback loop to even engage even more. So just just start by starting I guess.


Alvaro Proano 1:07:08

No, I really have to I'm really grateful for the all those people are just, you know, all of you are very wonderful because you're promoting this environment of being able to ask questions, being able to you're you're bringing a resident who's not even an apologist into a podcast, I think the oldest is really wonderful because you're valuing everyone. You're valuing people who are just starting, you're valuing people who are the giants of neonatology. But you're also valuing those of us for starting and I think this you know, I advocate and I promote other residents, also to us via Twitter, I think that we all have so much to learn from everyone.


Ben 1:07:48

Yeah, so this this episode, since we're talking about that is going to be airing in the month of July, where we have a program director on this month, and then we're gonna have we have, we're gonna have your interview offer. So try to bring some awareness to the challenges and the needs of the community in and around residents and fellows and trainees. So this is all very exciting. We've went over time, obviously, as usual. That's the That's the trend. But thank you so much. Overall, people can can obviously find you on Twitter. Do you want to tell people where? what's your what's your handle? I think it's I don't want to butcher it. I think it's a prime new Prime new A, is that correct? Yeah,


Alvaro Proano 1:08:22

it should be perennial. A, but there's no NDA, that's a big pet peeve of me like, I don't understand why we have all this technology. And in there, we're not able to write people's names correctly, even on Epic, even on social media. And anyways, I guess it's because the way it was


Ben 1:08:42

finished. So let's, let's finish up. Let's not finish on a negative note, because I think what you just brought up is something you have mentioned on Twitter and is a definite knife. I freaking love the idea. But can you talk a little bit about your your thoughts that you shared on Twitter about named pronounciation and the EMR


Daphna 1:08:59

because you know, we struggle with it, we want to do better. And we really struggle with pronouncing.


Ben 1:09:05

So for example, here in South Florida, we have a lot of Haitian patients, and their names are French sounding, and I know how they're supposed to be pronounced. And then I have to hear how other people pronouncing it. And there's, it's not their fault. I'm not blaming anybody, but there's no opportunity to even learn how to pronounce it. And the funny thing is that when I pronounced it in the correct way, people are very receptive to like, Oh, I didn't know and then they pronounce it correctly afterwards. So they just need that little help. And so can you share with people what you had suggested? That's really


Alvaro Proano 1:09:33

I don't know. I like to post my ideas on Twitter to one of my ideas was that we should read like, we have all this EMRs and I don't understand why we're able to put videos and audio on emails and on whatsapp on things like that, but not on an EMR and we should be able to record people's names, how the parents or how the patient wants it to be pronounced, recorded and have it on the On the EMR, and then the provider can listen to it before or the clinician can listen to before going to see the patient. Because you're actually, you know, you have the picture there, but you don't have how it sounds. And you don't want to butcher it, you want to respect that person. And I think, you know, and then for, like, HPI, we should have videos there. Like, I think there's so much more to be done on the EMR real.


Ben 1:10:24

I don't know, the video in the HPI. But I think the the idea of, of the name pronounciation is something that sounds feasible. And I think this could be a great way for a podcast to jumpstart something. So if you have the disinterest and you want to get this going, again, get in touch with Alfonso, and something will come out of it. I mean, this is the idea.


Daphna 1:10:45

It would help us a lot if like PubMed would do the same thing, right for


Ben 1:10:53

so many names that we're just like, venturing, it's like, you know, like when you're walking in the dark in your daughter's room, and you hit the Legos, and it's like, it's just painful. Yeah, same when we have to pronounce the names of these authors from from other colors.


Daphna 1:11:07

Yeah, we're really trying, we want to do better so so maybe we could get it on PubMed to that would be very helpful.


Alvaro Proano 1:11:14

That's why Twitter is good. Yeah, Twitter should have that too. I think that's why Twitter is good because you're able to express your ideas and maybe, you know, maybe they can become a product or become a project.



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