Hello Friends 👋
This week we have the pleasure of hosting Dr. Ravi Patel on the podcast. Ravi is a young and already accomplished neonatologist that embodies the attributes of a modern-day neonatologist. His exceptional research work has been published in some of the most impactful peer-reviewed journals. He is also an early adopter when it comes to leveraging social media for the dissemination of evidence-based practices. Daphna and I had a terrific time chatting with him this morning, we hope you'll enjoy listening to this episode as much as we enjoyed recording it. Cheers. - Ben
Bio: Dr. Ravi Mangal Patel is an Associate Professor of Pediatrics and Director of Neonatal Clinical Research at Emory University and Children's Healthcare of Atlanta. He is passionate about evidence-based medicine. His research interests include necrotizing enterocolitis, neonatal transfusion, caffeine therapy and perinatal epidemiology.
He is an executive committee member of the American Academy of Pediatrics, Section on Neonatal-Perinatal Medicine. He is also a principal investigator in the NICHD Neonatal Research Network, chair of the International Society for Evidence-Based Neonatology (EBNEO) and president of the Southern Society for Pediatric Research.
Dr. Patel received his MD from the Medical College of Georgia and an MSc from Emory University.
We spoke about Michael Lewis' book the undoing project. Grab your copy here: https://amzn.to/3QUJb87
You can find links to some of Dr. Patel's published wok below:
The transcript of today's episode can be found below 👇
Welcome Hello, everybody. Welcome back to the incubator podcast stuff. No, how are you?
I'm doing well. I'm doing well. We have such an exciting podcast.
Yeah, it's it's, it's a podcast that has been both requested. But that actually we had wanted to do for some time and for sure. And we're very excited to have Dr. Ravi Patel on the show today with us. Yeah, this is this is very, very exciting. And he's a he's a superstar of the field of neonatology. He is one of these young neonatologists that when you look up and you see the amount of work that they've actually accomplished, in, in what what I guess you could say the early phase of their career is quite astonishing. I mean, the caliber of the research work of the publication, and, and Ravi is somebody who is not who's a multi talented individual is research his work on with EB Neo social media. I mean, he's, he's really doing it. So it's very, very exciting to talk to him today. Do we have any announcements before we begin today, or before we give Robbie's bail? I don't think so. No, just board review podcast will be released tomorrow. We're talking about BPD definitions. It's going to be fun. But yeah, without further the, the I guess we can tell people that the neonatal network grants is application is open. And yeah, if you want to get some funding for your research project, it's a very straightforward process. And you can find out more information on our website, www dot the dash incubator.org. Okay, so for the people who are like, Who's this Dr. Ravi Patel thing. Saying that? No, I'm literally I would, I would be curious to know who would not know him at this point. But Ravi is an associate professor of pediatrics and director of neonatal clinical research at Emory University and Children's Healthcare of Atlanta. He's passionate about evidence based medicine. His research interests include necrotizing enterocolitis, neonatal transfusion, caffeine therapy and Perinatal epidemiology. He is an executive committee member of the American Academy of Pediatrics section on neonatal perinatal medicine. He is also a principal investigator in the NI CHD, neonatal Research Network, chair of the International Society for evidence based neonatology that's EB Neo that we mentioned earlier and president of the Southern society for pediatric research. Dr. Patel received his MD from the Medical College of Georgia and an MSc from Emory University. Yeah, without further ado, please join us in welcoming to the show Dr. Ravi Mangal Patel
Dr. Ravi Patel, thank you so much for being on the show with us today.
Speaker 3 3:52
It's great to be here. I love the pod. So, it's fantastic to actually be here with both of you.
Yeah, this is this is a long overdue interview Daphna and I have been talking about having you on the show for a while and then or you're busy, you're busy neonatologist so we're very happy that we're finally getting to record this episode. For so I guess we like to start our interviews when we're talking to neonatologist and and try to find out a little bit about what was the path that led them to the NICU because there's always a path somehow it's not something that you're you're born saying I want to be resuscitating preterm babies. If I if I remember correctly, you mentioned to us that you the path of to the NICU for you was paved by by a pediatric surgeons. Is that Is that correct?
Speaker 3 4:38
That's right. Yeah, I started med school thinking I wanted to be a pediatric surgeon and actually, one of the first rotations I did was pediatric surgery. And he'd start the morning in the NICU. And I think you know, one of the lessons learned was what's what what seems like a great profession when you get into the daily routine. It may be very different. And I knew very quickly because I spend time in the operating room and I found it so tedious. And I was always waiting to leave the operating room and go back to the Nikita round. And that was the first time that maybe I have a different calling and that experience, you know, being in the NICU and rounding and it was just such a foreign place. And it was very, it felt very at the cutting edge of medicine at that time.
Okay, I thought that I thought that you were gonna say, oh, no,
sorry. But no, I was gonna, I'm grateful that you had that experience, because we're lucky to have you over, as we say, on the light side here.
Speaker 3 5:36
Nothing against pediatric surgeons out there. We have wonderful colleagues who do amazing things. And we couldn't do what we do without
I think we should be thankful for the pediatric surgeons for bringing to our field. So many people, myself included, because so maybe it's maybe one of their biggest contribution to the field of neonatology is just pushing a lot of people towards the NICU.
It makes sense though, right? We're people who we like procedures, we like the acuity. We don't shy away from the critical aspect. But we like some of those those that maybe not rounding of I love rounding, but I'm aware that not many.
So you you, you practice in in Georgia, and the thing that that you are probably the most famous for Ravi is your work on necrotizing enterocolitis. And before we talk a little bit about neck, I wanted to know again, like what how exactly did you get interested in pursuing research work and quality improvement projects on the topic of necrotizing enterocolitis? Over over something else was was it again? Was it a person was it? Was it an experience that that led led you to that?
Speaker 3 6:52
Yeah, you know, I still remember the very first baby, I took care of the head neck as a first year fellow in my first rotation. And it was such a striking disease, you know, from just initial onset of symptoms to rapid progression, needing intubation, and then, you know, within 12 hours headed towards surgery and feeling like you know, no matter what you did, you could you kind of interrupt the course of the disease. And at that time I was this was very early in my fellowship, I was looking at research opportunities, and there was something that stuck with me about just how mysterious and how frustrating that disease was. And I had a chance to work with a researcher that had a lab at Emory. Her name was Dr. Patricia Denning. And she was really interested in kind of understanding a little bit of the pathogenesis of NEC with working with murine models. And so I spent most of my fellowship trying to understand cut development, and kind of what what was the normal course of maturation in this maximise model. And we understood that there was this really big change in terms of this immature intestine that was very leaky, starts to get less leaky and maybe more mature. And one of the things we discovered was that it was maybe because of bacteria that were colonizing, that the murine gut, that then led to us actually feeding this on mice back probiotic bacteria, we give them entry lactobacillus from Gnosis, and we showed that you could accelerate the maturation of the gut. And so that was my first kind of foray into, into studying necrotizing enterocolitis, really, to understand kind of susceptibility and, and, and specifically about the kind of leakiness of the gut and tight junctions and also my first experience with probiotics really is a in the lab. And then I kind of had a come to a moment of, you know, as I was entering my third year of do I really want to spend my life in the lab, you know, working with mice, and I think this is, you know, there's many people have probably had similar experiences, it's a
rite of passage. Do I want to spend my life in the lab,
Speaker 3 8:52
and I love what I, you know, I love the kind of science and the ability to ask questions and get rapid answers. But one of the things that was very challenging for me, was this kind of very, very diving deep into very narrow areas that I think was felt like I was farther and farther away from the infant in the NICU. And, and I always loved reading papers and journals, you know, many of the things you highlight where you read a paper and you see, you know, I could apply this tomorrow, my practice, changing pulse ox targets, feeling good about using caffeine, you know, these are things you read this study and you say, Okay, this is this is ready to, you know, this is really at the end of kind of the translational spectrum of things that are very applicable. And that always, I think, excited me about clinical research. And so I took a big shift at the end of my training to, you know, from the lab to really say I wanted to pursue clinical research, although I had, at that time not really done anything. So it was felt like I missed an opportunity to play a little bit of catch up and was fortunate to get support for training when I when I joined us faculty to kind of catch up and learn some of the the tools and But that's for clinical research.
I'm struck by how humble you are. Because your basic science research is like paradigm shifting. And the fact that you were able to do, like, in fellowship is amazing. And then you said, but you know what? I can still let me let me take on this clinical kind of translational work. And and you were able to do that in a pretty short amount of time. How did you do it?
Speaker 3 10:29
Yeah, I was particularly well, I was a little bit of a risky proposition when I was looking for faculty positions, because, you know, I said, I want to do clinical research, I didn't have a single clinical research, study, no training, you know, I don't blame I don't blame skeptics, chiefs and chairs to say, we sure we want to invest in this person. But I was pretty persistent and very clear. And what I really spent a lot of time negotiating for was time, protected time for research, as well as pursuing a master's in clinical research, and a CAE award. And that was part of kind of my recruitment. And I ended up doing all those things. And I think that time, and really the training, which I would say, is essential today, for those that are interested in a clinical research careers really getting the tools and the training necessary was it was I think, very important. So that was important for my career in terms of learning good epidemiologic methods, understanding biostatistics. And also, I think one of the most important things is actually learning where you, you know, the things you don't know, and having, and realizing there's always gonna be somebody out there that probably is going to be you have more expertise in this area, and knowing when you can reach out to, for example, experienced biostatisticians, that that probably are going to be able to help you in more ways than you would have realized, you know, not having understood kind of the nuances of statistics and methods.
Yeah, I think this is somewhere where our training is really failing. And you're echoing something that Eric Jensen spoke of on the podcast about learning the intricacies of research design methodology is key if you want to actually conduct meaningful research, something that while he Carlos spoke about, and I feel that maybe some trainees are not planning to do a career or planning a career in research, and maybe they don't need as much like they may not need, like a full master's degree. But there's definitely a middle ground that we're not hitting when it comes to our training. And I'm not sure if that's something that should come in medical school and probably in residency, or fellowship. But I mean, you agree that there's maybe a shift that needs to happen in how we train our future neonatologist?
Speaker 3 12:38
I think it's, that's a great point. And I agree, I think it's challenging partly because the methodology of research has changed so much. And some of the tools used are not are kind of hard to grasp. You know, we do a five day course that I was part of as a fellow in kind of a boot camp for research, I think you get a very superficial kind of good, high level framework for what you need to do, but it's really insufficient. And then, you know, between that five day course, and you know, two year master's degree program, there really isn't anything in between that, at least for a lot of trainees to get that. And I'm not sure exactly what the best strategy, as I think there, there probably is this need to kind of fill that gap, even for people to better understand and read papers, you know, there's newer methods that are coming out, you know, Bayesian analysis is one that's been an area of focus for the new nail Research Network. And I think there's a lack of common understanding of those things. So it's tough when you're reading this paper out there, and you don't fully understand the methods, how do you actually then apply it to your practice or interpret it, and I think we have some opportunity there. And maybe it's things part of our motivation for kind of our EB Neo journal clubs was partly trying to do it in bite sizes of tackling some of these questions that, you know, meet the needs of learners who aren't going to sit through, you know, an hour long lecture or two hour long course, on one specific topic to try to give at least some high level view of things. But I agree, I'm not sure how we can address that challenge. I'd be curious if you had thoughts on that.
Yeah, I think I think it has to do with with workshops, and and really taking a different in my opinion, it has to do with taking a different approach. I think people are going to fall on one side or the other of a of an artificial fence either you want to take part in research, and in which case, you will need more sophisticated training in order to conduct the research. But I think if you're saying no, I just want to be a clinical physician, I do not want to take part in research activities, then you probably need a little bit of a bootcamp in order to be able to critically appraise the literature that's going to be coming out that you will be reading that you will have to interpret in order to change or not your practice. So I think there's probably a little there's probably a middle ground on where we can provide enough to residents and fellows so that they could decide whether they're interested in pursuing more or less and creating these avenues, I think, but it's definitely something that will be important in the future.
Yeah, I think, like you're saying, I mean, it really underscores, I think, where some of the deficiencies are, that even just even just in being a practicing clinician, like to use evidence based medicine, your daily practice, you really have to understand some of those basics. Some of those basics that are not really taught in your college statistics course, right? Using statistics in interpreting data is different than, you know, learning the basics of statistics. So yeah, I think we, we maybe, maybe we'll all collaborate on that, then.
Speaker 3 15:46
Yeah. And I think, you know, the ideas of breaking down the walls of learning, which used to be so much of what you learned about research was, you know, based on, on where you trained, and who taught you in the classroom setting, and I think now there's this wonderful community out there, and a lot of I think, open access, you know, kind of reopen access education, YouTube videos, I mean, I have learned a lot from just watching videos over the course of the years in terms of statistics, and just little pieces of things that are excellent. And I think there's opportunity, you know, a lot more opportunity today, than maybe 10 years ago, and just self directed learning. But that always requires kind of motivation for people to pursue that.
I wanted to go back to NEC because I feel like we're I moved away perfect. We moved away too quickly. The I think you have a very novel approach to the management of NEC and and I wanted to ask you, before I asked you to reveal what's the cure for NEC, do you think the approach to NEC will come in the form of a single or maybe a couple of interventions? Or do you think that truly, the way we'll reduce the rates of NEC to a negligible number is through care bundles, you know, where we have a bunch of interventions that when packed together, we really get our rates to be very, very low. And I think both both approaches have been discussed in the literature. But I'm wondering what what your thoughts are on which one is probably holds the key to the future?
Speaker 3 17:21
I would say? That's a great question. I think that care bundles are going to be what addresses that I think neck like BPD is a multifactorial disease with multiple drivers. And so it's, it's also challenging disease, because it probably is there different phenotypes or types of NEC that might have different drivers that need to be addressed. And so I think cure bundles are, are probably where the best opportunity is. And addressing that I think are the key drivers are non human milk feeding, inconsistent feeding where you know, improvements in use of mothers on milk donor human milk, well, that's not possible. Standardized feeding regimens are important. And then there's this component of dysbiosis, or addressing antimicrobial stewardship is important, and maybe probiotic therapy, or supplementation. And then something about abnormal oxygen, gut oxygenation and oxygen saturation targets. And I think you know, that that bundle of things, and you could expand it with other other items that might be based on, you know, less, less certain evidence will work. And I think we've seen that across a number of centers that really have shown if you can apply what we know today, in your unit, you can actually achieve important reductions in NEC. And we've seen that from reports from University of Utah, Oregon Health Sciences University, a number of places, even large groups have shown declines in AC, but I don't think that gets us to zero. I think the challenge is that there still is this residual amount of neck that we still don't fully understand what why that infant developed any see, and we have that in our own Qi work where we do neck Cuddles, where a baby develops neck and we go through, what are other things we could have done to prevent it and, you know, all the boxes are checked that we did all the things we think could have prevented it and what were the risk factors and none of the boxes are checked in you're you're scratching your head? Why did this baby development see? And I think there's still some areas that I think we don't know enough about, and that might be actually more upstream. And maybe it's things that that are influencing development in utero?
In utero. Yeah. And I wanted then to then jump on that to to the discussion of on probiotics. I mean, it seems that probiotics hold a lot of promise, and there's so much discussion around the topic of probiotics for preterm infants. Why why do you think there's so much why do you think there is so much resistance to this to this, this new intervention?
Speaker 3 19:58
Yeah, it's it's a fascinating Um, you know, kind of evidence translation question, which is, you know, there's all this evidence out there. And yet there's this kind of gap between the evidence and actually translate into practice. And that differs around the world. If you go, you know, take a long flight to Australia, New Zealand, you know, most of their Nikki's are using it. And here in the United States, it's a minority, I'd say, probably 20 30%, although we've seen increases in their proportion, and there's probably a few things. One was my sense was there was a lot of NICUs, that were interested in robotics, after the programs child came out of Austria, New Zealand that showed are important reduction. And then there is this, this unfortunate case of a of an infant who died from a contaminated probiotic that the developer that was contaminated with mold was a single case that the product was pulled off the market. But you know, there was an FDA alert that came out. And I think that gave a lot of people pause, rightfully so about, about the concerns about quality. And I think that stuck around for a lot of hesitancy about about that, or even that was a single case. And today, we have, compared to 10 years ago, or when, when the program's child came out, I think we have a lot more products that have better quality that are available. There's probably also a push from industry that wasn't there as well, that I think has led to some more uptake. But there's a natural hesitancy, and for some units, you know, unless there's an FDA approved preparation, that's, that's kind of the line that they have in terms of waiting for that. And there's trials ongoing. As a disclosure, I serve on the data safety monitoring board have one of those trials, that's looking at it FDA approved product. And so I think there's some people that are waiting. And and I think the other issue is just, you know, our mental frameworks around data and around evidence, and, you know, on a daily basis, in the United States, there's probably a baby that develops any see. And, and if we continue doing what we're doing, you know, in your unit, I always say, when people are hesitant, I asked them, you know, what's your neck incidence? And are you happy with where it's at? And if the answer is no, then the next question is, well, what are you going to do to decrease it? Well, we're already doing donor milk. And we're already doing these efforts on increasing mother's milk. And we've done antimicrobial stewardship. So what else are you going to do? When you look at the bag of, of what I would say is evidence based approaches to reduce any See, I think, you know, that's a very small bag of things that you can choose from and in that, for me is probiotic supplementation should be one of those things where I think it's worth consideration. And each unit then has to kind of decide what their comfort level is, and where their incidence is, and, and make choices on that. But I do think it should be one of those things that's considered.
And you're also go ahead, and I'm sorry,
no, no, I was gonna say, you know, it is a small bag. And sometimes we feel so hopeless when it comes to neck. But I think even just this discussion with you today is a good reminder of how far we've come in terms of neck research and, and reducing the incidence of neck. We talk a lot about definitions on here, and how can we study things. And so I'd love to hear your thoughts on just our definitions of neck, you know, the future of diagnosing neck so that way we can make better choices. And then I think, have had more effective studies, if, you know, if, if we had more information diagnostically on that?
Speaker 3 23:45
Yeah, absolutely. I think, you know, the definitions and diagnosis and neck is a big challenge. And one of the concerns has been whether in clinical trials of any see that what you're getting is contamination with with, you know, focal intestinal perforation of spontaneous intestine perforation, which I think nowadays, people are probably more attuned to than they were in the past. Where with just bowel staging, you know, depending on how it's applied, that that is a challenge. And they'll staging was never intended to be a case definition or diagnostic definition. It was really to stage the progression of NEC and to kind of guide management. It's just been adopted now as the most common diagnostic definition. There's groups that are trying to get at what are the clinical characteristics that that might be important features or diagnostic criteria for any See, although I would say there's no consensus yet. And the biggest challenge is what's your gold standard? Now, if you're looking at, at any senior trying to come up with different measures or criteria, what's the gold standard? And I think that's where the challenge is. What's needed to go forward? I think if we have better biomarkers, at least some biomarkers that go along with that that are very correlated with any SEER specific to gut injury that might differentiate from absence or other conditions that that I think is what I think will hopefully be out, there's been a number that have been examined, I think none of them probably have the kind of performance. That that's, that's ideal. And there's a number of groups looking into that. And I think, you know, in the same way, you mentioned, Eric Jensen, you know, really took an evidence based approach to the diagnosis of, you know, diagnostic criteria for BPD. You know, I think there's opportunities to do that for NEC really to kind of step back and say, Okay, let's, let's, let's look at how useful these various criteria Donald distension, what is still part of being a scam gas, you know, nematocysts, and how well they, they correlate with any C, and one of the most striking things was a study that was done by Shell Battersby at the UK, were half of the cases of any C in that country that were part of their definition didn't actually have any mitosis. So you're thinking, okay, that's, that's classic NEC, and yet, half of those cases didn't have that. That's been reported by others. And I think it's, it's this, maybe there's these different phenotypes that we haven't come across. So a lot more work to be done in that area. And I think it really matters because you know, how you diagnose a baby or a patient depends determines how you monitor them, how you treat them, what their outcomes are, whether they're eligible for specific therapies, and I think that is, it's really a critical piece of clinical care is is is improving on how we diagnose different diseases and conditions.
Yeah, nematocysts is one of these things where it feels very archaic, great, if that's the criteria for NEC, I mean, if you're waiting for nematocysts, to develop to be seen on X ray, there's definitely a long process that starts off much earlier. So to me, it's, it's not really surprising, but it's also highlighting how today we do have new technologies, and we have so many more ways to monitor our patients, maybe it's time that we at least aim to detect and pick up things a bit earlier before the intestine perforates. That'd be That'd be nice.
Speaker 3 27:02
And I think there's probably a spectrum of you know, that net neck might be the end result of kind of gut injury, inflammation that's that's going on, I think there's opportunities to understand that as neck becomes more uncommon, and I think that's gonna be the challenge as the incidence goes down, it's gonna be a harder entity to study. But upstream of neck, there might be these surrogate measures that might might actually allow us to better understand what's driving, whether it's dysbiosis, or gut inflammation, or biomarkers of good injury, that might be helpful, you know, if we had the same markers of, you know, high blood pressure being a surrogate measure for cardiovascular disease, and maybe we can target strategies to reduce high blood pressure, and eventually that will help reduce heart disease, you know, do we have I don't think we have today, what the surrogate measure is for any see that might be targeted, you know, that might be targeted, that can help produce that outcome that's maybe more common, easier to study and easier to quantify.
All right, I got all my neck questions out of the way.
Thank you. Thank you.
Unknown Speaker 28:04
I'm talking about next.
I mean, actually, I think that's what's tremendous about your, your career is that I mean, you've studied a lot of things. And so that's uncommon, right? So most people pick an area of interest, and that's what all their work is related to. But you've been on some, you know, groundbreaking papers in in five or six different topics. So, one, how do you choose what to work on next and, and to, you know, is it overwhelming to you know, it's hard, it's hard to be an expert in everything, but you're, I think you're as close as it gets.
You're the Elon Musk of neonatology.
Speaker 3 28:47
Well, thank you for that. Comment. I I sometimes don't feel that way. But I hope never to emulate Elon Musk on Twitter. You know, I probably violated
I've met I've met Yeah,
Speaker 3 29:07
I probably violated one of the rules that's often given to trainees and early career folks would just, you know, pick an area to focus on and stay focused on that. That's, that's very common advice. And part of the reason and I received that advice as well, and, and part of the reason I I strayed a little bit from that is because I think, you know, follow up what excites you what's passionate and that was always kind of where I've stayed and so, you know, the areas of interest have been in NEC but also an email transfusion, caffeine therapy and survival of extremely preterm infants. And I think also it was the, the opportunities as field shift shift over time. And so, you know, I was very interested in caffeine that was one of the first you know, as a transition from clinical from working in the lab to clinical research. How can we optimize the use of caffeine and 10 years ago, I really wanted to do this clinical trial of prophylactic caffeine use, which is, you start caffeine on admission to the unit, versus, you know, you wait till the infant develops apnea. And that at that time, it seemed like that was a very pertinent question. You know, fast forward to 2022. And you look at data, I think most places now are just starting, when when babies are meant to unit just starting routinely on caffeine. And so the field has shifted. And now if you want to do that, it would actually be a study of actually delaying the initiation of caffeine, because most people are actually just starting it as a routine, which was different maybe 1015 years ago. And so I think that, that those opportunities in certain areas, you know, for example, caffeine, therapy, and those questions, you know, can can shift as time goes along. And, and that, I think, you know, working in different areas allows you to really adapt and changes as questions, new questions arise, as fields change as what's pertinent, neonatology today might not be 10 years ago, and that's been part of my interest and why I've really valued working in different fields, although it's challenging, it's hard to keep up with, with what's going on in different areas. And I think as necrotizing colitis, you know, we just finished a large prospective study and a few centers, really focused on studying NEC. And one of the challenges is we've done so many things to reduce the incidence of any C, you know, we were, we've had about a fifth of them to spit a number of cases that we were expecting when we started this study, you know, in 2017. So it's a great problem to have. And actually, probably the most important thing is we've, we've reduced any see, but I think it makes it harder, it's going to be harder and centers that are adopting these practices, you know, these bundles of strategies, if you really want to study any see, you have to, you know, enroll two 300 prospective infants to get enough enough babies to even in make some sense, I think that that's where these opportunities shifted 10 years ago, that wasn't, that was not the case. You know, we had when we first started working on our neck prevention efforts, we had about a 12% incidence of NEC. And that's a lot now.
Yeah, I think I think this is what you're touching on an issue in training that is that is, in my opinion, Paramount and the idea of, quote, unquote, pick your lane, right? Early on, is the worst advice you could take as a trainee. And I recommend people reading the book by Michael Lewis called the undoing project, where he talks about the work done by Mr. Tarkovsky Tversky and Daniel Kahneman, who are Nobel Prize winning economist. But the idea was, you should have no attachment to any project you take on, because you may quickly realize that the project was not a good idea. And the only way to keep moving forward is to quote unquote, dump the project and move on to something else. And this idea that there's this endowment effect that as as the sunk cost fallacy, where the more you pour in the more you're like, No, no, I have too much invested, I have to keep going. It's terrible. Because in many cases, especially in the case of research, it's so demanding. You're fighting for resources, you're fighting for time, and it can lead to burnout and unhappiness. So I think, I think you are robbing the example of know, if something piques your interest one day, just pursue it. And it's, it doesn't matter that it's not like you, it doesn't matter that you said you like neurology and now suddenly you have to look at something related to Gi, just just do it because you might stumble on something amazing and make a meaningful contribution. So yeah, I don't have a question. But I really, really appreciate your comment.
Speaker 3 33:50
So well, I'm gonna have to have a I have a new book to put on my reading pile.
Yeah, yeah. highly ranked. You know, before, before we started, we talked about, you know, things like breaking down silos. But the same is true within neonatology in our different areas of interest. So we different people who, you know, gravitate to a different topic may look at a problem differently. And so that kind of cross pollination, I think, is super exciting and saying, you know, if we're doing this in BPD, why not in NAC or if we're doing this in neurodevelopment, then why not in nutrition? So I think that having being dynamic having the flexibility and is is ripe for new research questions?
Speaker 3 34:35
Yeah, absolutely. I couldn't agree more. I think this is one area where I would say for some, my basic science colleagues were you know, we studied disease X in the model of disease x, and we look at therapy, a on disease X. You know, it's possible that there's common pathways that affect a lot of our diseases, you know, inflammation or other pathways that might influence PPD or a P. And I think there could be a lot of it advantage of actually looking and collaborating in terms of kind of more broadly assessing neonatal disease models for similar therapies, I think that makes it much more attractive for industry and clinical trials, if you find this new therapy that actually shows effects across multiple different disease models, that that really could be one of fundamental if it moves forward and is successful, changing the outcomes for infants with with, particularly in therapies that are for prevention, and I think we still are a little bit siloed. In terms of a study, you know, I'm looking at, at therapy a, and I'm focused only on on any C or only on BPD. And not really thinking more broadly across kind of across a number of diseases. We do that in clinical trials, we have primary outcome, but we look at a lot of secondary outcomes. And sometimes what we find is actually an effect. We weren't exhibiting on secondary outcome. But I haven't seen that as much in the preclinical work, I think that's an opportunity. And one other area that I've really been very fortunate to kind of get get experience with is actually, you know, as we're breaking down silos, actually the collaboration between patient families and clinicians and researchers, and that has been, I think, one of the most fruitful experiences that I've had over the last five or so years, particularly working with the NEC society, which is this wonderful organization that is founded by somebody by the name of Jennifer canvasser who lost my good, she's awesome. Mica, Mica. And they have really brought together I think, in terms of breaking down silos, bringing together, you know, researchers and clinicians who are maybe working in very narrow areas, and really to try to get get the groups together to think together to work together to collaborate together, which I think has been fantastic.
Yeah, I think that part of the neck society, the idea of bringing in parents to actually move shift the the shift the goalposts, where instead of having a committee of physicians or researchers saying this is what's important to study, and look at parents and saying, what matters to you, what should we really focus on, is so simple, and so trivial, and yet so groundbreaking, that Daphna and I often say like, why is this not happening across the board? And I think, and I think whoever is focusing on any areas of research, if you take that approach, I think you there's definitely success at the end of this of this road for anyone who pursues the same model.
Speaker 3 37:36
And we we've just finished kind of a few year effort where we've gotten together, we got together an equal number of clinicians and researchers and patient families and try to come up with what what are your priorities in the areas of any scene, and we're going to share that next month. So I'm sure you know, what people came up with. But there's certain areas that are incredibly important to patients at almost, there's almost nothing out there. You know, what are the outcomes of infants develop neck after two years of age? You know, there's almost no, there's such scant amount of information, that's hugely important,
out of sight, out of mind, right? They get discharged from the NICU, and that's it, they're no longer our problem. And if somebody's
pediatrics issue, right, and that immune ecology issue, yeah, really cool.
Speaker 3 38:17
And so that's not something I would have thought about until, you know, really, once you start hearing from patients and families, you know, this the importance of that we're really, we really need to kind of rethink, you know, where we're focusing our research priorities on.
So when you think about sorry, when you think about medicine, I mean, one thing that has always held true is like a strong group of parents who have always propelled medicine forward, especially, I mean, patients in general, but especially in the field of Pediatrics. So that's neat, why not invite them to the table without them having to, you know, push shoulder their way? You know, very cool. Go ahead, Ben.
Since we're talking about research, I have to get this in, because I feel like shortly we'll be saying we're out of time, there's no time to ask but you, you've done great work with the NI CHD, neonatal Research Network. And I wanted to talk to you about the paper where that you first authored that was published in the New England Journal of Medicine. And the paper is called causes and timing of death in extremely preterm infants from 2000 through 2011. And that it's a very inconspicuous title. But for the people who remember really, that paper sparked a massive discussion in the field of neonatology because you guys started reporting outcomes for babies at 22 weeks. And and I feel that the discussion really exploded after this paper came out, can you I'm always curious for the young investigators who are listening to the podcast. Can you walk us through what happens when you complete the manuscript you submitted to the New England it gets accepted, it gets published and then the waves of requests and questions come in like how do you how does that what happens?
Speaker 3 39:58
Now well off Start with, you know, I had a wonderful mentor, Dr. Barbara still who is our Chair of Pediatrics at Emory. And she was just the most gracious mentor who kind of took me under her wing. And she was our principal investigator for the NICS network. And then I, you know, I had early on kind of that was, that was the dream of, when I started off of kind of what I wanted to be, and one of the things I was shooting for, and I've been fortunate to, to transition and work with just some incredibly talented and brilliant researchers. And it is a very, you know, submitting to the New England Journal or high impact journals are very stressful, because they, they're very intensive in their reviews and critiques and and, and so it is quite, it's quite a relief when it actually gets accepted. And then I think, you know, The striking thing is actually that people, you know, when you read it, you're never really sure what the impact of anything you published is going to be, or two people care, they're going to read it. And so one of the one of the things that is just as how many people reach out and actually care about what you're doing, and actually intellectually engaged with your work and ask you questions about, you know, what about this? And, you know, why do you think this is and, and some of that is through speaking engagements, some of this just through email, and it, I think it keeps you going as a researcher, because you realize, you know, that there's actually a lot of people out there who are very interested. And I remember getting an email from an adult oncologist in Houston that read the paper and actually was asking about questions. And I was thinking, you know, I would have never imagined that to happen. And so there's these people that are really interested in this work. And, and so that that was, I think, one of those experiences about what about when it comes out? But there's lots of research. That's excellent and wonderful. That's not, you know, not, it's published in a lot of journals. And I think maybe today, it's less important, because of, you know, a lot of ability for people to access journals anywhere, as opposed to what comes in your mailbox, that I think there's good research in many places,
but when you're the first author on the New England paper and your emails on the front page, like it's like, the first story on the APM. us you know, it's like, everybody, everybody's watching, and I relate to you. Yeah, relate to what you were mentioning about the editing process, there's this, there's, I can imagine, I can only I have never submitted to the New England, so I wouldn't know. But I can only imagine in France, there's this famous quote about like editing. And it's like this author who said, today was a good editing day, I spent half the day deciding to remove a coma from a sentence and the other half, putting, putting it back and at the end, basically, the whole day, nothing has changed. But that was a whole day of editing. And I can only imagine the number of revisions that you must have had to go through. And yeah, how do you deal with that, by the way, because I feel like sometimes, you deal with revisions and reviewers and like you're moving further and further away from the original manuscript, you said, and you have lost complete track as to what your original product looked like. And you just hope that they eventually say yes, because if you have to backtrack and resubmit the original manuscript to another paper, it's another journal, it's so traumatizing. But have you ever felt felt that?
Speaker 3 43:10
Yeah, you know, it changes a lot. I mean, they have a fantastic editing team. And they're very precise with language, I think that's one thing I've learned from that process is just a degree of precision in which you, you write about certain things. And I think also the caution, and one thing about the new internals, they're very cautious in terms of the language, the words that are used to describe the findings, and so that, I think it's very, very important, it was important learning lesson for me. And sometimes it gets to the point where they are. For this, it wasn't the case. But for other other publications, sometimes actually, the interpretation of the way in which you interpreted the data might be different than the ways in which they would, you know, suggest, I think that, you know, maybe airing more on the side of caution, and there are certain things that some of these journals like subgroup analysis, where they're very cautious about how it's interpreted and reported in the words reported. So it's definitely a experience. And in the paper does turn out very different than the first draft submitted, you look back, and it's sometimes feels like somebody else wrote your paper. And that's partly because somebody else did do a lot of editing. And just, you know, the content is the same I think it's just how it's how it's reported in the languages,
put yourself a second author and put reviewer.
I want to ask about your experience with collaboration. And I know that sounds silly, but you know, when you're when you're a first grader, like my daughter, you're learning so much about collaboration and sharing and somehow in medical training, we've gotten the idea by the time you get to fellowship that like collaborating with others, like puts you at risk somehow, but I mean, your entire career. You you are, you've worked with the NI CHD EB ni out the southern society for pediatric research. And if anything, it sounds like those collaborations have strengthened your, your work, you've gotten a lot of things done in a short amount of time. So can you speak a little bit about how that has been a, you know, a cause for good in your life?
Speaker 3 45:21
Yeah, you know, one of the things that I realized very early on, that I really enjoyed, that brought me joy in academic medicine was working with talented colleagues, you know, just just learning from others, hearing different perspectives, you know, and, and getting to see how other people approach things. You know, I always enjoy when I, somebody sends out a manuscript, and you read comments of other people have any, I wouldn't have thought about that. And I think that's one of the things I really do enjoy about collaboration. And maybe it's a shift, you know, I think that, you know, today, it's really hard to do large clinical trials without a massive amount of teamwork. And, and sometimes there's, you know, one person, the first author that might get the bulk of the credit, probably, because they really led the design and got the funding and push the study through. But there's really this team of people that that's essential to actually do this work. And if the end of your day, the goal is to improve nail care and improve outcomes, that that probably is the most important thing, and just being able to contribute to that piece is important, you might not get as much traditional academic credit all I think that might be shifting in the views of depending on where you are. But I think at the end of the day, getting to participate in important studies that that will impact practice, I think that, for me is exciting. And I value that and I think collaboration is one of those were ways where you can achieve that in as long as you know, it's done in good spirit. And I think I've been fortunate to really work with a lot of wonderful groups. And, and I also have valued so much the amount of generosity that sometimes collaborators have terms of intellectual investment in the work that you're doing, are also really wanting to improve what you're doing and saying, you know, I think this is great, but have you really thought about this interpretation? Or are you sure that this is right? Or why don't you look into that? I think that kind of feedback you get from collaborators who think differently than us is invaluable?
Yeah, I think you're right, so much about the landscape of medicine is is changing. I think collaboration is definitely key to that. But you actually alluded to something when we first started about how important it was when you in your first job, and how you were able to negotiate for time for research. And I feel like that's a way that the landscape is changing, potentially, in the wrong direction. And it seems like it's much harder for new investigators, early career, Neos, to get the support, get the resources, get the funding, but especially the time protected time to do any of that work. Seeing is how medicine is a business. And neonatology is no exception to that. So what are the tips? How should new hires or people just had a fellowship? How do they how should they go into negotiations?
Speaker 3 48:28
I think it's good to have kind of a little vision forward about what your plan is. And one of the things when I didn't negotiate it was that I was very specific about what I wanted. But I'm very persistent. I think persistence tells you it tells the other person that this is really important to you. And the number one thing on the negotiating table for me was time, you know, it wasn't salary, it wasn't. And that was really you know, when you're because I generally am optimistic person, I think division chiefs and chairs in at least in academic medicine really value that they want talented, successful researchers. But they also have to make investments with limited resources. And sometimes you might not get everything you want. And then I would say my advice would be to really relentlessly pursue what your you said, you're gonna do, you know, I think that the struggle is you want to do a quick research and you might not have gotten as much time as you want, but you got some protected time and maybe it's for a limited period of time and then you don't take advantage of those those couple of early years. And now you're up against an uphill battle because you've missed sometimes this opportunity to show to your boss, this is what I've done in and and justify more time. So I'd say you know, the first couple of years out to really try to think about hitting the ground running and that requires a little bit of knowing what you what you're passionate about and excited about and good mentorship and sometimes it's just luck. of having the stars aligned. And I think for me, it was a lot of luck, I was fortunate to have wonderful mentors along the way. And I'm lucky for that, but no others might not be as lucky. And so there's this this bit of kind of good fortune in terms of career paths, the others persistence, you know, there is, I've gotten a lot of people over the years that have gotten rejected, you know, time after time, and eventually they start getting some wins, and then some more wins, and some more papers accepted and grants. And eventually things start to come around. And I think persistence is really, you know, having tough skin and persistence, which is a challenge, you know, it's hard to be a good clinician and successful and getting into medical school and getting into residency and fellowship, and then, you know, being rejected all the time when you're an academic academia founded that and just, yeah, you just got to think like a baseball player, you know, base, you know, you know, one out of every three or four times that you're doing good, and, and just keep, keep swinging the bat, you're trying. That's awesome.
I wanted I wanted to talk about social media. And I wanted to talk about Vimeo, because I think this is, in my, in our opinion, obviously, the future of of sharing information, sharing evidence, and eventually growing the neonatal community. I wanted to know when what you're you're very active on Twitter, you have a large following. When did you decide to make the jump and start joining the new Twitter community?
Speaker 3 51:31
I was, I was actually little bit skeptical of social media. And so I ended up we had a faculty development seminar held by our School of Medicine, and I went there. And it was all about social media for career. So it was kind of interesting. And I came in as a skeptic. And this was a person who was an adult cardiac electrophysiologist would post EKGs and, and use them as teaching opportunities. And so that's, that's kind of interesting. And this idea of educating beyond the boundaries of Emory, you know, that he had this following, and people were learning and they were engaging with his work. So I but the advice they gave me is, you know, give it sign up, and just get a feel for follow some people and give six months because it might be hard to navigate. And so I kind of came in with a soft entry. And started to follow people and, and get a little bit of a feel for what the community was. And then in 2017, I had a chance to kind of join EB Neo, and that it was an organization for those of you that know,
let's talk about the new. If you don't know what he'd been do is you're missing out. So let's, let's do it.
Speaker 3 52:38
So even he has this wonderful organization. It stands for the international study for evidence based neonatology, it was founded in 2015 by three people Stefan Johansson and McCollum, Norman who are at Karolinska in Sweden and Hirsch Kalani who I views who was most recently at the Children's Hospital, Philadelphia, who I think epitomizes evidence based medicine, really the society was to improve kind of evidence based neonatal practice. And part of the big mission was, you know, there's all this research out there, but how much of it is that you're reaching the babies we care for in the unit, and to kind of reduce that lag from kind of knowledge to translating into care. And part of the two and this wasn't the initial kind of initially how it started. And I think a big credit to people like Nick Biomet, and Clyde Wright, who are kind of early members of that group. And Nick really taking on this effort of really using social media as a way to disseminate. And, and one of the things and that was my first entree into the organization was kind of helping to to disseminate work through social media at that time, it was it was a small group. And we've really grown from a wonderful cadre of volunteer passionate evidence based medicine, who kind of curate the literature and do the heavy lifting to keep the busy clinical and intelligence up to date by at least letting you know, there's a study out there, here it is, it may or may not be relevant, but you know that it exists, you can like it, if you if you are keep track of it, and be aware of it. And maybe for really high impact studies, there's conversations that happen that allow people to put these studies into context. And for me, 90% of what I learn about research now comes from Twitter. That's where I find the vast majority of new research, particularly things that are very pertinent to what I do, and things that are outside the scope of what I might think about. There was a study today about whole blood transfusions in Africa, in children and kind of the impact of that versus PAC red cells transfused with that would you know, that's not something that I would normally see. And that's something I saw because of Twitter. And it makes the world feel a little smaller as well. I've gotten to make good friendships with people outside of the US and and get to know them and it feels like there's this community of people passionate about evidence based medicine and ontology that that I value tremendously and that I think was lacking before I joined Twitter and before I was part of EB Neo And we hope that, you know, part of my aim is to try to get trainees and as well as established neonatologist, who might be skeptical to try to at least open their hearts and minds to the idea of using this as a key tool for, for keeping up with lifelong learning and evidence based medicine might not work for everyone. In my mind, there's downsides to social media, but I hope people realize that this is your community out there, and this whole opportunity to learn and stay up to date that is occurring in social media that, that they might be missing out on, if they're not already engaged.
Well, I know that
Speaker 3 55:37
what you're doing is great, you know, also, you know, the podcasts, you know, just just ways to make it easy in the lives of busy people to stay up to date on what's going on and have a good feel for where the fields moving and what's going on. You know, it's a great way to, you know, on your drive home, just just not, you know, feel what's going on. So I love,
I feel like, yeah, when we talk about social media, I'm trying to implore to people like, you know, when you go to a conference in, you leave, like rejuvenated, because he's had all these interesting conversations. The same thing is happening every day on like, a slightly smaller scale, on Neo Twitter, where if you pull it up, somebody, especially you, you know, it's talking about something, and you can learn so I mean, it's, it's a problem, right? Because he's starting to spend a lot of the day Twitter but but you're learning a lot, learning a lot. So I'm glad you're here.
Speaker 3 56:27
And it's it's impressive, the you know, when you look at some of the metrics of actually how broad engagement is that there's actually a large community people that are engaging, interacting, and I do hope that for trainees that, that this is part of their part of their education, DNA technology is, you know, outside the walls of their institution, the best way to do that, you know, there's, I think, today, lots of opportunities, you know, webinars, podcasts, but but that social media is something that makes it easier. And I think it probably also requires some constraints because it can, there can be an addicting nature to that. And, you know, I think just to be cognizant that thinking of it as a tool for engaging and learning and to separate that out from kind of all the other parts of social media that might be part of your personal life, that kind of, you know, that this is very different, and to try to think of this as one of those tools that you can use to for lifelong learning and to keep up with evidence based medicine and what's going on in the field.
Yeah, another aspect of social media that I think goes very much underrated in the professional sphere and in our case of neonatology is the ability to effectively network with people. I think it used to be that you purchased a registration for PBS and you were hoping to bump into this person and talk to this person. And I think what people are not realizing is that in today's day and age, you can literally connect with anyone across the globe in the field of neonatology and have meaningful interactions. And just, it's kind of it's kind of amazing. I mean, I remember when I was studying for the boards, being able to just like shoot message to Dr. Dr. Martin and say, Hey, like, and being able to talk to her, which again, without Twitter, I would have never been able to interact with her, I would have had to, like, find her at a conference. And and eventually, networking can lead to amazing opportunities. And in our in our case, I mean, again, we were able to bring them on the on the show, and then even do a podcast with them on for your review. So I think people are failing to see the real potential when it comes to what you'll be able to achieve once you connect with with other colleagues. And and there's an there's a lot of people who are on Twitter, who are extremely brilliant researchers like yourself, and there's a long list of other Twitter accounts that people can follow. So do you talk about that when when you give talks about social media about the ability to network and and this aspect of social media?
Speaker 3 59:05
Yeah, absolutely. And, you know, I gave a talk recently, the American Academy of Pediatrics workshop in Scottsdale, and one of the things I asked and was, you know, kind of talk about the role of Twitter and I put out to the community, you know, tell tell me about the experiences of, of Twitter, and I think, definitely, I remember you saying something about, you know, it makes the world a little bit smaller, and, and I shared some of those snippets. But I think networking is critical, because there's this community of very people who share a lot of similar passions that you probably aren't going to otherwise encounter. And reading about them on the page of a journal just seems so distant whereas if you're interacting and and, you know, having conversations it it feels a lot smaller and networking and it's very common. I mean, this might have happened to you know, you go to conferences Hey, I know you from Twitter you've kind of felt like you know that person because following them on Twitter says,
we have a Twitter friend or colleague, you're well, I tell you, your your talk was effective, because we saw a big bump in near Twitter right after you gave that lecture. So I think it's something people are, are looking for, right? I mean, it's human nature to be seeking out community. And so I think sometimes medicine can be really isolating. And so definitely, I think it's been helpful, I want to before we get totally away, if people want to get the full benefit out of the work, you guys are doing an EB do what's the best way for them to connect with that,
Speaker 3 1:00:45
I'd say follow us. We're on Instagram, Twitter, and Facebook. And so just to follow Eb, Neo, the, the Twitter handle is at EB Neo, you can also go to our website, EB neo.org, we have a monthly newsletter that you can sign up for that newsletter actually tries to capture the key curated articles, you know, if you're trying to look at articles, every month, we have the article the month that's voted on by the community that's selected from our social media editors, and that's the one article every month that you should should keep up with or try to read, we would say, you know, that's the one and then there's, that's, you know, I would say the best way to, to engage with the video. And if you're interested in learning more, you know, please reach out to me, you know, I'm on social media, we'd love to, we've been fortunate to have very passionate people who've engaged with us who do a lot of the heavy lifting in terms of curating the literature. And in their reviews that we have with the partnership with Acta paediatrica, that are kind of quick reviews of the literature. And we have a relatively new Journal Club, which was more on kind of education on evidence based, you know, aspects of evidence based medicine, maybe getting a little bit in the weeds of things like Bayesian statistics and effect estimates and things that you don't really encounter that that we're trying to make in terms of Bite Size opportunities for learning. So it's
the things I think that used to shine you away, right, the things you say, Oh, I don't want to I don't want even think about that. And you guys are doing a fantastic job. It's, I mean, I've consumed that on YouTube, right? It's on YouTube. So it's really, really good. And if you like me are trying to understand better statistics and the way things are done the way they're done. It's fantastic for for that purpose. So yeah, great, great content. Okay, so then definitely can I go?
You can go. But I have one topic that I will address when you're done.
I think I'm probably the same topic. Go ahead.
Well, I mean, I don't think we can finish a conversation with you. Without talking about education. I feel like you have been asked to give lectures on the gamut of things, including just how to navigate life as a as a neonatologist. And I just, you do such a good job, you bring in humor, and you bring in different adult learning styles. So when you're sitting down to give a lecture, like how do you plan it out? You know, what do you what do you look for to make a big impact? Because Because your lectures kind of universally leave live leave big impacts?
Speaker 3 1:03:16
No, thanks for that I had the benefit of actually studying one of who I think it's the best teachers, which is my current chair, Dr. Lucky Chang. And one of the masterful things he does is he starts with kind of a, you know, a hook of trying to get some speaking a little bit less formally. And you know, we're so trained in terms of didactics. And just conveying information that we don't get, get this kind of intellectual engagement. And so that was one of the ways I tried to shift. And I think it's an iterative and learning experience of, of trying to give educational content that that is maybe less overwhelming and more getting kind of capturing people's minds in terms of thinking about things. It's a challenge, I would say still in learning and still trying to figure out, you know, what's the right style because, because for different people have different learning styles and different desires. But, you know, there's one what I went to learn how to be better teachers workshop about 10 years ago, and one of the things they said is, every presentation, you have cut the number of amount of words on each slide in half, and then cut it in half again. And so that's always been one of one of the things I've tried to do and then kind of what what do you really want to learn your audience to learn in 20 to 30 minutes because after that they probably lost you and maybe even less nowadays. It's hard because as a teacher you also want to there's so much you want to teach and trying to try to decide and cut it down is just incredibly hard. I think it's I find it much harder to give it 20 minute talk them to give a 45 or 50 minute talk, it's so much harder to try to really think about what you want to convey in in a short time window. And so that's, you know, that's really sort of my philosophy. And, and I've, I think I continue to learn and I always, always try to pay attention to, to other people who do it really well and kind of learn their secrets. And I'm sure TED talks are a great inspiration for for how to do it. Well.
Yeah, I forgot I forgot who I read there was talking about the editing process and says, First, take out the chainsaw. And then take out the scalpel. And the rule is always the same Chop, chop, chop, chop, chop. Oh, I mean, yeah. And I think that we do see that when we have word counts commitment on abstracts and stuff like that we're like, we have, we have to make this as impactful as possible in 200 words or less. And there's always opportunities. And and I think also, people tend to forget that PowerPoint and slides are meant to be visual aids, they're not meant to be the actual presentation, you're giving the talk. You're talking. Yeah.
Speaker 3 1:06:06
Yeah, one of the favorite things which you don't get to do at conferences is Chuck talks or, you know, digital smart boards, which is, when I'm when I'm rounding on our resident teaching unit, you know, I love that idea of just having a chance to kind of,
yeah, concept mapping and being able to actually let the process unfold in real time. Right.
Speaker 3 1:06:27
Yeah, and, and kind of getting feedback from learners in real time, I think that's been the challenge. And the zoom, that we're getting back to meetings is just, you know, sometimes feels like you're talking into this blank screen, and you never know, you get no feedback of as everybody asleep on the other side of the big attention. Is this actually meeting their needs. And so it's, I think it's a learning experience, it's, it's challenging, but for those that are starting off, I would say, you know, just start with, if you're asked to give a resident, you know, give a small talk to, to a smaller group, you know, treat it like you're giving the most important talk. And, and try to, and one of the rules I received that I got from another colleague, who I admire a lot was never give the same talk twice. If you're giving a talk and you give that same slide deck, again, you've missed opportunity, really, you should think about how can I update this and improve this and refine this and kind of thinking that and that's always been something I've followed with me as always, there's something I can make better.
Now you can have it
I, we went over time, but that's okay. And my last question did have to do with education? I think you're somebody who has mentioned and is committed to what you call lifelong learning. Right? And I think for people who are at outs out of training, what is the key to being a good lifelong learner?
Speaker 3 1:07:57
I think it's a it's a challenge, you know, I find just with all the things in our lives, you know, where do you put keeping up with the Nina literature with, you know, family and work obligations, and, you know, making the time for dinner. And so I think early on, I would say is think of strategies that work for you, it should be very personal of what works for you, that might be sitting by the fireplace in the winter, and reading your stack of journals, or perusing through that or might be scrolling through Twitter, and maybe at least having some things that are on your reading list or attending conferences or, or a mixer, or listen to a podcast or something that kind of works for you. And try to make it a routine. I think that's that, for me has been, you know, just trying to build this as part of kind of, you know, just like you have to go round and you have to sign notes, there's just no, there's not many people who like writing notes. But it's just what you have to do just part of your, your career, and it's important to you what you do, and then that way, you know, kind of keeping up with learning should be part of what you do. I think going to one conference a year that is just not going I think that's going to be insufficient, you know, that there's just too much going on in our field and too much information coming. And so fortunately, there's lots of opportunities out there now, especially with groups doing webinars, and so just finding what works for you and kind of sticking with it. And, and also to manage it doesn't have to be overwhelming. Sometimes it can feel that way. But really to say you know, if I can just do one article a month, let's start there and and then maybe move and move forward from that.
I like that. One getting getting better 1% Every day, it will lead to significant improvement. So it's a very zen approach, I think that you have to lifelong learning and and this idea that the goal of Zen philosophy, right is to always be a student. And so I really I really like that I think we should never really see ourselves in a different light.
Speaker 3 1:09:54
Yeah, and you know, I was giving a talk recently on Transfusion Medicine, Dubai and I you know, I would I thought everybody in the world would probably be aware of the planet to trial. Now, platelet transfusions, and that is not the case. There's people that don't. Is that really the case that you know that actually there's worse outcomes with more? Yeah. And so I think we under sometimes underestimate the importance of kind of keeping up and of kind of getting getting knowledge from PDF files on the website, to people's minds and actually, to the care they provide. I think
there's still a lot of obstacles. It's still despite how easy it has become compared to 100 years ago, there's still tremendous obstacles that need to be addressed.
And work to be done. We
are very conscious of that. We're conscious of that at the incubator as well. Ravi, this was this was fantastic. It's always a pleasure talking to you. You are so easy to talk to. And it's difficult to do a one hour interview with you. I mean, there's so much like, you're just mentioning your work on blood transfusions, like we haven't even touched? I think if no, if anything, I'm hoping that people will be intrigued and will start seeking you out on Twitter and look out for your names on various papers and really reach out to you if they right, it's okay for us to share your Absolutely. I mean, yeah. And and so thank you, thank you so much for being on with us today. We're so great. Thanks.
Speaker 3 1:11:22
It was a pleasure. Thanks. And I look forward to listening to more of more of your podcast.
Thank you. Thank you.
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