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#116 - Dr. Patrick Myers & Dr. Nicolle Dyess


ONTPD NICOLE DYESS PATRICK MYERS

Hello Friends 👋


We are shuffling our release schedule to bring you a timely discussion about the recent proposal for changes to the pediatric residency program requirements. We have the pleasure of hosting Dr. Patrick Myers and Dr. Nicolle Dyess to discuss these polarizing changes. We hope you find this conversation helpful and that the resources suggested by our guests and listed below help make your voice heard.


Thank you for listening!

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Do not forget to register for our upcoming conference March 27-29 at www.delphiconference.org. We are encouraging our listeners to register by offering a 30% discount by using the code INCUBATOR at checkout.

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Find out more about Organization of Neonatal-Perinatal Training Program Directors (ONTPD):

https://www.aap.org/en/community/aap-sections/sonpm/ontpd/?ref=the-incubator.org


Find below some of the links discussed on the podcast this week:

https://www.dropbox.com/s/jd056t1xxokqx8a/ACGME%20Pediatric%20Residency%20Changes%20to%20Neonatology%20-%20Key%20Points.pdf


ACGME-Pediatric-Residency-Changes-to-Neonatology-Training
.pdf
Download PDF • 171KB
Summary-and-Impact-of-Major-Requirement-Revisions
.pdf
Download PDF • 183KB

Here is the ONTPD video helping you walkthrough the comment submission page:

https://www.youtube.com/watch?v=NFCiWxEegHI


Find below the webpage where comments can be submitted to the ACGME:

https://www.acgme.org/review-and-comment/320---pediatrics---major-revision/

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Dr. Patrick Myers is the Fellowship Director of Neonatal-Perinatal Medicine at Lurie Children's Hospital and Northwestern University. He trained as a pediatrics resident and neonatology fellow at the University of Chicago. Dr. Myers is the Chair of the Organization of Neonatal Program Directors. He was selected to represent the Neonatal-Perinatal Medicine education community on the Council of Pediatric Subspecialists by the American Academy of Pediatrics section of Neonatal-Perinatal Medicine. He is a recipient of the Northwestern Neonatal-Perinatal Medicine Fellowship faculty teaching award. Dr. Myers is a member of the ACGME Neonatology Milestones 2.0 writing committee.


Dr. Nicolle Dyess is an assistant professor at the University of Colorado and the Education Chair and ONTPD Liaison of TECaN.

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

Ben 0:54

Welcome Hello, everybody. Welcome back to the incubator podcast. It is Sunday Daphna. How are you?


Daphna 1:04

I'm doing great. I am recording from the grievance conference. So I'm excited to be here. But we knew we wanted to make time for this special interview.


Ben 1:16

That is correct. And I am very excited to talk to our guests today about some of the changes that are coming to pediatrics and pediatric residency. We have the pleasure of having on with us today. Dr. Patrick Meyers. Dr. Meyers is the fellowship director of the neonatal perinatal medicine at theory Children's Hospital and Northwestern University. He is the chair of the organization of neonatal program directors. He was selected to represent the neonatal perinatal medicine education community on the Council of pediatric subspecialty by the American Academy of Pediatrics section of neonatal perinatal medicine. He is the recipient of the northwestern neonatal perinatal medicine fellowship Faculty Teaching Award, and is a member of the ACGME neonatology milestone 2.0 writing committee. We also have the pleasure of having with us Dr. Nicole Dyess. Am I pronouncing your last name correctly? Yep. Perfect. Awesome. Who's the assistant professor at the University of Colorado and the education chair and oh ntpd liaison of tikkun Nicole, Patrick, thank you so much for making the time today and joining us on the podcast.


Unknown Speaker 2:26

Super excited to be here with y'all.


Ben 2:30

So I guess for we should start, we should start from the beginning. For the people who are wondering why we're even discussing program requirements for pediatrics residency, can you tell us exactly what has happened in the past few weeks that is causing such a stir?


Speaker 3 2:47

Yeah, so every 10 years or so the ACGME review, committees are required to evaluate the current specialty specific program requirements to review the current requirements and see if any revisions need to be taken. And so in the last few weeks, the ACGME release to the proposed revisions for the pediatric residency program requirements. And there have been quite a few major changes that took place that has caused quite a stir among the neonatology committee or community.


Speaker 4 3:23

And just to maybe add on, you know, I think most of us as fellows and residents know that the ACGME exists, but it's really the governing body for every fellow resident in the country. And whether you're allowed to have a fellowship or residency is directly determined by the ACGME. And so the rules they set forward, are actually the rules that govern how residents are trained how we become pediatricians and fell. So like, this is a big deal, because this is essentially like the the rulebook for the next 10 years.


Ben 4:01

Right. And this actually sets the standard for what we're going to expect our pediatric training programs to deliver when it comes to education, training and mentorship. And so it really is a key document and a key publication. But that may affect the generation of pediatricians that are being trained.


Speaker 3 4:24

Exactly. And just like you mentioned, Ben, the ripple effect of that, right, it's program requirements for pediatric residents who then either go out to practice in the community as general pediatricians, but also a good set of them go into subspecialty training and so it's going to change the caliber for lack of better word of pediatric trainees that are coming in for better or for worse.


Speaker 4 4:51

You know, it impacts things like how do you what procedures do you know or don't know? How do you are you required to take care have children that are dying and have had those experiences? How much time do you spend in different units and it will have like really profound ripple and impacts in terms of our workforce, right? And where people can practice and where people feel comfortable to practice.


Speaker 3 5:20

Right. And so it's kind of as a whole, not only within the neonatology community, but also as just pediatrics as a whole.


Ben 5:27

Right. And so you're already touching up on some of these changes, I guess, Patrick, and, and for people listening, I would like to recommend to follow on Twitter physician, Brian Kerr Modi, who has posted a very nice thread going over some of these sort of pretty interesting changes. You mentioned procedural training. And, and in this new requirement from the ACGME, the requirements for resident to learn like specific procedures are quite are removed, and a resident may not need to know how to place an umbilical line. And some people may say that's, that's fine, but also bag mask ventilation is gone. And instead, this requirement has been replaced by the ability to perform procedures that are quote, unquote, and I quote considered essential for their area of practice, which, I guess could be very scary. Because if you are not moving on to fellowship, where you will learn these skills, or if you're not moving to an area of the country that has a nice subspecialty support system, you may find yourself in an area where as a pediatrician, the expectations of what you will need to do are quite high. And we read these stories of rural areas where a newborn is delivered prematurely, for example, and they call the pediatrician. So can you tell us a little bit about what your thoughts are on on this item, specifically, since it was already brought up?


Speaker 4 6:56

Nicole, I think when Nicole and I were talking, she actually had like a really good experience about this. But I think that our concern, like, globally is that people need to have like some base standard for being a pediatrician, right? If some if a parent says, you know, is there a pediatrician and my baby's in trouble, the response shouldn't be? Well, I'm a pediatrician, but I don't know how to like initiate life saving care. I don't think anybody expects us anybody to be a PICU or NICU doc or an IDI doc. But I do think that like as a community, we should have some standard, where we've had experience, we've have some comfort level of jumping into that experience. And I think that the procedures just being removed is like actually pretty troubling, I think to the neonatology community at large. And I think that the next part of that is I think that just speaking to equity, right? Like, I mean, as you alluded to Ben, there are many parts of the country where you know, the ABP tells us that the workforce is just really unequally distributed. And we're going to really under serve a lot of families, a lot of kids were the those general pediatricians are really the corner store stone of providing care to our families.


Speaker 3 8:18

Yeah, absolutely, Patrick. I mean, I'm at the University of Colorado, and we serve a southern state catchment area. And there's a lot of rural community around Denver proper and Colorado and the amount of times that I'm on the phone, the transport phone with a pediatrician who has is taking care of a recently delivered pre term unexpected delivery. And walking them through the resuscitation. is quite numerous. It happens to me every time I'm on call, and it happens to all of my fellows every time they're on call. And so this isn't going away. And what Patrick said about the equity is what my biggest concern about this change in the program requirements for pediatric residents, I worry a lot about the distribution of our workforce and whether those pediatricians going out into communities that are underserved now with a lack of required minimal, especially resuscitative. Procedural will further that inequity that we're seeing across the nation and lead to even more health disparities. Yeah, and


Daphna 9:27

certainly in many communities, like you said that there are general pediatricians are the ones who attend deliveries, not neonatologists. So do you guys have any thoughts or, you know, what is the discussion about why they've these changes are, are upon us and why these changes specifically?


Speaker 3 9:50

Yeah, I think, you know, the big, the big overarching concept that I do think the revisions that the majority of the revisions move toward Does this general move in medical education towards competency based medical education as opposed to time based medical education, and more individualization of education tracks, which is great, it's a beautiful feet to kind of try to move towards but at the same time making sure that we have our guardrails up and making sure that there's a minimal standard of care that we are and that we are training our, our pediatric workforce in.


Speaker 4 10:31

And I think part of the question too, is, what are those minimal competencies? And I think that's where I think having input from a larger portion of the neonatology community is important. I mean, is it bag masked, putting in an LMA putting in a low lying UV doing NRP and pals? Or are there other things? Is that list too exhaustive? Is it? Is it too short? I mean, I think that generally the program directors are kind of in that list. But I mean, also to Nicole's point I, I do actually, when I read the intent of the ACGME, I'm actually totally on board, like they're trying to push medical education to be more innovative, to kind of work with the science behind med ed to kind of like help us craft a better experience during residency and fellowship so that we produce better trainees and I actually, I think a lot of the requirements do that. I think that the concern for the neonatology program directors is that we kind of like to to Nicole's point, we're missing some of the guardrails, right, there's some minimum standards that we should all be able to do to kind of call yourself a pediatrician. And I think those have need to be explicitly spelled out. And, and be a little less confusing. There's like one point where they say you need to be able to like, resuscitate somebody. But then you also don't need to know any procedures such as backmasking. And you know, there's an incongruence, between NRP and pals and, and some of the statements, so we're really advocating for putting in the guardrails, putting in the medical minimal expectations for all of us, totally.


Ben 12:15

And we've been talking about procedural skills, and some people may see well, but even if the requirements are not there, at least, you know, you'll rotate through the NICU and you're you'll see certain things and maybe you'll get it from there. But even that has been has been affected by this new publication where the old requirement for minimum of like two, one month blocks of NICU and PICU are now gone. And the new requirement basically calls for 12 weeks of intensive care with at least four weeks of NICU and four weeks of pick you and the faculty that are supposed to train residents. Also, the requirements for these individuals has changed were to be a pediatric residency program, you had to have certain specialty faculty like Nick, you pick you, er, physician, and so on. And now, the board certification for number one, these, those prescriptive requirements are gone. But also the fact that these specialty faculty had to be board certified, is also gone. And they just need to, quote, possess the qualification judge acceptable to a review committee. And this is demonstrated in an ability to teach. So this is this is really deep seated changes that could really have important ramifications. What do you make of these changes in both the requirements for ICU rotations, and also the more loose requirements for specialty faculty in the pediatric residency program? And I have a question following up, I'm setting you up for a question. So I'm curious to hear what


Speaker 4 13:59

I mean, I think the minimum requirements probably I think that's one of the biggest program director challenges, right. I would think we need at least eight weeks in the ICU in both eight weeks in the NICU and eight weeks in the PICU. Because those are where you learn some just core skills that you cannot ever experience anywhere else. And some skills that are pretty sad, but are really important, like about 75% of all children who die in a hospital die in the NICU or PICU. And having that experience, no matter who you are, if you end up being a rheumatologist or a general pediatrician, I think having somebody an experienced board certified neonatologist or PICU doc who has done this a while and can mentor and teach people about how do you manage your own grief and be empathetic at the same point? How do you deal with end of life discussions? How do you deal with Palio of care. But it's also the place where you'll learn how to deal with crisis. You, you don't want to have somebody who graduates from pediatric residency. And the first moment where they have to deal with a crisis situation is with by themselves like you, you need a fair amount of reps of like having an adrenalin shoot through the roof as that term kid doesn't breathe in the delivery room, or you're the first person in the room when the ET tube comes out, right? There's a lot to be said about, like learning kind of like, general soft skills is the right way, because I've really just viewed them as unbelievably critical. Having those experience moments of seeing children die having those communications with families being in those crisis situations. And honestly, I don't think we're going to advocate for 16 weeks, four and four. But I mean, it shouldn't be more than that. Because those are irreplaceable, irreplaceable experiences for every pediatrician.


Ben 16:06

I think what some of the soft skills that you're talking about, I think, for me, during residency were to learn from the emergency physicians from the PICU attending in the NICU attending was the way they thought, right. So for example, were the emergency like the emergency physicians, beyond the different cases, whether it was a laceration that needed to be sutured. But this idea of thinking like an emergency physicians where you're like, I need to, I need to rule out the things that are going to kill you right now. Because that's what emergency medicine is. Or the thinking of an ICU physician, which is, which problem can I tolerate? And which one can I not tolerate? Can I allow certain things to go a little bit off the road so that I can fix a bigger problem. These things, I feel like, you learn over time, it's hard to walk in, in a unit and within a span of a week or two pick up on these things. These are sort of deep cultural elements of the different units. And and it seems like we're going to be losing that in this new


Speaker 3 17:02

way. Right. But and, you know, to piggyback on that, one of the big points about residency is is learning how to differentiate that variation in illness, right, knowing how to pick Oh, I am not worried about this child, or, Hey, this child is kind of sick, oh, man, I cannot handle this at all this baby or patient is critically ill. And I worry that if we're cutting down a huge part of that spectrum, that the experience and exposure won't be there to make those decisions after residency training as distinctly as if we had more exposure to the critically ill.


Speaker 4 17:41

I mean, having said that, you know, we're I'm going to advocate really forcefully for some readjustment to the ACGME. Plan. And I think we can do that as a community by like advocating for their open comment period. But they're there, they're in a tough position, right? Because what they're trying to build in some is some other skills like how do you deal with mental health? How do you deal with like, quality improvement? And so I think that, you know, as we've advanced as a profession, we I feel like it's becoming impossible to learn everything during residency. And I think that the trick for the ACGME and for most program directors is what do you give up? What do you really focus on? And what can you learn now, what can you learn later, right, and I feel like, as a program director, I try to make I have to make those uncomfortable choices almost all the time. And I feel like maybe we're a little out of balance with the current recommendations.


Speaker 3 18:40

Yeah. And to comment on that second revision about the removal of board specialists, specialist from the core faculty, right. So you're still going to have faculty who are board certified on your rotations who are doing kind of bedside teaching, but the removal of the requirement of having these board specialized, intensive care physicians from core faculty within residency program, in addition to decreasing the amount of time in the ICU. Another thing that I worry about is who's at the table right, who's who has a seat at the table, who's deciding what the rotations that they do have look like and ensuring that okay, if we are going down the limited intensive care unit rotation pathway, then let's make sure that those roads limited time are use to the best of our ability and encompass as much as we can teach.


Daphna 19:35

Well, I one of my questions I have two questions that kind of on opposite ends of the of the coin here, but I wonder too, when we talk about how does this impact neonatology, do you think that less residents will have an interest in neonatology you know, even myself who are you know, neonatology was high on my list? You take that first rotation just to like, figure out the law. just sticks. And then you eat your next rotation you start to get your feet wet, get more complicated patients, but it's not really probably until your third visitor so that you really feel the, the, the, you know, the excitement of the NICU after you get over that that really steep learning curve. So do you think this will even impact people who choose to go into neonatology or the other intensive care specialties?


Speaker 3 20:27

Yeah, I think the, the worry about the infrastructure of our pipeline into neonatology is definitely something to consider. I mean, even in my short career, I've seen more and more medical students entering residency without any exposure to the NICU at all during medical school and so to then during residency, decrease that even further, not just from a rotation standpoint, but also taking core faculty away, in which case now you you don't have those role models that you that you make have a strong connection with that then kind of gear you towards a path and to neonatology. And, you know, in the past year, we saw a decrease in, in not only of applications into neonatology, but also an increase in the unfilled fellowship spots. And I wonder if that will worsen.


Speaker 4 21:18

Well, and also kind of interestingly, I worry about people who pick me in a topology and don't know what they're getting into. Right? I think that, you know, to your experience, definitely like, there are definitely people who are gung ho on day one, and then they hit a level for NICU and are like, Oh, no, I like babies, but I don't like the throat. That's okay. Right. You don't want those people in fellowship, because that's not what you should cite know what you're signing up for. Right?


Speaker 3 21:45

Or to find out way late in residency that hey, you know, neonatology is great, and then feel so unprepared. When you graduate, an entering fellowship, and then the ripple effect, again, into fellowship training, like do we need to now change our requirements from a fellowship training perspective in order to, I don't know, increase the clinical time increase the exposures, and in early fellowship to make sure that we're then now training adequate neonatologist?


Ben 22:13

So my question that I wanted to ask you guys was, Is this is this the end of Pediatrics residency as we know it, right, there's this there's there's this concern that training pediatrician has become impossible beds are closing left and right inpatient units are, are being I've seen a transition to er observation beds. And so this idea that, hey, we have a primary care need in this country for pediatrician, and, and we just need to crank out pediatricians because we need this and this is going to come now it looks like at the expense, it's already coming at the expense of sub specialists. But is this then going to become something like we see in Europe where you can become a pediatrician, or you can go on a track to become an intensivist? Some other way, and then we're going to see this fragmentation of pediatric residency as we know, it's,


Speaker 4 23:01

it's so hard to know. I mean, I definitely feel a lot of frustration in the community. And I've heard a clamor increasing clamor to make a kind of a hospitalist base pediatrics versus an outpatient based pediatrics. That gets really complicated really quick, I wouldn't even know where to start. And this I kind of have like a med Ed, like admin type of person. But maybe, right. It's just, I think there's a lot of frustration, because I think that one of the challenges has been that it's, it's been hard for the children's hospitals and the ACGME, to kind of hear the voices of the intensive care specialties, because we're not really represented on a lot of those governing bodies, or we are but in a, you know, one out of 15 people and things like that. And so I think people feel threatened and undervalued, which is one of the reasons that people are so upset right now. And then I think that people are pretty pessimistic about the future. But I think that, I don't know, I'm not I mean, I think that we, we always figure a way to make this work. It's just, you know, how do you kind of shoehorn, what you need, and I think that's kind of the baseline is, you know, what, what do we actually need our residents to know, like, and how do we best deliver that so we'll get there but this is might be a little painful in the meantime.


Speaker 3 24:27

Yeah. Another frustration that I hear out in the community is, you know, the big rise and birth of fellowship, the number of fellowship programs right and so now it feels like you can't even begin to practice after you finish residency and have to enter more training in order to feel competent and ready to see patients and so I wonder as well if we're going to see more fellowship programs as well as kind of, instead of the death of Pediatrics


Daphna 24:58

wanted to interesting Whew, because, you know, we still practice the quote unquote general pediatrics in the NICU, especially because the babies may stay with us for so long, which may not be as true and say the adult ICU or the peds ICU. I mean, the other day, we had a terrible case of eczema that I was able to manage. I looked like a superhero for the family and for the nursing staff, just in treating, you know, basic eczema. I did my I had an follow up question, which was really about the flip side of the coin. You know, we're always talking about the lack of procedural opportunities for people who want to go into neonatology. Just to play devil's advocate, might this not be a way that those those trainees will get more opportunities?


Speaker 4 25:57

I almost wonder if it'll be the opposite. Because I think that most, most academic centers will actually have to increase the amount of hospitalists and NPS or pas that provide services as a way to kind of replace the, you know, eight to 12 weeks that are eliminated from NICU. And all those people have credentialing needs themselves. And I think that if you are going to be you know, a tourist in the NICU for four weeks, where you you come and you go, and we liked you a lot and hope you join us. But you know, we will never see you again, I think it becomes easy to kind of focus on the community you have. And so if anything, I worry that residents will get to do even less.


Ben 26:44

I, I wanted to ask you about the just now. I'm just forgetting my my, my question. In terms of the these new requirements, I got it, I remember what I wanted to ask, it seems like it's really meant to help relieve a certain segment of the hospitals and teaching hospitals because it feels like for a large Children's Hospital, things seem like they will be able to go on as they used to. But these smaller community hospitals, which are really getting stranded from lack of sub specialties, lack of pediatric beds, this is sort of coming, these new guidelines are coming to relieve them and sort of help them not shut down because we've seen a lot of pediatric residency program just shut down because they it started off as certain hospitals having a quote unquote, smaller pediatric residency that then got stranded because of lack of bed and use to send their residents to the teaching hospital for certain rotations that they no longer had. And eventually, this became such a paradigm that they just had to shut down. So is it. Is it true that this is really meant for these types of hospitals? And is there a way? Was there a way to salvage these teaching institutions without compromising the whole educational paradigm?


Speaker 4 28:04

i That's a hard question. I almost feel like goes to like a bigger issue, which is funding. Right. I think that one of the big challenges that just peds isn't funded well, and so hospitals don't have an incentive to keep it around. I, I don't, I don't know what the actual intent is. I mean, the the intent statement, I totally agree with like, I've read it multiple times now. And, and, and totally believe in it. I just don't quite think we got there. I know that the larger I mean, I work at Northwestern, which is uh, you know, we have really like a cute kids and really high census, and we're gonna have to make some radical changes to the entire residency schedule to kind of like, meet, we're so specialized that we don't actually fit into any of the buckets anymore, as written and a lot of the kind of, like, fairly prescriptive requirements actually are going to won't work either really big hospitals. I feel like maybe just the medium sized hospitals that works for Well, and, and the smaller hospitals, and the bigger hospitals are going to be have to change a fair amount. I don't know. I don't think saving it will say hospitals though.


Speaker 3 29:23

Yeah, I mean, back to your point bed. They, you know, the ACGME did state that overall to try to increase flexibility of the requirements. It is recognized that there's a shortage of physicians and practitioners in certain sub specialists. And so some of the prior requirements were quite strict in regards to the type of board set certified specialists that needed to be on your core faculty. From a neonatology perspective, there shouldn't be a lack of board special, you know, board certified neonatologist out in the nation, and you know, yes, increased flexibility in order to help some of those smaller programs meet some of the specifications to graduate pediatricians. But at the same time, we shouldn't just be cranking out pediatricians without kind of, again back to those guardrails and basic fundamental procedures or resuscitative. skills needed that shouldn't fall on those restrictions of others. Like other specialists have that neonatology and Critical Care Medicine do not face.


Ben 30:26

This episode is proudly sponsored by Reckitt Mead Johnson recommened Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive Enfamil portfolio for premature and low birth weight infants learn more at HCP dot meet johnson.com. Piggybacking on what you're just saying, that it doesn't, it looks like the these new requirements, ignore what just happened during the pandemic to me, because we just went through a pandemic where everybody was asked to take on whatever role like, you know, the famous, the famous meme about like, you better get vaccinated if you don't want the radiologist to intubate you. But now it looks like we're not even going to be able to intubate. So, have we not learned what just happened from I mean, hopefully, we don't have to face this again. But the pandemic really highlighted that they were that we all needed to know certain things. Was that you think, taken into consideration or not at all, or I don't know,


Speaker 3 31:24

such an interesting point. I would love to hear responses.


Speaker 4 31:30

I sure wish I knew like the I mean, I've talked to some of the review committee members, and they're really thoughtful, well intentioned people. But they I think they just don't have enough of a critical care. Input, right, because I think that I think that's just the baseline issue. Right. Like, I think that some of the things that we provide, we don't currently have a voice to have them said, because the people on the ACGME review committee are working really hard. And I know that we throw tomatoes at them a lot, but they actually are good people.


Daphna 32:07

Thank you can I can believe that? I you know, we've been focusing obviously a lot on neonatology. But do you have a sense of how this will impact you know, our future consultants, people in other sub specialties that we still rely on in the NICU?


Speaker 3 32:27

I think you know, one of the biggest things goes back to that conversation about pipeline, I worry a lot about pipelines in general. So specialty pipelines within the field of pediatrics and having less and less exposure to not only rotations, but to mentorship, and whether that's gonna continue to aggravate the phenomenon that we're seeing.


Speaker 4 32:48

I worry a little bit about just finances, I know the ACB ACGME doesn't consider them. But many NICUs are kind of the economic drivers of large hospitals, large and medium sized hospitals. And a lot of the economic engine goes to funding those sub specialists we really desperately need and value like ID and room and GI and pulmonology that are under funded by the current funding scheme. And so I wonder if we have to spend a fair amount of money, hiring new NNPS hospitals pas, whether some of the downstream effect will be that there will be less capital to provide for the sub specialists we really need. So and then, you know, and you you don't have enough ID ducks, you can't train ID doctors either, right?


Ben 33:48

Is this is this a win for the the nurse practitioners, physician assistants? Is this is this are these new requirements, leveraging the fact that we're going to need more physician extenders where we may not need as many specialized trained physicians and we're going to just have one person with a being part of a team of six with physician extenders. Is that Is that something you think that this is


Speaker 3 34:17

hitting on one side of the coin? Absolutely. I think we are for sure going to need to increase our staffing workforce. On the flip side of that coin, there's I mean, we're all experiencing the shortages nationwide of of these kinds of advanced practice providers and nursing staff and I wonder if it's going to stress the system too much.


Speaker 4 34:38

Yeah, I think in Chicago a couple months ago, I heard that there were 99 Open nurse practitioner slots. If everybody has to hire another three or four, it's gonna be exciting.


Ben 34:57

So I think we're talking about this a In a way as if this is already implemented, but but it isn't. And then there's really opportunities right now for our community to share their opinion and share them with the ACGME. So can you tell us a little bit about this, this period, this moratorium where there's an opportunity for discussion? And how do people who I'm sure are listening and are yelling in their car? How do they share their opinion with the powers that be?


Speaker 4 35:27

The AP ACGME has an open comment period till April 5 of this year, in which any person, pediatrician or family member neonatologist medical students can submit comments. And that comment period is actually the thing that they take the most seriously. And so I think I would really encourage everybody to go, comment, give me your thoughts. Oh, ntpd has is working on kind of like key points, because I think that the issues, and just the somewhat Byzantine, a numbering system of the requirements are a little confusing. So kind of might immoral, we'll have a little sheet that we're hoping to send out to all the program directors and T can so people can and spread across our community so that people can have like a little tip sheet to work through the comments. But yeah, I think really just take the 510 minutes to comment that it takes because this is so critical to our our community, and only if we kind of massively respond, will they pay attention.


Speaker 3 36:36

And again, to emphasize it's not like these revisions are happening every other year, you know, these happen every 10 years. And so we need to make our voice heard now, because whatever goes into effect will affect the next decade of trainees.


Ben 36:54

And we will we will link the the address to the comment section so that people can actually not really, actually I'm wondering is it? Is it better? Is there is this the best way for us to share that information with our audience to share the link where people can actually submit comments, or is this going to be something like there is for other more national legislation where they're like, Hey, we've already written the comment, if you just want to do this,


Speaker 4 37:23

I think linking the comment is probably the comment link is the best. And the key points, you should be able to either cut and paste and do the better if you spend an additional 30 seconds to personalize it. But we will try to make this as easy as painless as possible. But the more heartfelt and genuine it can be. I think the better because I think that the ACGME really does. I think there's a lot of concern in the community and, and express that concern.


Speaker 3 37:53

And like Patrick said, We'll share those key points too, though, and TPD T can listservs and social media platforms, but also please please share those with your patient families, with your nurse practitioners, with your nursing listeners at your community, as the open call is open for everyone.


Ben 38:13

Very nice. So we'll have that in the episode page. Definitely any any more questions, because I wanted to ask Patrick and Nicole about their, their passion for education. And I wanted to make sure that we did not forget anything about the ACGME and the new requirements.


Daphna 38:28

No, I mean, I think we've done a pretty good job. I'm looking forward to those discussion points, because I think it will help people craft their their commentary if they're feeling worried about that. And we're happy to propagate that as well. But I too am curious about learning more about our two guests. So please


Ben 38:53

you can ask the first question, go ahead.


Daphna 38:56

Well, I mean, the big question, really is why education right, there are so many opportunities and different pathways for neonatologist. So, you know we have a lot of trainees Why Why stay in education in particular.


Speaker 3 39:18

And trainees are what Fill my cup so I always get always ask my trainees and they'll always get asked, you know, make sure that you include in your life, things that fill your cup because there's a lot of things that drain our cup, right? There's those patient family experiences that we dread, or those bad patient outcomes that also cause a lot of stress and turmoil in our lives. And you need to make sure that both in your professional and in your personal life that you have built in safety guards to maintain your wellness and for me it's interaction with trainees and so education is a huge part of my life and I hope it continues to be for the rest of my career. I hope to be continued to be an interviewer Well, part of program leadership and education, whether it be locally and nationally. And so, for me, that's the main reason to stay in education.


Speaker 4 40:11

I think it's just really high yield. Like, you get the most bang for your buck as a person, like when you are able to work with people who go on and just do it way better than you did. And innovate. It's just really, like, so exciting to see people two or three years out, and you're just like, holy smokes, you've come so far, like, we are going to be a better group of doctors. Because of the the trainees we currently have. It's just really exciting. And kind of personally, it keeps me honest. Right? You got to keep up with people. And that's not a bad thing either.


Ben 40:53

Yeah, students keep you humble. For sure. I and some of these questions, just just remind you of man, my memory sometimes can can fail me. But I guess one of the questions I have for you guys is because we all love education, right? I think it is somehow in the genetics of being a physician. I mean, the etymology of the word physician comes to goes back to teaching. And I feel like a lot of us would say, Yes, I'm a I'm an educator, I teach students residents at the bedside, I enjoy it tremendously. But then when we're looking at educators, like you who are taking it on more of a meta level, where you're really looking at how is education being delivered, it feels sometimes so scary, because you're like, Oh, my God, this is like so many meetings. And so it's, it's no, it's no longer fun. Like, it's no longer the fun of teaching at the bedside. And so I am wondering, what is that experience been like for you guys? And what is the feedback you would give to people who are considering getting involved in education, but are reluctant to move past the bedside and may be going into these program directors office and


Speaker 3 41:58

certainly a learning curve. I mean, it's like alphabet soup to learn about all the national organizations that kind of interplay with a program, right development and running a program. So it's definitely intimidating. At first, I would say the biggest advice is to just get involved. For me. I was the first fellow at my fellowship program to focus in medical education research. And although that was intimidating, the more meetings that you're able to build connections, both locally and nationally. So for me, I joined T can fairly early on and was able to develop a quilt of mentorship quilt both of local mentors and national mentors that have helped pave my way and make things a little bit easier. Joined, you know, Patrick with O ntpd. And within ntpd, there's the national neonatology Curriculum Committee, which is open to fellows interested in medical education research, another great way to network and going to conferences and meeting all these amazing medical educators who who can show you that, you know, our community, I'll be it. We're small, we're small, but mighty, and that everything is possible. And together, we can work together to become successful medical educators.


Speaker 4 43:13

I mean, I would just to echo what Nicole said, I mean, it's just a great community to be part of, I think that that's, I'd say, jump in try. See if you like it. Oh, ntpd and TKN are really good to work really hard at mentoring, new program, just like directors, associate program directors or people just interested in med Ed. But I think for me, the big cell is like, it's just a really wonderful group of people who work really hard. The paperwork and challenges, I think, are not insignificant. So you do need to kind of, you know, but that's any job, right? Like, you just the trade off is going to always be there. And my sense is, yeah, no, I think it's just it's a the people are like, what really makes this job, both the fellows and your fellow program directors.


Ben 44:08

Yeah. And that goes to that goes back to every fellow just raving about their program directors, everybody, I haven't met a fellow who hasn't told me that their program director was the best. So like you said, it creates a community of really amazing individuals. One of the questions I wanted to ask you was that it's it goes back to some of the things that we've talked on the podcast about medical training and residency training, that education is a science and we're not taught about how to how to teach we, we sort of are supposed to pick it up on the go, I guess, from good educators. But how do you guys navigate this? Dislike? I mean, maybe maybe you did. You did seek out this type of education but how do you navigate the lack of formal education in teaching and in education when you enter this realm of supervising supervising train He's in fellowship programs.


Speaker 3 45:02

You know, I for me, during fellowship, I pursued getting a master's in education. And I remember learning, you know, education theory and teaching theater theory. I was like, Why didn't I learn this like years ago, like in elementary school, no one teaches you how to study. They're just like, Go memorize this, go take the test. And when actually teaches you like the fundamental science of, oh, you know, I can spend significantly less time trying to learn this material and learn it for good if I do it this way instead of how you're usually taught. And so for me, it is sharing that knowledge with my trainees. So I try to be hard every time I meet a trainee, hey, you know what, like, what are you studying for let's talk about your studying strategies. Let's talk about how learning actually works. And try to incorporate little tidbits into whatever presentation I'm giving or whatever teaching moment that I have been trying to share that wealth with everyone that I need, because it floored me when I learned it.


Speaker 4 46:02

And I think that, you know, being a program director is becoming an increasingly more professional activity, meaning that like many of the people, like Nicole have like master's degree in education, because it's getting complex. But I think the benefit of that is that those more professional program directors are really sharing their knowledge with those of us who don't have master's degrees, I don't have a master's degrees in med Ed. And I think that the organization's like, oh, and TPD, the P T. Can are actually, because of the knowledge that we now starting to have within our communities are really good at like, you know, oh, and TPD has bootcamps for new program directors, which all the old program directors sneak into. We have, you know, like day long sessions, and there's just a lot of opportunities that really didn't exist when I was a little younger. So I think that we are slowly getting that information out there and absorbing it.


Speaker 3 47:02

Yeah, shared webinars. Now, thanks to COVID everything has gotten kind of virtual, which, you know, has a lot of disadvantages, but at the same time, we've been able to share so much wealth of knowledge via webinars across the nation and that's been fantastic.


Ben 47:17

Yeah, the the ability to get an online education today has been amazing. I mean, I remember finding out about about the science of re education when I was reading this book, I forgot the author's but it's called Make It Stick. And then you you hear all these all these studies, and you read about all these studies where Oh, my God, this has actually been investigated. And this would have been quite helpful, as Nicole said, when I needed it back in med school. So there's, there's thankfully, like you said, today based on the the the online education that's available, there's really a lot of opportunities to to learn more about the science of education. Definitely know you wanted to ask something about Ken No, NTPs, I'm gonna let you.


Daphna 47:55

Yeah, well, since we have the pleasure of having you both on and maybe you can tell us a little bit more about the T can ntpd collaboration, and what are kind of the current priorities for your work together.


Speaker 3 48:11

Man T cannon Oh, and TPD have really been working hand in hand over the past few years on several large initiatives. So one of the biggest ones that both Patrick and I are a part of is we've been leading the job search series, helping our graduating fellows learn about how we, you know how to do this first job search for the first time in your life so late in your career. A lot. It's, you know, it's a very intimidating transition point that causes a lot of stress for our trainees. And so we've been able to kind of standardize that curriculum and disseminate it on a national level and, and that has been really fulfilling for me to watch more and more fellows utilizing that resource and, and being more confident in themselves in during the job search market, especially, you know, with the ups and downs that we've had in the past few years.


Speaker 4 49:03

You know, I think we're very natural allies. There aren't very many program directors, but the ticket is, uh, mazing ly large and has a lot of energy, which is great. But we're the other thing we've been working on is point of care ultrasound. I think there's a lot of need for that and a lot of program directors who have been get applicants who say like, Hey, how do I like to learn to point of care ultrasound and you're like, great, I know how I wasn't trained myself. I don't have any faculty. What in the world do I do to do this? It seems like a great idea. So we've got we're working on a point of care ultrasound like series on like, how do you build a program with what's the mentorship structure? How do I gain experience? Where do I go? What kind of machines do I buy? And I think for me, like kind of as an OT, PT chair, I think that maybe getting to went back to one of your points was I do worry a little bit about program directors globally. It's It can be a pretty hard job. And I think COVID made it harder. And so trying to provide mentoring and kind of wellness resources to us as a community, I think it's really important because I think we're often squeezed between the ACGME and the hard realities of really advocating for our fellows. So how do you, how do you teach skills? How do you provide like we do a big Cafe series like every other month on like, how do you actually practically run a clinical competency committee? You know, what do you do with a fellow who is really struggling? And I think those have been helpful. I think part of it is like just the technical skills and wisdom from older program directors, and probably equally important is the half an hour of chit chat that happens about like, could you believe that this happened to be right?


Speaker 3 50:54

Yeah, and also all the work that we're doing from a pipeline perspective. So trying to increase our community into the residents and the medical students who are interested in neonatology knowing that they're going to be rotating less and less with a new NICU. But how do we get that information out there to kind of describe our field and, and build excitement and interest in our field. And so working really closely with residents and medical students to develop things like the webinar series on how to apply to a neonatology fellowship program and what we're looking for, from the fellowship program perspective and applicants. Not only that, but a lot of resources for fellows in training themselves, such as the online with experts webinar series that Oh, and TPD and T can host this year we we implemented that big like Mega flip biostatistics course throughout the year that that, you know, if you don't have a well established statistics course at your program, you can utilize kind of this national resource like the net St. On along the same lines, the National neonatology curriculum that we're trying to build as well so that we can kind of standardize education throughout our programs.


Speaker 4 52:01

I mean, just kind of, let's say, echo what Nicole said, I think a lot of it is just as opposed to 110 program directors, doing everything themselves. We've really been trying to focus with, like pecans help and involvement. Like how do we share resources, right, because now that we've got zoom and like online platforms, like, you know, like, very much like what the incubator does, like you've kind of really nationalized education and how we think about like, journals and stuff like that. I mean, I think that's, that's really helpful. It's not infrequently that I get fellows who were like, Oh, I saw this great article. Like, I heard this great thing on the podcast and like, do you think we can talk about this article Journal Club, and I'm like, Yes. And you've got a great cheat sheet to boot, but that's okay.


Ben 52:50

Miko I wanted this gonna be my last question. But you mentioned something where you're saying you're trying to reach out to residents and trying to generate interest in neonatology and give them an outlook as to what life could be at neonatology. What exactly are the points that you highlight in this day and age to residents to make neonatology quote unquote sexy? And what are the things that what are the things that people are looking for? And I guess that's something that I found a lot of us as attendings when we have a residence that we kind of like and we say, hey, what, what should I tell them about the field that hopefully can sway them in coming in coming to our site?


Speaker 3 53:28

I think, you know, one of the things that we're working on in this is this like day in the life of a neonatologist video, in which case we broadcast the broader array of neonatology. Right, it's not just, you know, level four neonatology, but there's so many different types of NICUs that you can work in. And so trying to emphasize that trying to emphasize, procedures, as there's a lot of procedure oriented medical students and residents who kind of forget about the field of neonatology, again because of the lack of exposure. And so showing the breadth of things that we see and treat as well, right. So I feel like a lot of people worry about, oh, you just do this day in and day out. But really, like, it depends on the NICU work. And then you can, you know, your days can be extremely different depending on what, what's going on. And so so some of those, those are some of the things that we highlight.


Speaker 4 54:21

And just, we're really privileged that we get to do ICU, but we also get to develop relationships with our family, right? Like that's actually a fairly unique component to our jobs. And it's like, it can be very joyful.


Unknown Speaker 54:35

Exactly.


Ben 54:38

Yeah, there's there's nothing that beats the feeling of waking up in the morning and saying, I'm gonna go help save some babies. That's kind of nice. And And sorry for my picky folks. But we're not in the business of turfing patients to someone else so that's


Unknown Speaker 54:51

when people grow but


Ben 54:55

that's right. That's right, Nicole, I've I hope I think I've said A bunch of people on this episode with me questions, but that's okay, though. Well, we'll make it up over over the long haul. That Nicole Patrick, thank you. Thank you so much for making the time and going over all these proposed changes with us. I think this was very informative. And I think it gives people a lot of a lot of resources and information about what to what's going on and what to do next, we will link some of the resources that we've talked about on the episode page, and we look forward to chatting with you again.


Unknown Speaker 55:31

Thank you for having us.


Unknown Speaker 55:34

Real pleasure. Thank you so much.


Ben 55:37

Thank you, definitely see you later.


Unknown Speaker 55:41

Bye, everybody.


Ben 55:42

Thank you for listening to the incubator podcast. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcast, Spotify, Google podcasts are the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address NICU podcast@gmail.com. You can also message the show on Instagram or Twitter, at NICU podcast or through our website at WWW dot d dash incubator.org. This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns. Please see your primary care professional. Thank you


Transcribed by https://otter.ai



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