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Mythbusters Series (featuring the TeCAN team)


Mytbusters TEACAN incubator neonatoilogy review


Hello Friends 👋

We are thrilled to announce the launch of our new series of episodes on the podcast titled “MythBusters”. In collaboration with the American Academy of Pediatrics TeCAN team, we’ll be debunking myths surrounding work in the NICU and neonatology. Dive deep into these fun episodes available on the Incubator and Neonatology Review podcast.

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For more insights into the TeCAN team and to get in touch with the panel featured in this series, please find the details below. Happy listening!

Dr. Anisha Bhatia (Chair) - Anishabhatia2@gmail.com

Dr. Ashley Lucke (Past Chair) - AshleyLuckeMD@gmail.com

Dr. Sasha Amiri - sasha.amiri3@gmail.com

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The transcript for episode 213 can be found below:

[00:00:00]


[00:00:34] Ben: Hello, everybody. Welcome back to the incubator podcast. We are back with a very special episode today. Daphna, how are you? First, I always have to ask, how


[00:00:43] Ben: are


[00:00:43] Ben: you?


[00:00:45] Daphna: Well, like, uh, we were talking about Off Air, we've really been looking forward to this collab. So, um, I'm pretty pumped that we were able to get five people all on at the same time. That's no small feat. And, um, I think we've got [00:01:00] some really good info to share.


[00:01:01] Ben: Absolutely. And, and this, this series is prompted by an email that we folks at TKEN about The busting myths in and around neonatology. And so we're going to have a special episode about that. We'll talk about the inception story of the series. And so, first and foremost, I'd like to intro introduce our, our, our guests, our panelists.


[00:01:24] Ben: Um, we have, uh, Dr, uh, Sasha Amiri. That's on with us today. He is a second year fellow in unitology at Rush University Medical Center. Sasha. How's it going Yeah, uh, we are joined also by Dr. Ashley Luck, who is the immediate past chair of TEACAN Hey, Ashley.


[00:01:46] Ashley: Hey, good morning. Thank you.


[00:01:48] Ben: And Dr. Anisha Bhatia, who is the current chair of TEACAN Hello, Anisha.


[00:01:53] Anisha: Hi, good morning.


[00:01:56] Ben: So, um, the inception story [00:02:00]


[00:02:00] Sasha: working


[00:02:02] Ben: about of


[00:02:03] Sasha: to


[00:02:04] Ben: in neonatology saying let's do a


[00:02:06] Sasha: to


[00:02:08] Ben: to of are hovering


[00:02:14] Sasha: certain myths residents


[00:02:16] Ben: guys begin and, is what is the


[00:02:26] Sasha: Yeah, absolutely. Uh, so one of the things we're always working on, uh, through TCAN is to outreach to, um, residents and try to showcase the field of neonatology and what makes our field so great to them. So, um, anecdotally, we've definitely all heard, um, certain myths among residents and medical students about, um, how things are in the field of neonatology and we wanted to either, Um, validate some of those myths, or, um, debunk some of those myths, or, or say that it's complicated, that things, you know, aren't black and white, and sometimes it's like that.


[00:02:59] Sasha: [00:03:00] Uh, so, we started off by, um, Surveying medical students and residents at different, um, uh, institutions to see, uh, what kind of, uh, statements or, or concerns that they've heard about our field and, uh, we took the ones that were most popular and we kind of distributed them out to our, uh, listservs of, of, uh, attendings and fellows in neonatology, um, in order to get basically a composite somebody Um, and we took, uh, the ones we saw the most and that's what this project turned into, uh, essentially a document to summarize, uh, all the different, um, uh, answers to these myths, uh, so to say.


[00:03:49] Ashley: Yeah, I think, you know, from the program director standpoint, which I feel kind of weird now I'm bridging that gap going from TEACAN [00:04:00] to a fellowship program director as an APD. One thing that's been really concerning for us is we see the past few years, there's more neonatology. slots open than what we've had applicants applying into.


[00:04:14] Ashley: And so what is the future of our field? You know, where, where does it end so that all of us on this call one day get to retire? Cause if we keep it this rate, none of us are going to retire. So not only filling the spots, but getting the best applicants with the most diverse backgrounds, the best perspectives and experiences.


[00:04:37] Ashley: From all the data that we know that if you have a doctor that looks like you, your care is probably going to be a little bit better quality and better outcomes, which I know you guys have talked about that in the past. So that was another big goal is there are myths out there and there are things that just kind of get passed on on the sites and the blogs and the social media accounts that [00:05:00] residents and med students even before they even become a resident are reading.


[00:05:03] Ashley: And so where is the truth? Because we really don't want to see people neonatologist.


[00:05:13] Daphna: Yeah, I gotta say I feel like um medical students and the the current generation is so Much better at like looking forward than I felt like I mean I had an idea of what I wanted to do But I was like i'll just go to my rotations and figure it out But now there's so many ways to find information, especially like you said through social media and on the internet that yeah Hopefully we can set I


[00:05:42] Ben: Yeah.


[00:05:42] Ben: call this the Amazon generation where we look for reviews and before making any decisions we go through this intense research process when I mean since I was a kid there was no such thing you just like go with it and then you say I'll figure out how


[00:05:56] Daphna: figure it out.[00:06:00]


[00:06:00] Ashley: The buffet line of pediatrics.


[00:06:03] Anisha: Yeah,


[00:06:03] Ben: Anisha, sorry.


[00:06:05] Anisha: would echo, um, Sasha and Ashley's sentiments, too. Like, especially the workforce component of it, and especially understanding that angle from some of the research that I'm doing with the section. Um, there's, you know, if you have fewer people neonatologists. And then when we talk about things eventually looking towards Maybe making a little bit of progress in our field in terms of work hour reduction to sort of align with other intensivists in our field.


[00:06:36] Anisha: It becomes really critical to like not only represent our field really well and bust these myths, but also like think about what. Our workforce looks like and the composite and the people that we enter into fellowship or welcome into fellowship, and that eventually enter our workforce. We really want to make sure those numbers match or exceed the number [00:07:00] of people who are retiring the fields that we don't hit that shortage.


[00:07:05] Ben: Yeah.


[00:07:05] Ben: almost like, uh, yeah, the pension plans in Europe where the aging population is forcing people to work longer now Um, so I want to before we begin because we've been teasing now these these myths and I guess We're going to dive into a few of them today. I wanted to To provide a disclaimer saying that obviously these are questions that we hope Um people are going to ask of you as physicians as trainees.


[00:07:30] Ben: Maybe they'll come from residents. Maybe they'll come from fellows Um, and we're going to give our opinion which is just that it is our opinion. This is what we perceive uh to be our experiences and there's probably going to be some bias in there that's going to be inherent to Our background and our and our training and our careers and so


[00:07:50] Sasha: do


[00:07:50] Ben: want people to feel like they don't have a voice.


[00:07:53] Ben: So, number one, if you have an opinion, please, you can email us and we'll be happy to read some of the feedback that you guys, [00:08:00] uh, send us. You can email the, the podcast, uh, through our email address, nicupodcast at gmail. com. And you can even suggest more myths as we record more and more of these episodes.


[00:08:11] Ben: But, uh, if nobody else has any, uh, other disclaimers or anything like that, I want to dive into our first myth of the day.


[00:08:18] Sasha: Let's do it.


[00:08:20] Ben: Let's do it. So, um, I guess the, the first myth that we often hear is that, um, neonatology is a boring specialty. It's a specialty where basically you deal with RDS, BPD and NEC and that's really it.


[00:08:33] Ben: And if you are a curious clinician, then this is not the specialty for you. What do


[00:08:39] Daphna: we all heard this from our, the PICU faculty we worked with, right? So of like, maybe PICU, maybe ER, maybe NICU, and they're like, oh, this is why you shouldn't go into NICU, right?


[00:08:50] Ben: love our PICU folks, by the way,


[00:08:52] Daphna: That's right.


[00:08:53] Ashley: Yeah. We do love our PICU folks.


[00:08:56] Anisha: Right?


[00:08:58] Ashley: think we've all heard that [00:09:00] though if it was boring, I don't think I could do it. Uh, I have some of the worst undiagnosed work ADHD, I think known to man. Um, so, you know, the idea of an outpatient practice and clinic to me, I think most neonatologists. That is not your idea of how you want to structure your day.


[00:09:23] Ashley: So, you know, the variability that's available in neonatology. So I would say myth, first of all, but you know, you could start your day going to a delivery, go round, and then you get called to. You know, do a procedure, you have a family meeting, you may do a complex prenatal consult, maybe the next day you're rounding at a community site, or you may be at a level four, you may be in the follow up clinic. Um, you know, part of my day is spent running neuro NICU rounds. So you can even sub sub specialize. I think, and this is congruent [00:10:00] with the feedback that we got is there's so much variability in the day. I, by no means, I think it's boring. But, you know, the flip side of that is you have to be ready for an unpredictable day.


[00:10:12] Ashley: So if you're somebody who wants to know exactly at 11. 15, this is what I will be doing. Maybe neonatology is not for you, because you never know what's gonna walk in L& D. You never know what parent is gonna, you know, need to have a meeting, uh, sort of unexpectedly, so... For people who are looking for a lot of variety in terms of practice settings, acuity levels, types of communication, you know, working with parents, to me that kind of embodies neonatology and we didn't even add in research, quality improvement, advocacy, all those other aspects to that.


[00:10:50] Ashley: Okay.


[00:10:51] Daphna: Yeah, I think we make a great point about the different types of practices. And there are, I mean, there are hundreds of ways [00:11:00] neonatology and split up your time, uh, you know, depending on where and how you work. And that's not even talking about the pathologies we see, which are getting more and more complicated, I feel like, every handful of years.


[00:11:15] Anisha: Yeah, absolutely. I think, um, 1 angle that I really appreciate is, you know, All right. Thanks. Especially when you are presented with multiple congenital anomalies and trying to get to the bottom of a unifying diagnosis and working towards that goal. And while you're also supporting their, you know, physiology, and also you're practicing on a spectrum to like, you might have the.


[00:11:39] Anisha: Some days where things are a little bit easier and you have your, you know, your feeder growers, and then on other days, you're doing high acuity resuscitations, um, you're doing, um, high acuity and sometimes life saving measures and the NICU. Um, and I just love the process of thinking through that physiology, um, [00:12:00] depending on the type of shock you're dealing with, for example, um, or sorting through whatever, you know, physiologic process that you're trying to kind of, like, get to the bottom of and overcome.


[00:12:11] Anisha: So, the problem solving aspect, I really enjoy and find very rewarding.


[00:12:18] Ben: Yeah, I think what's interesting about what you're saying, Anisha, is that number one, it combines a lot of aspects of a multitude of specialty. So I think to me, going to a delivery room really reminds me of when I was a med student and I was working in the ER where you're waiting outside for the ambulance to arrive with your trauma patient.


[00:12:37] Daphna: You


[00:12:37] Daphna: don't know what you're to get.


[00:12:38] Ben: Exactly, you don't know what


[00:12:39] Daphna: got an idea about it, but you don't know what it's going to


[00:12:41] Ben: and It from


[00:12:46] Sasha: the


[00:12:54] Ben: maintenance on


[00:12:58] Sasha: that's I [00:13:00]


[00:13:02] Ben: um, I think from standpoint,


[00:13:03] Sasha: things we be


[00:13:07] Ben: all these other specialties sasha any any thoughts on that question


[00:13:10] Sasha: Yeah, one last thing I'd like to add from the fellow perspective is, um, Because the field of neonatology is relatively newer than a lot of other fields of medicine, um, you know, our research is still limited and there's things coming out every day on different newer ways to do certain, uh, things. So that's, I think, what lends to the excitement of it is just, um, you know, how fast things are changing and what we used to do five years ago might not be relevant in five years.


[00:13:37] Ben: And I think that's a good point too, right? I mean, I I always enjoy looking at the books that the library gives away because they're too old And if you look in the neonatology section, right you you see


[00:13:46] Daphna: They haven't given them away yet.


[00:13:48] Anisha: No.


[00:13:48] Ben: Well, in the neonatology section, they have these, these like books from the 80s and like the, the, the, the, the table of content is thin.


[00:13:56] Ben: There's not much. And, and when you compare it to today, when [00:14:00] you see double volumes, thousands of pages, I think clearly this is no longer a boring specialty from a pathophysiologic standpoint. There's a lot of pathologies that we have to recognize that we have to deal with. Um, and I think. That transition sometimes can be missed by other physicians who haven't realized how fast our field has evolved since the 70s and 80s.


[00:14:22] Daphna: One of the other things I love about neonatology, I think makes it a stand out from basically anything else in medicine is when our patients come to us. Right. In your medical school, you're like, well, you got to learn about the past medical history. And we know that the babies have some quote unquote medical history because they're probably part of this.


[00:14:40] Daphna: Diad as a, as a fetus and we know, you know, maternal diseases affect neonates, but that's what I tell parents. Like, we're just getting to know your baby. There are so many things that we don't know about your baby because they're new and it's really like. Sometimes like detective work and trying to figure out, you [00:15:00] know, what, what is, you know, what are the genetics of this baby?


[00:15:03] Daphna: What are the underlying pathologies? What is unique to this baby just because of who they are as opposed to any other baby in the unit? What does their family bring to to


[00:15:16] Sasha: so


[00:15:16] Daphna: And think that's makes neonatology so special that every Every single new is like a puzzle waiting to kind of be discovered,


[00:15:29] Ben: So since I'm a big fan of Mythbusters, the TV show, I think we should end every myth with either a myth being busted, plausible, or confirmed, and what I'm gathering from the team is a unanimous busted. don't think, I don't think Neonatology is


[00:15:43] Ashley: It's really busted.


[00:15:44] Sasha: so.


[00:15:46] Ashley: We're biased, though. We need to put that disclaimer in there.


[00:15:49] Anisha: Yeah,


[00:15:50] Ben: that right off the bat, right?


[00:15:52] Daphna: But I would say all those other specialties are also biased when they're trying to influence people using this myth not to go [00:16:00] into neonatology.


[00:16:01] Ben: hmm. Um. I guess we're going to do one more myth


[00:16:06] Sasha: to


[00:16:06] Ben: this episode. um, this is a myth that again, comes up very often, especially from people who are not in neonatology. And this is the myth of people saying that the NICU is just a sad place and that it's a place where, uh, there's lots of sick babies, and this is where babies go to die.


[00:16:24] Ben: Uh, and so that's why you should stay away from the NICU because of sad of a place this is. Who, who wants to take this one?


[00:16:34] Anisha: Yeah, I could.


[00:16:35] Anisha: . All right. So, um, well, you know, Sasha and I are on different ends of the same institution, actually, and I'm out in the community is like a frontline position. So I'm. In the community when I'm on, it's really just me, um, on with a unit of about 10 to 15 patients. So, I think, honestly, the trend towards trauma informed care, um, and really trying [00:17:00] to understand parental mental health and well being, um, and just showing families that they have, And intense like wealth of support in the NICU, not only through us, the nurses, but also our ancillary staff.


[00:17:15] Anisha: I think that's, you know, really rewarding in some ways to help families get through a very, very difficult time and we hope that we can see them through, um, through the end with a good outcome. I know it's not always the case. And yes, You know, unfortunately, sad things happen. Um, we lose patients sometimes and it's devastating all around.


[00:17:34] Anisha: Um, but I think, um, what I find intensely rewarding is just. Being able to kind of, you know, relate with families and also, um, support them through, like, just an unbelievably difficult time where they're really seeking to control whatever they can, but so much is just simply out of their control. So, um, I would say that angle is what I really appreciate a lot about what we [00:18:00] do.


[00:18:03] Sasha: Yeah, I completely agree with that. One of the most gratifying things, I think, um, at work is having a patient who unfortunately has been in our unit for many months, um, because they were born very premature. Um, and now you get to finally go see them go home, you know. So, um, a lot of difficult call shifts with those patients, and they, you know, made a lot of staff assists happen, but, um, now they're in a better place, and they're able to go home with their parents, and, and, you know, there are very few things that I think compare to that level of, of, you know, rewardingness, so, um, that's really nice to see.


[00:18:38] Ashley: I feel like the NICU is just a place of profound experience, and it goes on all ends of the spectrum. I mean, we would be remiss if we didn't warn people who are considering our field that there are times of just deep, profound grief and sadness. You know, especially in the [00:19:00] unexpected. situations. But there is something that was different for me when I was thinking about PICU versus NICU.


[00:19:07] Ashley: It's so funny, Daphna, how you're like, PICU, ER, NICU. Literally, that was all of us. And at some point, we all thought we were going to be OBs. We all throw that one in there. Or MFM. I don't know. Anyway. But one thing that was different for me, and it definitely changed when I became a parent. So for anybody who's listening, who's also Coming to the decision point through the lens of also being a parent, there was something different about grieving the death or sudden, you know, devastating injury to a child that you have known for decades, you know, and, and seeing the varsity trophies and the pictures on the wall and the pic you, that was just personally, and this is total opinion personally for me, that was too much for me, it was a different feeling of loss.


[00:19:57] Ashley: Of I've just lost someone who for, you [00:20:00] know, 17 years has been an everyday, you know, part of my support and my life and my joy. It, I, I'm not trying to downplay it at all, but it is different when a family has an ultrasound of a baby they've never met. And they, they know from the beginning, you know, at 20 weeks, they, they know.


[00:20:20] Ashley: the same time they even know the gender, that this is just going to be a different journey for me. This, this is different. And, you know, we talk a lot in the NICU about parents who have difficulty with bonding and attachment. I got to think that there is some protective mechanisms to that because you don't know how it's going to go.


[00:20:40] Ashley: And so as a parent, you know, if you open your heart up a hundred percent, That hurts a hundred percent, you know, two hundred percent when it doesn't go well. So I only bring that up to say there are periods of that. There are absolutely days and I think, you know, it lives on with all of us forever. We always remember those cases, [00:21:00] but there's so many more moments of joy that outweigh those.


[00:21:06] Ashley: And for me, I always approached it that there's sadness in all of medicine, you know, even in ambulatory outpatient, you know, well child visits, there's a lot of sadness now. Um, and there's a lot of chronic disease. There's a lot of social situations as luckily families are feeling more comfortable disclosing things to us and involving them in their story to where we can hopefully, so, you know, emotionally support them.


[00:21:33] Ashley: My best friend's a general pediatrician and she's got some really heavy days as well. So I would say just medicine in general can sometimes be very sad, but you have to look at what's the, the join to sadness ratio. And if that's tolerable for you, then that's a field you should explore. Because, you know, people would probably say the same thing about picu, he monk, er, you know, everything has [00:22:00] sadness.


[00:22:00] Ashley: And so finding the joy and seeing what the, the future life is that we grant through neonatology, you know, the years gained. think if you're a forward thinking person, then that's where neonatology is a good fit.


[00:22:13] Ben: What an interesting point you're making because you're right. I mean, there is, there is loss in every aspects of the hospital, but in the NICU, it almost as if it's the loss of the potential for something rather than the loss of, of things that you've bonded with, that you've built memories with. And, and that's things a little bit less, as you say, cause it, it still stings, but it's not, it's not this, it doesn't have the same impact.


[00:22:36] Ben: And I think. To echo some of the points you've all made which is that we've been giving our opinion as well on a lot of these myths But some of them are substantiated with data and so when you look at data from the NICU the outcomes for babies are excellent and you look at survival rates and And so the the majority of babies who are admitted to the NICU are babies of I would say more [00:23:00] mature gestation So not a hundred percent of our census are 22 weekers So they actually compose the minority of the census and they're the ones with the worst outcomes and so what you realize is that the field is dominated by a population of patients that inherently, thanks to the evolution of our specialty, do have phenomenal outcomes.


[00:23:22] Ben: And so I think that, like you said, while there are, there are, it's just, we all have this bias, right, where we retain the things that hurt more than the ones that were pleasant. So you, you don't. Feel the same joy and you don't the intensity of the feeling is not the same for every discharge home than the ones that you lose And so there's this imbalance that you always feel but in truth Most of our patients go home do well return a few months later and they're doing good and they're eating and they're walking And I think that's that's very reassuring.


[00:23:54] Ben: So


[00:23:55] Ashley: Yeah, and a testament to our colleagues who follow our patients up, [00:24:00] know,


[00:24:00] Anisha: Yeah, I do have a role and follow up like, a few times a year. We do, we do like 1 follow up visit for a lot of our patients. I think that they're under the cutoffs. If they're born under 32 or 34 weeks, they qualify for follow up at least for one visit. And I just find that so rewarding. I mean, especially when you knew this was like a high acuity resuscitation or, um, you know, it was a patient you cooled.


[00:24:26] Anisha: They once started off really sick and then they're actually thriving and doing really well and follow up. That just shows you, I think that's immensely gratifying because you see like the fruits of your labor. You see, you know, families that are thriving, um, who are, you know, Maybe if they hit a couple of bumps along the way with access to therapies and things like that, like, I love that extra checkpoint so that we can, you know, bridge that gap and make sure that they're getting the right referrals and getting access to speech P.


[00:24:55] Anisha: T. O. T. if that's what's needed to really support the best [00:25:00] possible outcome as they go through their early childhood years and beyond.


[00:25:05] Daphna: And if I can put a plug because we're trying to get more people that are interested in palliative care into, into primary neonatology. Um, I think, um, on the other end of the spectrum, right? We, like you said, most of our babies do well. We love seeing their success in follow up clinic. And, there is a population of babies that no matter what we do based on their clinical picture may not survive.


[00:25:38] Daphna: And I think we still have this opportunity to provide, um, you We don't say death with dignity so often in the NICU, but that's still what it is about these little humans whose lives will be short and their families who, you know, regardless of how long they've known this human, this is a trauma they carry with them for [00:26:00] the rest of their lives.


[00:26:01] Daphna: And we really have an opportunity, um, to create. Um, some memories for them, let them feel like parents for the time that they have it, make the infant's passing As comfortable as it can be and as informed for the parents as possible And so, that's something that we do in in neonatology and we You know, we're time period to maybe engage this family in this really emotionally, um, impactful time.


[00:26:32] Daphna: And, um, you know, walking with families and supporting families is. Is one of my favorite parts of the job and sometimes that is Unfortunately around death and dying but it's not like our job ends, you know, that's just part of the job that can also While emotionally, you know, every loss is is devastating.


[00:26:56] Daphna: I think can also be rewarding [00:27:00] as a Um, you know healthcare professional minikyu


[00:27:05] Ben: and so I guess we can leave this one at maybe plausible because There are some sad moments,


[00:27:10] Ashley: complicated.


[00:27:11] Ben: Oh, there we go. It's complicated. We'll leave it complicated. I like that one. Okay, uh, we're gonna close this episode and we uh, thank you all for your time. We'll see you all on our next Mythbusters episode.


[00:27:23] Ben: Ashley, Anisha, Sasha, Dafna, thank you all so much.


[00:27:26] Sasha: Thank you.


[00:27:26] Daphna: bye everybody


[00:27:27] Anisha: Thank you.



The transcript for episode 214 can be found below:

The transcript for episode 215 can be found below:


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