My primary educational interest and mission have been sharing new medical literature with peers and near-peers (so mainly attending physicians, pharmacists, APPs, ID fellows and ID PharmD residents). For several years in fellowship, I ran a monthly literature roundup website called IDjournal.club, and then once I became a full-time faculty (and parent) and no longer had dozens of free hours a month to devote to that, I shifted focus to @IDJClub, a monthly global ID journal club held on Twitter, which I co-run with a few other faculty across the US and Canada. At UNMC, in addition to the standard faculty teaching responsibilities, I co-run two workshops focused on teaching practical antibiotic knowledge and how to approach "antibiotic failure" with interactive cases to second-year students about to enter clinical rotations and fourth-year students about to enter residency.
Tell us how you became interested in medical education.
I had many mentors in medical school and residency who were either masters of medical education, like Daniel Musher and Maria Rodriguez-Barradas at Baylor, or junior faculty passionate about building their careers around expertise as educators, like Zaven Sargsyan, and these folks really sparked my interest in education.
I also had the good fortune of being in a residency class with a bunch of other future star educators around the time the concept of "residents-as-teachers" was really kicking off, and so we organized an "Academy of Resident Educators" in which we defined a specific curriculum centered around education workshops, completing teaching-hours and obtaining peer review and feedback. This let me and my co-residents approach growing our skills as educators in a much more intentional way than we would have otherwise- and it meant that I was able to apply for a faculty position straight out of fellowship with an education portfolio that included something like a hundred hours of teaching time, letters with course rankings and summative student comments, etcetera.
How have you integrated medical education into your career?
I have a small portion of FTE dedicated to medical education, which really supports work on two interactive student workshops I co-run focused on practical knowledge about infections and antibiotics (i.e., when to think about infection, the human microbiome and how that shapes the microbiology of common infections, risk-benefit calculus in starting and stopping empiric antibiotic therapy, the spectra and side effect profiles of common drugs, and how to approach situations in which the empiric antibiotics aren't helping). I also give monthly lectures to our students and residents on UTI and orthopedic infections and have two annual sessions on IAI and endemic mycoses with the fellows where we try to go "beyond the guidelines" and discuss the nuance of the literature that supports practice around those infections. Finally, I co-run @IDJClub, the global ID journal club on Twitter, and honestly spend way too much time on Twitter learning and talking and once in a while teaching about new papers with my online ID community.
You started ID Journal Club as a fellow. Tell us how you identified this as a need and how you have now developed it into what is now a very popular Twitter space.
ID Journal Club is an interactive Twitter session, but before that, it was a monthly review website, and before **that** it was a chain email with all my co-fellows. My original inspiration was the "Puscast" literature review podcast by Mark Crislip, which I listened to religiously and for which I was always hungry for more content. The second was of course, Paul Sax's long-running HIV and ID observations, which I appreciated both for Dr. Sax's highlighting of new literature and syntheses of whole bodies of literature in long-form discussions. So, honestly, the original format of ID Journal Club started less as filling a need in the community and more as filling the need of "maybe someday I can be as smart as these folks if I read like they do"!
As for the modern Twitter journal club, I can't take sole credit. There was a big response to the website journal club in the ID twitter community that probably kicked that off, but it was really the brainchild of Ilan Schwartz, with support from Todd McCarty, my long-time mentor Laila Woc-Coburn, and myself. And honestly? We developed the journal club by doing it and doing it regularly - that's what builds and maintains an audience - by choosing a variety of articles that would hold wide appeal and by being "lucky" (?) in having hit our stride just as a global pandemic started and suddenly our community had little free time and a huge need to stay up to date on the ID literature.
How do you mentor trainees to read journal articles? Do you have a particular approach?
Sure. I think most of your time should be spent looking at the methods- this is the most important part of any paper because if the methods are flawed the results may not matter, and even if they're sound, understanding the methods (population, data and outcomes definition, follow-up, etc.) is key to understanding the generalizability of the results. I also tell folks to look carefully at the statistics and especially anything they don't understand, because it's easy to lie with statistics. In the remaining time, I focus on the results and especially data presented in the tables and figures- esp. figure 1 and table 1, which I often think of as extensions of the methods because they tell you who/what was included in the study and what that population actually looked like (again, is this study generalizable?). If there's any supplemental file, go look at it! Many authors or groups are terrible able hiding their most interesting, useful, or damning results in the supplement. Finally, I look at the discussion to see how the authors contextualize their results in the larger literature of body and pay special attention to what limitations they acknowledge and if they note anything I missed.
You are a very productive scholar. What guidance can you provide early career clinician-educators struggling to produce manuscripts? How can they advocate? What is the right balance of clinical work (which may inform your manuscripts) and scholarly work?
You need time to do good scholarly work. My most honest answer to this is go find a faculty position with a stellar division chief who is invested in your scholarly success and who will either carve out a fraction of FTE for you as dedicated research time or will give you some assistant medical directorship or other position that comes with FTE and takes fewer work-hours than it funds. My other most honest answer is think really hard about where you're going for a job and what kind of community support you're going to have, especially if you have young children, and if you have to go where you won't have those things, think about how you can spend your money to mitigate other life stressors/timesinks (e.g. cooking, cleaning, childcare during inevitable school closures) so you aren't left feeling like you have choose between academic success and relationships with your SO/kids/family.
There is no single right balance of scholarly and clinical work - that depends on your scholarly focus and career goals. For me, I know I can't get meaningful scholarly work done in less than a 2-hour block because it takes me time to get "in the zone". So, I need a couple dedicated half-days off most weeks just to write. If you're doing bench research, that *needs* to be the main thing you do if you want to keep up with other labs. Anyone looking to hire you at >50% clinical time for a few years until you've finished enough bench work to write your K is not setting you up for success.
For more specific advice about getting manuscripts published:
- Build a "writing circle" of colleagues you work well with and who have similar interests. Middle authorships are infinitely better than non-authorships
- Actively recruit medical students and residents (an email to UME staff may help- does your shop had a student research coordinator?) to spearhead projects and especially data collection, which is usually the most time consuming part
- Look for opportunities to do meaningful research that doesn't involve waiting for IRBs. Does your shop offer umbrella IRBs that you can use over and over to do different projects on one topic? Can you get IRB exemptions for quality improvement work? Is there a public dataset relevant to your work? Is there a systematic review that's worth doing?
- Start with the end in mind. When I begin drafting a paper, I start with the journal I'm targeting, the word/table/reference counts, the short list of peer reviewers I want to suggest.
Do you have mentors you look towards, and (if so) how did you identify them at different points in your career?
This could be a list of a hundred names. Most folks I've met through ID twitter in fellowship or the first few years of being an attending, which is SUCH a powerful tool for building collaborations and mentorship/sponsorship networks beyond your own neck of the woods. I'm very grateful to Mary Estes, Barbara Trautner, Laila Woc-Coburn, Paul Sax, Tara Vijiyan, Angela Hewlett, Laura Certain, and my chief Mark Rupp for the scholarly opportunities they've generously provided, and especially to my peer mentors and the folks just a few years ahead of me who I often learn from or turn to for guidance, like Jasmine Marcelin, Kelly Cawcutt, Darcy Wooten, Prathit Kulkarni and Jennifer Spicer.
What advice do you have for someone who is starting a career in medical education?
Narrow your focus and set specific goals, then stick to them. I have a "content map" in my office with a handful of topics that a) I care about, and b) I have FTE support to work on, and that helps me define my work priorities. A lesson I am still trying to take to heart is that there are ALWAYS going to be more opportunities than you can say yes to, so it behooves you to only say yes to those that align with your core mission and will advance your career, then actually deliver on those, versus say yes to everything and do a mediocre job with most of it.
Also, go read your shop's promotion and tenure criteria! Do you need papers for promotion, and if so are senior authorship or journal tier critical components of that? Do you need officership in your specialty's national association, or grant funding, or to win specific institutional teaching awards? If promotion matters to you, identifying these specific milestones is invaluable because it let's you plan your early career to meet them.
What other innovative educational program or process are you most excited about currently?
The ID podcast space has really opened up over the past few years- if you aren't listening to Sara Dong's "Febrile", Erin McrCreary & SIDP's "Breakpoints", or Callam and Jame's UK-based "ID:IOTs" podcast, I think you are missing out on the best education content for ID fellows and faculty being produced today!