Podcasts Killed the Radio Star: Leveraging Digital Education Tools for Modern Learners

Buddy Creech: [00:00:12] Hi, I'm Buddy Creech, and this is Let's Talk ID. You know, medicine is suited for lifelong learners because of the continual cycle of discovery, innovation and then dissemination of information. And just as the 1910 Flexner Report revolutionized medicine in the early 20th century, innovations in digital education provide an opportunity to fundamentally change how we engage our trainees and how we continue to learn over time. Today, I'm joined by Sara Dong, who's an adult and pediatric infectious diseases physician at Emory University School of Medicine and Childrens Healthcare of Atlanta, where her clinical focus is transplant and immunocompromised host ID. She earned her medical degree from the Medical University of South Carolina, and then completed her med peds residency and chief residency years at the Ohio State University Wexner Medical Center and Nationwide Children's Hospital. And that was followed by a med peds ID fellowship at Beth Israel Deaconess Medical Center in Boston Children's Hospital. And she's the creator and host of the Febrile Podcast and Learning platform, co-host of the ID Puscast podcast and the program director for the ID Digital Institute. Sara, thank you for joining me today.

Sara Dong: [00:01:21] Thank you for the invitation. Excited to be here.

Buddy Creech: [00:01:23] This was a trip up, potentially because I had to say the phrase "ID Puscast podcast" and that's not something I can say very quickly many times.

Sara Dong: [00:01:32] [laughs] Apologies.

Buddy Creech: [00:01:33] No, it's great. This is good. I mean, this is how we hook them in, right? This is how we hook in new folks into peds and adult IDs is with clever names. All right. So I ask this of everybody because it's really, really important to me. At least tell me how you got into this. I mean, your medicine, your peds, your med peds ID. Obviously you don't like making decisions.

Sara Dong: [00:01:54] [laughs]

Buddy Creech: [00:01:54] But like, how did you get into this arena of of med peds ID? What were those foundational exposures that you point to to say, that's why I'm doing ID.

Sara Dong: [00:02:04] You know I think I probably always had a suspicion that I'd be interested in ID, but I didn't officially commit until I was in residency. And my story is probably similar to a lot of others. Meaning, I saw people who were excited about ID, who encouraged me to go pursue ID, and I think a big part of it was I would see people and think, I really want my brain to work like yours does. I want to think about patients like you do. Cool. In med school, I did an adult ID and peds ID elective, which in retrospect is very cool and I realize it probably not super common. And just remember having a lot of fun. And I had a couple, you know, impactful patients living with HIV on some of my inpatient services. And at the time, I think another big draw is I was leaning towards global or international health and had done some international clinical work. And not surprisingly, there were ID folks sort of peppered through those experiences. You know, I don't even know if they remember me, but I remember working with them and really looking up to them. But, you know, I picked med peds. I decided, you know, I figured it out. I'm going to be a hospitalist, of course.

Buddy Creech: [00:03:10] Right, right.

Sara Dong: [00:03:11] I did an adult ID consult rotation, and then at Nationwide Children's, there's a pediatric ID inpatient service staffed by ID docs. And then I later did the PEDs ID consult elective, and I think it was always there. I was like asking for ID opportunities. And then eventually after some ID lectures, like one on TB, I just went up to some of the attendings and said, hey, do you have any projects for resident? And from that I got to work with Dr. Sue Wong, who's on the adult side at OSU, and then Monica Ardura, who I adore and love.

Buddy Creech: [00:03:44] Same, same.

Sara Dong: [00:03:46] Gave me mentorship and support on the Children's side. And really the whole, I have to give a shout out to really the whole Nationwide Children's peds ID division, like Becky Wallen, just lots of role models that were encouraging and went to my first IDWeek, and all the pieces sort of fell into place. At some point, I realized my hesitation for saying I wanted to do ID was that I was scared to go through the match again. I had couples matched, and you know, that experience amplifies a lot of parts of it, meaning the positives are enormous. I get to spend live in the same place as my husband, but also it amplifies all the stress and challenges of that experience. And I think once I got over that and came to terms with it, I was all in and so did med peds ID, thanks to you talking to basically everyone under the sun about ID, adult and pediatric and med peds ID, and you know, it was the right fit for me because I didn't want to sort of give up either hat. But hopefully this resonates with people. It was really just the people I was around and having good experiences related to.

Buddy Creech: [00:04:49] You know, it's funny, we, Natasha and I, led the the training program here at Vanderbilt for for about a decade. And one of the images that we kept coming back to was this idea of the students and the residents that would that would identify maybe some interest in ID they were almost like cell types. There were some that were highly differentiated. Right?

Sara Dong: [00:05:10] Yep.

Buddy Creech: [00:05:10] They knew exactly what they wanted to do. They wanted to work on this one receptor, that's on this one cell type, that engages with this one other thing, and that's all they want to do. And that's their widget and they're awesome. And those are the folks that win Nobel Prizes. And then you've got this other group of folks who are really completely undifferentiated. And those are kind of challenging because you don't know how to get them. But you strike me and, and we've got plenty of these people that we can point to that were really pluripotent. We just needed the right stimulus at the right time, and we could become a lot of different things. And for most of us, I think it's very relational.

Buddy Creech: [00:05:47] Maybe it's a particular, like you said, a particular patient, a particular time. I can still think back to my second year rotation and seeing a couple of patients, I can almost feel like I'm in that room again, and that was the right stimulus at the right time. And then, because I'm a vaccinologist, every everything comes back to prime boost. There was always a prime in med school, and then there were a series of boosts along the way that got me to the point where I'm like, okay, I'm going to be an ID doc now. Okay. Very cool. So one of the reasons why I'm excited about this episode is because this is in the flavor of a, of a crossover episode. So I'm really fond of because through this Let's Talk ID podcast, one of the things that we're also trying to do is engage with others who are in this space, like Febrile. And so can you talk a little bit about how Febrile started? It's now under the IDSA moniker, I guess now, but talk to me about how that originated and what you hope to accomplish with Febrile.

Sara Dong: [00:06:43] So it actually didn't start really as a podcast, I have been working with the ID fellows network and doing these, they were called tweet chats. Obviously it's X and all the names have evolved, but really a synchronous live chat structured around sort of made up cases to teach about ID. And I had pitched this idea and you know, we were doing these and I realized there were pieces of it that people really enjoyed, meaning they liked talking about ID, they liked building out differentials. And as I was reflecting, it was taking a lot of effort to do these things. And, you know, there wasn't really a good way to catalog or archive it, meaning for learners to go back to or for me as the educator, to say, here are the things that I've created. For me, one of my ideas behind it is that I wanted people to talk about why they made decisions and ID, and the platform that is Twitter/X is fueled a lot by those sort of hot take, let me say, this zebra thing the fastest I can, and that wasn't my goal. I wanted some of that, like next step, deeper nuance. And I wanted it, people's perception, especially outside of ID, to not just be, oh, here's this long list of things that the ID doc wants. You know, to have it be clear that there's a lot of thought that goes into, well, if this test comes back, this is what I'm going to do with it.

Buddy Creech: [00:08:09] So this resonates because, you know, I've got two in college and I've got a caboose, a 12 year old who's in sixth grade. And it's really funny to watch, even just in those ten years or so, how learning strategies and just the process of things, how they differ. Right. So my my college students now are really knee deep in the why something happens and and having to show their thought process. My 12 year old is exactly as you said. She's like, I got the right answer, by guessing, why does it matter how I got it? I was like, because you don't understand what you're doing. And so this really resonates with me because I think so many of us who trained maybe in a slightly different era, I mean, I'm not 105, but but I've been around for a little bit longer. I miss those days of process based differentials and the why, rather than a group of learners maybe shouting out a diagnosis one at a time as single word, where we're just sort of saying something and it doesn't have a meaning or a context. So can you talk a little bit about how you're trying to, to engage that, like what tools are you using? I mean, quite frankly, to help our learners use full sentences in how they process a case.

Sara Dong: [00:09:24] When I made the shift to do Febrile, I had a lot of good examples, meaning, you know, in residency, there were a lot of folks who were I knew people who were involved in Curbsiders and Cribsiders and, you know, seeing examples from them. And then the nephrology folks, the NAF social media collective and the cardio nerds, they were doing good examples of this already. So I have to give a lot of credit to that. But I wanted these to be case oriented because it gets people excited and it draws them in, but also to have them hear the thought process of someone else walking through the case. And so that's kind of been the focus, if, if at all possible, is to think about those sort of clinical diagnostic reasoning most of the time and or the. Reasoning when the answer is not black and white, it's just the usual gray of ID. It's been a little bit of trial and error, right? I was a fellow when I started it, and even though I'm technically an attending now, I still kind of just feel like a senior fellow sometimes. That's why it's very helpful when people give feedback on which formats and styles of the show have been helpful to try and sort of move it forward. But for me, it was it was nice, meaning, it took this, hopefully one of the skills, that we all try to do when you're teaching in clinical case conference, and just translate it into another format that, you know, reaches a probably a few more learners than our usual clinical case conference. And then for me, it's really nice to sort of be creative and try to teach a lot of the same concepts in different formats. So whether it's writing something up that goes into the consult notes or converting it into some sort of visual communication, like the infographic, those are all skills that I think we need as modern educators to share knowledge, but hopefully [laughs], I answered the question that you pitched.

Buddy Creech: [00:11:21] No, this is perfect. Yeah, I you know, I think the infographics thing, I don't want to sleep on that because I've seen a lot of those. And they're clever, they're engaging, they're memorable. It's amazing what a font choice or a color or the layout on a page. And, and I'm struck by the fact that so much of what we do is now two dimensional on a screen. It's a digital textbook. It's a, it's an EMR that you're not flipping through. And I'll be honest, at 50 years of age, I struggle more reading a book electronically than I do when it's in paper form. And I know that I'm halfway or three quarters. There's there's a tactile and a visual sense there. So what I feel like those infographics do is they take what could be a two dimensional table of differential diagnosis, that I'm not going to have any retention on, and changes it just enough. It's not three dimensional, but there's some element in there that makes it more memorable. So most of us don't have access to like really cool graphic designers. Obviously you do, because it's really cool.

Sara Dong: [00:12:31] No, you can do it yourself! And that's why I love to teach people, I can.

Buddy Creech: [00:12:37] I love it.

Sara Dong: [00:12:38] But I mean that that is something that I, I hope people see. They probably do sometimes think that there are more people involved. But like I do a lot of the Febrile infographics and I try to teach people how to do them.

Buddy Creech: [00:12:50] Okay. That's cool.

Sara Dong: [00:12:50] And I hope that people see this as, it's just a skill set. It's like any other skill set that you can acquire. And I think it it the learning curve is probably not as bad as people think. But just to pitch that you can do it. And honestly, you're all expected to. Anyone who's submitted a paper recently has had to do a visual abstract. So that is effectively the same skill set. So I'll just make a pitch to say you can also do it! [laughs]

Buddy Creech: [00:13:16] Yeah, this is like saying, come on, it's just a piano concerto. It's just a skill set. Everybody can do it.

Sara Dong: [00:13:22] [laughs]

Buddy Creech: [00:13:22] Um, no, I'm not going to let you deflect that too much because for those who haven't seen these infographics, they're really good. They're worthy of saving to your phone or printing out and putting in a work room just on a little bulletin board, because they can be really helpful, whether it's modified Jones or modified Duke criteria or whether it's, you know, whatever it might be. Our brains work fundamentally different when they're engaged from multiple angles, right? So if we hear things, if we see things, if we feel things, there's a lot. And this is why I think this case based approach that you're taking, obviously we do it for a case conferences. We've done it throughout medical training. It's a two edged sword. We've got to have the rudiments in place before we can then apply them to a case. But I mean, I'll tell you, my mom had discoid lupus and it was a profound experience when she was diagnosed when I was a kid, because it wasn't clear what the pathophysiology of it was, wasn't clear what treatment was. And and so it was a second year medical student learning pathology. I remember picking up Robbins textbook, which is still one of the most intimidating textbooks still on my shelf, and it was hard to interpret what was happening until I got to some things about lupus and histones. And all of a sudden, I care about these cells and care about what's happening. So is that your experience as you're working one-on-one with learners, as you're getting feedback about these these tools that you're using? I have the sense that case-based learning allows us to to anchor it to a real person, a real disease, a real process that gives it just a little bit more flavor. Is that fair?

Sara Dong: [00:14:56] Yeah. So I do think that's part of it, like getting people hooked. And I think what people don't realize is that it takes a long time to prep episodes like this, to be efficient, in the window of time that you have available. And I do find that earlier trainees need a little bit more help to craft episodes and say someone who's a fellow or faculty member who's used to condensing cases. And so that's been a really interesting thing to see. Obviously, we do that in clinical practice. Right? Maybe someone needs a little more coaching as a student than a resident and a fellow. And it's the same thing in creating these resources.

Sara Dong: [00:15:38] I'd say the other thing about adding clinical context is I do think there are folks who are not in the clinical space a lot who have either shared with me anecdotes or emails or responded in a survey that said, this gave me way more context for the things that I do every day and found that motivating. And the other thing about these sort of case based ones that sort of feel relatable, is that I hope that a lot of these resources are like a catalyst for conversation. I like to compare podcasts, sort of like, to a book club. No one says that a book can't teach you something because it's not bidirectional, which is one of the sort of judgments that get passed on.

Sara Dong: [00:16:20] Digital education is like, oh, it's a one way thing, but a podcast can be just like a book. It can be opening a conversation between a learner and that faculty member to talk about that case, you know, talk about what if scenarios and sort of expand on it. And I've had a lot of, those are my favorite messages. When people say, hey, I like every time I listen to episode, I go find this attending whose my mentor? And we talk about that episode.

Buddy Creech: [00:16:46] Oh, that's great.

Sara Dong: [00:16:47] Those are really cool things that I don't know. It's hard to capture and explain or quantify. I don't think we necessarily need to. It's just there's so many aspects to trying to be intentional so that it can be, not just like something that you listen to, it can be a teaching resource. If you're a faculty member, it can be a conversation starter and a group of trainees, like if a group of fellows listens to an episode and and talks about it. So that is a really, really cool aspect of things like podcasts and digital education that, you know, people maybe don't talk about as much, but I think is a key reason why they're so popular.

Buddy Creech: [00:17:24] Well, and it extends what we can do, right? Because on a busy service with only so many learners, but a ton of patients, we sometimes have to pick and choose which cases we're going to take a really deep dive in. And quite frankly, sometimes we overlook a suboptimal presentation or a suboptimal differential because we've got 23 other folks to talk about in a fairly short period of time, and that sometimes can be a disservice to our learners. So I'm going to put you on the spot a little bit, recognizing that you don't have a PhD in adult education, neither do I. But we're both engaged in education and engaging with learners. So my question is going to be where do you see some of the biggest, I don't want to say holes, I don't want this to be just kind of a complain fest about about newer generations of students or learners or whatever,  i don't mean it in a negative way, but I'm just curious. We've changed how we do med ed over the years. Folks are getting into the clinical arena much sooner than they used to, in part because we're trying to to anchor them to real patients and real processes. But where do you see some of the either blind spots or holes or things that we in ID really need to step into for medical education over the next, say, five years or so?

Sara Dong: [00:18:44] Well, and this one's probably a little separate, but many of these sort of podcasts and digital platforms are ways that early trainees are hearing voices or establishing role models. And I think just to put that out there, that I think that's a big, important aspect of utilizing these resources is to reach a lot of those learners that maybe don't have an ID attending that they work closely with, maybe they haven't had a consult service rotation. So I'm going to put a pin in that just just to make a pitch.

Buddy Creech: [00:19:17] That no, that's perfect from a recruiting standpoint and from a, from an exposure to ID standpoint, I think that's huge. I mean, we certainly see that with the Curbsiders and the Curbsiders, seeing hospital medicine and ER being very highly prominent there, and looking to them as trusted folks in the community. No that's great.

Sara Dong: [00:19:35] So that's one part. I in no way think that digital education is made to like, supplant or replace what we think of as our sort of, quote, traditional medical education, meaning grand rounds and conferences and didactics and our big meetings and so on. These formats are there to enhance those resources. Maybe there's some standalone options, but I think ultimately that's kind of the goal is for them to blend and sort of be a hybrid. And this is really hard. Like, how do we use these resources to our advantage to serve that complementary role and to basically to create synergy. Like synergy between what you're doing locally, what is available online from our journals and our national organizations and our major meetings. And so I would love to figure out what are ways that we can take things like podcasts or similar online resources, whiteboard talks and so on, and, and incorporate them into curricula that you make for a rotation. You know, someone's coming through their transplant ID rotation, what resources do you refer them to, and when do you do it to complement what you guys talk about? And that's a huge a huge topic. But I think that is a really important place that we could do better. That will take hopefully some people who are excited about and hopefully I'll be one of those people that's excited to ask those questions.

Sara Dong: [00:20:58] Can we build synergy in any other way? Is there a ways to build in that, almost like spaced repetition for things that come up in didactics or from a national meeting, sort of reinforcing knowledge that you've gained from somewhere else? And that's what I have a little bit of trouble figuring out what's the best way to do it. And the challenge of digital education is people worry about how much they can trust resources, who and what they can use to share with their learners. That's a huge burden to feel like you can create something that folks can refer people to. And I feel that with Febrile, for example, are there ways that we can build infrastructure into digital education to almost have like an editorial process, the way that journals do? These are all things that I have lots of ideas for future directions of sort of Febrile and other things in general. The big frontier is how do we how do we meld them together and how do we do that? Well, in a way that benefits our learners and helps us as educators fill in those gaps when you're on a really clinically busy service.

Buddy Creech: [00:22:02] Yeah. See, this is this is what I love thinking about is this idea of how do we in this day with these tools, how do we take the best of what we've had in the past and the best of what we have now, and bring those together? I think that's exactly what you're saying. For me, nothing will ever replace sitting with master clinicians in ID, saying, I've got a kid with pneumonia and hilar adenopathy who's got a crazy exposure history, and let's just run that differential. Like that's nothing. I mean, there's a lot of things that get me excited about medicine. Let's be super clear. But like clinically, that's my jam. I want to be able to sit and think through all of those categories. And different people over the years have given me different tools, you know? So Kathy Edwards always asks why. And it's multiple wise. It's like four whys like, well, why did he get this? Oh, because he had this infection. Why did he get that infection? And you have to think about the physiology and then you've got people like Tim Peters, who was a fellow when I was a resident who, a lot of those differentials would always have. Okay, what are the bacteria, the fungi, the viruses, the mycobacteria, the parasites that can cause this particular disease? So different people, I've piecemealed all of those into this sort of patchwork quilt that becomes a style. And I think that's what I get excited about with Febrile, with with other tools that we have, how can we take the best of the best and build new quilts?

Sara Dong: [00:23:42] Yeah, and giving people access to more voices and examples is how they're going to build their style. And hopefully Febrile can be one of those resources for people to to hear from others. That said, I, I do hope that we will also continue to sort of flip it and maybe we'll have episodes where like an attending presents a case and the fellow starts the conference. We've had some of those.

Buddy Creech: [00:24:06] I like that.

Sara Dong: [00:24:06] So I like there's lots of ways to build it out, but that's what people really value with Febrile is they feel like they have access to people, these master clinicians or experts in other locations that maybe they wouldn't have been able to interact with on a sort of normal basis.

Buddy Creech: [00:24:23] And I love the longevity that it then provides, because we have right now generations of master clinicians, some of whom are starting to retire from clinical practice, and their voice won't be as loud as it has been for the last 20 years. And then we've got new folks coming in that have their own incredible styles. And one of the weird things, and one of the the things that should all give us pause but give us excitement, is that undoubtedly your podcast is reaching future master clinicians, and it's forming their style. It's forming how they're going to approach things. And boy, if you can't get excited about doing ID and doing med education, after thinking about what you've been able to accomplish and folks like you in different arenas. I really think this is exciting for us in ID, and I love your point that if we're going to want to recruit, we need to be at the front of the line. We need to be front and center, establishing our trusted voice, establishing that we're really good at what we do, that we're excited about what we do, that we can use innovation. And I get excited about that. So maybe let's think about recruitment with these tools. Can you hum a few bars about how you think we can deploy these, especially to early learners, maybe even to college students? That'd be weird. But how do we how do we get people engaged through some of these tools?

Sara Dong: [00:25:49] Yeah, and some of it is is sharing it with earlier learners as a as a supplement. What I would love to do and actually what febrile I intended it to do in the beginning but didn't quite get there is I would love to have it where it travels and is visiting different fellowships or residency or whatever it is, obviously remotely or in-person would be fine, to highlight those voices and interact with people are there because I've, I do think that that is a way that, you know, if someone didn't listen to a podcast, but someone they know is on it, that probably is a nice introduction. But I have struggled with figuring out what's the right level to target it at, because I think that I started as a fellow at its heart. I made it for fellows. But there are plenty of residents and medical students who seem to be listening. And so how can we maybe have some episodes that highlight ID interest groups? That's something that we hopefully can get off the ground and have more medical students that are on the show and sort of tell us what would be interesting and engaging to hear about ID.

Sara Dong: [00:26:54] And so I actually encourage a lot of people for Febrile to think about, you know, everyone contacts me when they have like a really zebra case because they love, you know, they want to share it. But really, the most impactful episodes are when people talk about like bread and butter-based topics, because it stretches the full spectrum of learners, and it gives your content longevity for people to continue to refer to over and over. And I hope that if we do more of that, that maybe we should do more fundamental episodes sort of targeting earlier learners. And I probably haven't done the best job of that. But that's something I'm trying to brainstorm. You know, what's the best way to engage more with younger learners? Because I acknowledge that some of Febrile is probably, it's pretty deep in the ID weeds. Again, by intention [laughs], usually but that's something that hopefully we can do a better job of. So I get really excited when we have med students who are interested in the podcast. I think we probably just need to make episodes that is more approachable for them than sometimes we have done before.

Buddy Creech: [00:28:04] Well, sure. I mean, what's the saying, right? If you hear hoof beats, it's probably a horse rather than a zebra. It's probably a horse. And this is one of the things that I think probably drew me in. Sounds like it may have drawn you in to ID. ID was one of the few specialties where I didn't feel like I had to give up an understanding of the other organ systems. I didn't have to give up cardiology or nephrology. I just don't understand it as as deeply as my cardiology and nephrology colleagues. But I still have to remember what an arrhythmia does to cardiac output. I still have to remember what interstitial nephritis is. And that appealed to me. And so we occupy such an incredible niche within the medical establishment that we are both laser focused. But we also have a very broad understanding of physiology so that we can engage others as we need to. So we're both a bridge as well as a destination. And I think that's I think that's helpful.

Buddy Creech: [00:29:02] Well, Sarah, you're doing awesome work. If our listeners have not checked out Febrile yet, this is your opportunity to do so. It's literally everywhere where you might find a podcast. So you're not going to have a hard time finding it. But check it out. Give it to your fellows. Give it to your residents who are rotating on your service. I think you'll find that they will be interested, and it's just really easy to to put it in the queue. And as new updates or new episodes come out, they'll be right there for your learners. Sarah, I'm really grateful for the work you're doing. I'm really grateful for what IDSA and PIDs and others are doing in this space. And I think, I think the future is bright. So thank you for joining me today.

Sara Dong: [00:29:40] Yeah. And can I just say a thank you to, I haven't said this, but thank you to everyone who mentored me and supported me and to everyone who's created, you know, Febrile is not just me, it's everyone else who's made episodes and made infographics. And that's a huge, I can't list everyone, but just to say a special thank you to people who dedicated time to making it a great resource.

Buddy Creech: [00:30:03] Oh that's awesome. Yeah, shout out to all of them who've played a role. And this is this is what it looks like. Moving forward, we're going to try to take the best of the best that showcases what peds ID, what adult ID can look like, how do we care best for our patients? How do we integrate new discoveries into the care that we provide? This is where I think those of us who have been doing it for maybe a little bit longer, get really excited about what the next 15 to 20 years looks like, because we're on the precipice of being able to deliver care in such an exciting and innovative way, and engaging our trainees to take that and run with it moving forward. It's a very cool thing. So, Sara, thanks for joining. Really grateful. Join us next time for Let's Talk ID.