Complexity in Medicine and Medical Education

In this season finale episode, Dr. Adam Cifu sits down with transplant nephrologist Dr. Michelle Josephson to explore the unique challenges and opportunities that arise in the later stages of an academic medical career. Dr. Josephson openly discusses the struggle to maintain a sense of relevance, the need to redefine one's priorities and goals, and the bittersweet experience of losing colleagues to retirement and passing. However, she also highlights the freedom and excitement that can come with this transitional phase, allowing her to pursue new global initiatives in areas like green nephrology. This provides an insightful look at navigating the "third phase" of a distinguished career.

In this episode, we speak with Dr. Jennifer Brokaw about her varied and impressive career in medicine. Dr. Brokaw shares how she transitioned from emergency medicine into founding a private practice focused on advanced illness management and end-of-life care, driven by a desire to tackle complex societal challenges she witnessed in the ER. She discusses the unique value she was able to provide as an independent advocate for patients and families, as well as the challenges of building a sustainable business model around these services. Dr. Brokaw's insights offer a fascinating look at alternative paths for doctors beyond traditional clinical roles. This conversation provides an engaging glimpse into one physician's remarkable career journey.

In this installment of our series talking with medical trainees, we're joined by Dr. Ava Ferguson Bryan, a general surgery resident at the University of Chicago. Dr. Ferguson Bryan shares her winding path to medicine, from initially pursuing English and art history, to discovering a passion for surgery during her clinical rotations.She provides an honest look at the challenges and sacrifices of surgical training, including the lengthy 7-8 year commitment and the impact on work-life balance, especially as a woman having children during residency. Dr. Ferguson Bryan also discusses the evolving landscape of surgical education, including competency-based assessments that may allow for more flexibility in training duration.This episode offers valuable insights for aspiring physicians navigating the realities of surgical specialties and the broader effort to diversify the field. Dr. Ferguson Bryan's personal experience provides a nuanced perspective on the progress made, as well as the work still needed to support the next generation of surgeon-trainees.

Gaining an inside look at the realities of medical training, this episode features a conversation with Layne Keating, a chief medical resident at the University of Chicago. Layne shares her experiences navigating the transition from medical school at the Frank H. Netter MD School of Medicine at Quinnipiac University to residency, highlighting the importance of being given autonomy and the ability to make real clinical decisions.She explains how this hands-on responsibility, even with the support of her team, has been critical for developing the confidence and problem-solving skills needed to be an effective physician. Layne contrasts this with concerns that overprotecting trainees from having to make tough choices during their education can make the leap to independent practice much more difficult.The conversation also touches on the use of letters of recommendation in the residency application process. Layne and Dr. Adam Cifu discuss how more holistic, thoughtful approaches may be needed to evaluate the suitability of medical trainees.This transparent discussion provides a unique perspective on the highs and lows of the clinical training journey, as well as insights into improving medical education to better prepare the next generation of physicians.To read more:https://medicine.qu.edu/https://www.sensible-med.com/p/letters-of-recommendation-should-fb0

In this episode, we continue our series exploring the experiences of medical trainees. Dr. Adam Cifu is joined by Arman Shahriar, MD, a third-year internal medicine resident at the University of Chicago. Arman shares his nontraditional path to medicine, including teaching in Ecuador and working in the medical device industry. He provides a candid look at residency life, from the grueling schedules to the unexpected challenges and the camaraderie forged during training.Arman is also the author of two compelling articles: On One-Liners and Doing No Harm, which explores the power of language in patient care, and The Wrong Fight—Prior Authorization, a personal account of navigating systemic barriers.To read Dr. Shahriar's above-mentioned articles, check them out here:• On One-Liners and Doing No Harm: https://journals.lww.com/academicmedicine/fulltext/2023/10000/on_one_liners_and_doing_no_harm.24.aspx• The Wrong Fight—Prior Authorization: https://jamanetwork.com/journals/jamaoncology/article-abstract/2813580

Kicking off a series of talks with people in medical training, this episode features third-year student Nihar Rama discussing his experiences and insights so far. Nihar discusses how his personal background as a patient has shaped his empathetic approach to caring for patients. He reflects on the importance of maintaining confidence while also expressing humility, and the challenges of developing strong interpersonal skills alongside medical knowledge. Nihar offers thoughtful perspectives on how medical education could better assess and cultivate the human qualities, beyond just academic acumen, that are essential for becoming an excellent clinician.

In this episode, Dr. Adam Cifu sits down with Dr. Chadi Nabhan—a hematologist, oncologist, author, and healthcare leader—to discuss his inspiring career transitions and his latest book, The Cancer Journey: Understanding Diagnosis, Treatment, Recovery, and Prevention. They explore the phases of a cancer diagnosis, the emotional toll on patients and caregivers, and the critical role of communication and second opinions. Dr. Nabhan also shares insights from his work at a company advancing AI technology to accelerate clinical trials. He is also the author of Toxic Exposure: The True Story Behind the Monsanto Trials and the Search for Justice.To learn more about Dr. Nabhan's The Cancer Journey and read an article about the book, visit ASCO Connection: https://connection.asco.org/magazine/features/cancer-journey-dr-chadi-nabhan-uses-storytelling-plain-language-simplify-complex.

In this episode, we speak with Dr. Dee Fenner, the first recipient of the Bucksbaum National Award for Clinical Excellence. A trailblazer in the field of urogynecology, Dr. Fenner shares her remarkable journey - from being one of the few women in her medical school class to becoming a nationally recognized expert in pelvic floor disorders and reconstructive surgery.Dr. Fenner discusses how she found her passion in obstetrics and gynecology, and how she helped advance the burgeoning field of urogynecology. She reflects on the importance of creating a safe, comfortable environment for her vulnerable patients, and the challenges of training the next generation of surgeons. As she looks to the future, Dr. Fenner is both excited and apprehensive about how data science and AI will impact patient care. At the same time, she remains focused on mentoring her colleagues and ensuring her department's continued success. 

In this episode, Dr. Adam Cifu sits down with Dr. Micah Prochaska to explore the intricate ethical dilemmas surrounding end-of-life care. They delve into the complex issues of patient autonomy, relational autonomy, and the role of families in these deeply personal decisions. Through thought-provoking discussion, they challenge the traditional frameworks and reveal the nuances in balancing medical expertise, personal values, and the well-being of patients and their loved ones. This episode offers a poignant and insightful examination of the ethical quandaries faced by healthcare providers when guiding patients and families through the end-of-life journey.Dr. Prochaska also references a highly influential paper by Daniel P. Sulmasy, MD, PhD, and Lois Snyder, JD, titled "Substituted Interests and Best Judgments: An Integrated Model of Surrogate Decision Making.URL: https://tinyurl.com/yc2y9u5j

How do you measure clinical excellence? Host Dr. Adam Cifu welcomes guest Dr. Anna Volerman to discuss the realities of clinical excellence, diving deep into the challenges of delivering impactful care beyond clinic walls. Dr. Volerman candidly shares her experiences with self-doubt, the importance of understanding patients' daily environments, and her work to address health inequities. Dr. Cifu adds thought-provoking insights on the art of medicine, as together they explore the shift from merely treating patients to transforming systems for better health outcomes. This episode offers a heartfelt look into healthcare's complexities, making it a must-listen for those passionate about medicine’s future.