Founder of ACCRAC & Johns Hopkins Residency Program Director
1. Tell us a little about yourself and how you got to where you are today?
I had a fairly atypical path but one I wouldn't change even if I could. I grew up outside of Cleveland, Ohio, in Shaker Heights, and went to public school there. I went to Brown for undergrad where I majored in History. I went to Harvard for a master's in education and got my teaching license. I taught high school history (9th grade World History) for 2 years, which I loved, but there was more and more pressure to teach specifically to the graduation test and I didn't like that aspect of it. So I decided to switch things up and did pre-med classes and went out to UCSF for medical school. I initially matched in EM but fell in love with critical care and back then you couldn't do it through EM. So after a lot of thought I switched to Anesthesiology, went back to UCSF and completed my residency there. My wife and I had our first 2 kids while I was a resident and decided to try to get closer to family for fellowship so we moved to Baltimore for my SICU fellowship at Hopkins in 2014. I stayed on faculty when I finished and got involved in the residency program and took over as program director 2 years ago.
2. What advice can you give residents on ways to be successful/efficient during residency?
It's hard to narrow this down to just a few things but I would say first of all, take care of yourself. Residency is hard, partly because of the long hours but also because of how little control you have over your life and time. Take some time for yourself when you can, to work out, to be with your family, whatever keeps you well. It won't be as much as you'd like, but it's important to do it when you can. And if things get too overwhelming, or you are feeling burned out, reach out for help. It's not weak to ask for help; it actually shows impressive strength. Don't misunderstand me, we need to work on system-wide, structural changes to support well-being. The last thing we should be doing is telling residents that it's their job to avoid burnout. But while we push for system-wide changes and support at an institutional level, we want to support our residents as much as we can to have this time away from work to recharge and be well.
Another marker of a really strong, successful resident is someone who is a team player. Remember that the residents who are seen as consummate professionals, the ones who are the most lauded by their attendings, are the ones who are there for their colleagues when they need help. Staying the extra few minutes to help a colleague with a difficult case, or to offer someone a break before you leave, without even being asked to do so, will really make you stand out as an impressive trainee. The temptation to leave the moment you are relieved, or the moment your cases finish, is strong, but taking the time to check in with your colleagues and see if anyone needs help will rarely cost you much time, but really builds the kind of reputation that will follow you, and open doors for you, for your entire career.
Finally, as you get further along in your training the pressure to know all of the answers grows. If you don't know them, you often feel like an imposter and you worry that people will find out that you don't know the answers and will "discover" that you don't deserve your position. The most important thing to know is that everyone feels this way. You are not alone. Do everything you can to fight this pressure. You'll find that senior attendings are often more willing to ask for help than junior ones because they no longer worry about being "found out". Take a lesson from those senior attendings and ask for help when you need it or when you are unsure. Don't worry about someone deciding that you aren't competent because you asked for help. In fact, ask more often. Ask the nurses, ask your colleagues, bring everyone into the discussion. Keep an open mind, be comfortable with not knowing, and you will be much happier, and more successful, than if you feel you must always look like you know all the answers.
3. What advice would you give residents/fellows interested in pursuing a career in medical education?
If you're interested in an academic career in medical education I think the most important thing to realize is that it isn't enough just to like to teach. You need to figure out what your academic pursuit will be. Take some time to learn what educational research looks like and whether you might be interested in that. Learn about program building and curricular development and consider whether that excites you. Talk to as many people as you can who have built a career in medical education, whether in anesthesiology or any other field, so you can learn about their path and start envisioning your own.
4. What recommendations do you have for those preparing for their Oral Board Exams in terms of resources and preparation?
The most important thing to do to prepare for oral boards is to do as many practice stems as possible. Find a partner or a group of people and, in the months leading up to the exam, give each other timed exams as many days as possible every week. Beyond that, use any resources that you want to fill in the gaps in your content knowledge. It's the practice that is the real key. For the OSCE, make sure you are familiar with the stations, what they can contain, and feel comfortable with the style and length of each one. Make sure you know the TEE views that can be tested. And make sure you are familiar with the language of quality improvement projects.
5. What are your thoughts on wellness in medicine?
Wellness is another major topic and I touched on it in my answer to your question about advice above. We have a system of training that was designed to be centered around resident labor where learning was assumed to follow from the labor. What we need is to rethink the entire system to make it learner centered and wellness centered. We have to move away from our reliance on resident labor and focus on learning and well-being. It's a major undertaking, a complete rethinking of what we do and how we do it, but it is work that is incredibly important and needs to be done. In the meantime we need to do everything we can to support our residents in a system that is not conducive to supporting well-being. That means acknowledging that what they are doing is hard and supporting them in every way we can including encouraging them to ask for help when they need it, to take time off when they need it, and finding ways to give them time to take care of the rest of their life. We can't ask people to put their lives on hold for 4 years, it doesn't work and it isn't reasonable. We have to move beyond giving lip service to well-being and we have to realize that it isn't the trainee's job to avoid burnout. It's our job to redesign our system to make it a supportive one, not one that produces burnout.
6. What is your routine/ habits to stay up to date with our practice (reading articles, learning the latest evidence, etc) and what do you typically recommend trainees to do to stay up to date?
Staying up to date is hard but I think there are great resources out there. I would sign up for table of content alerts from Anesthesiology, A&A and sub-specialty journals of interest. Scan through them when they arrive in your inbox and read articles that seem interesting to you. Follow some great blogs like Pulmcrit, TheBottomLine, and LifeInTheFastLane. And, of course, talk to your colleagues and attendings about what they're reading and learning.
7. What are your thoughts on the importance of anesthesiologists being involved in leadership opportunities (ie., within the political arena)?
I think all residents should think about what leadership means to them and learn about different leadership styles. We, for example, teach Serving Leadership. As for political involvement, I think it's an individual decision and one that each resident, and attending, can make for themselves. A serving leader sees themselves as serving the members of the organization and seeks to empower those in the organization to be successful and achieve their goals. Instead of seeing themselves as sitting on top of a pyramid issuing orders to those underneath, a serving leader sees themselves as sitting at the bottom of an inverted pyramid, supporting all of the people in the organization, helping get barriers out of their way, so that they can be successful.
8. How did you decide on creating ACCRAC and what was your inspiration?
When I was an EM intern I listened to some great podcasts (EMRAP, EMCRIT) that everyone in EM seemed to listen to. When I switched to anesthesia I was surprised to learn that there was no equivalent podcast. I didn't have time, as a resident, to start one, but when I became an attending I thought maybe I would. Then, when I heard my residents saying they wished they had more audio resources, I decided to do it. I honestly thought it would be something that no one except some of my residents would use, and have been completely blown away to see that more than 35,000 people now listen each month around the world. I love getting emails from people from all across the US and the world. I'm inspired by the work that they're doing and their passion for their patients, their practice, and their colleagues.
9. If there are individuals interested in helping with ACCRAC, how can they get involved? Are there other podcast you listen to and recommend?
If people want to get involved in helping with ACCRAC they should contact me at email@example.com. We could probably think of some fun ways for people to get involved. If anyone out there wants to create some possible theme music, I’d be happy to consider using it as an intro. I listen to EMCRIT, which I definitely recommend. I don't know of any other really good anesthesia podcasts but am certainly interested in hearing about some if anyone knows of any good ones.
You can find the podcast at http://accrac.com/
"I know that too often it feels like no one cares about the work that you do, or appreciates how much time and effort you put into it. Being a resident, especially, is an often thankless, extremely difficult job. If there's only one thing I hope you will take away from reading this, it is that despite how it often feels, what you are doing every day is incredibly important and truly valued. Thank you for all that you do."
– Dr. Jed Wolpaw
Date of Publication: Spring 2019