Doctors Teaching Doctors – PediaCast 303
Dr Donna Caniano joins Dr Mike in the PediaCast Studio to talk about faculty development and doctors teaching doctors. Topics include medical mentorship, physician networking and keeping current, maintenance of board certification, translating research into clinical practice, and the best ways to provide patient education with evidence-based resources.
- Faculty Development
- Doctors Teaching Doctors
- Medical Mentorship
- Physician Networking & Keeping Current
- Maintenance of Board Certification
- Translating Research into Clinical Practice
- Patient Education
- Evidence-Based Educational Resources
- Dr Donna Caniano
Pediatric Surgeon and Field Representative
Accreditation Council for Graduate Medical Education
- ACGME (Accreditation Council for Graduate Medical Education)
- American Board of Medical Specialties
- American Board of Pediatrics
- PediaCast.org (posters in resources tab)
- HealthyChildren.org (AAP)
- Nationwide Children’s Health Library
- KidsHealth.org (Nemours)
- CONTACT DR MIKE – Ask Questions, Suggest Show Topics
- CONNECT NOW with a pediatric specialist from Nationwide Children’s – Referrals and Appointments
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital on Columbus, Ohio. It’s episode 303 for November 19th, 2014. We’re calling this one “Doctors Teaching Doctors”. I want to welcome everyone to the program.
So we’re going to go in a slightly different direction today. But it’s an important direction, particularly for the medical providers that we have in the audience. But I think this is going to be a topic of interests for moms and dads as well. How is it that doctors keep learning and growing and staying current after finishing their formal training of medical residency and sometimes fellowship beyond that? After all, the practice of medicine continues to change at an amazing phase. And if I continue practicing medicine the way that I trained back in the early to mid-90s, well, I’d be out of date in many areas of practice, and I’d no longer be up to speed with the current standards of care.
So the concept of life-long learning is really important in the field of medicine, not only for doctors but even more so for the patients that we’re trying to help. In addition to staying current, how do doctors learn to Become effective teachers and productive researchers? These aren’t really things that you learn in medical school or even residency for that matter.
The practice of medicine really demands life-long learning, and it demands mentorship, both as mentee and as mentor. It also demands accountability to the patients and the public can verify that we are indeed up-to-date. So, how does all this look from the inside? What are we doing well? Where are we failing? What resources are out there to tap into for those practicing academic medicine, for those involved in research, and for those taking care of the bulk of patients in any given community? Speaking of community medicine, how do research findings get translated into a change in the way community providers practice medicine?
In other words, our show today is going to take a look at exactly what it is that’s ticking inside the American healthcare system with regard to keeping current and staying on top of research. And to help me take a look at this pretty big topic, I have a fantastic guest joining me in the studio today — Dr. Donna Caniano, former surgeon-in-chief here at Nationwide Children’s Hospital and current field representative with the Accreditation Council for Graduate Medical Education. In other words, she’s out there inspecting our country’s training programs to make sure they’re doing a good job educating the next generation of American doctors and making sure those programs are instilling a spirit of the life-long development and learning.
We’ll get her settled in the studio in a moment. First, I want to remind you, we do have a blog here at Nationwide Children’s. It’s our 700 Children’s. You can find it over at 700Childrens.org. Some recent topics — myths about adult congenital heart disease, and more myth-busting on the use of hyperbaric oxygen therapy to treat cerebral palsy. Also, palliative care when there is no cure, that’s certainly a tough topic. Practicing positive discipline, what does that look like, and does it work? Also, the danger of laundry pods and seven myths and facts regarding celiac disease.
So be sure to check out those stories and more over at the 700 Children’s blog. Again, you can find it at 700Childrens.org.
Also, I want to remind you that the PediaCast is your show. So if you have a question for me that you like me to answer or you want to point us in the direction of a news article or a journal article, or you have particular topic you want us to talk about, it’s really easy to get in touch. Just head over to PediaCast.org and click on the Contact link.
Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.
All right, we’re going to take a quick break. We’ll get Dr. Caniano settled in to the studio, and we’ll talk about doctors teaching doctors, right after this.
Dr. Mike Patrick: Dr. Donna Caniano is a board-certified pediatric surgeon and a familiar face at Nationwide Children’s Hospital. She attended medical school at Albany Medical College, followed by a residency in general surgery at the Albany Medical Center Hospital, and a fellowship in pediatric surgical critical care at the Johns Hopkins Hospital. In 1983, she completed an additional residency in pediatric surgery here, back when the place was a little bit smaller, and known as Columbus Children’s Hospital.
Between 1983 and 1985, Dr. Caniano returned to the University of Maryland in Johns Hopkins serving as an assistant professor of surgery. But the pullback to Central Ohio was apparently too great — she had Columbus in her blood — and in 1985, she returned to our campus and climbed the academic ladder at the Ohio State University. In 1999, Dr. Caniano was appointed the H. William Clatworthy Junior Professor of Pediatric Surgery at Ohio State and named Surgeon-In-Chief at Columbus Children’s Hospital, which would so see a rebirth and a name change as Nationwide Children’s.
During her tenure at our hospital, Dr. Caniano served as program director for the Pediatric Surgery Residency Program, chairperson of the section on Surgery at the American Academy of Pediatrics, and the editorial boards of the Journal of Pediatric Surgery and Pediatric Surgery International.
In 2011, she retired from surgical practice, moved to Virginia and joined the field staff at the Accreditation Council for Graduate Medical Education.
She returns today as a guest of Nationwide Children’s and it’s an honor to welcome her to the PediaCast studio to talk about faculty development and doctors teaching doctors. So let’s welcome to the show Dr. Donna Caniano. Thanks for joining us.
Dr. Donna Caniano: Mike, it’s a great pleasure to be here. Just wonderful to see the hospital and to see how gorgeous the campus is.
Dr. Mike Patrick: Really, lots of changes lately for the positive. Great, great place to be.
Dr. Donna Caniano: I almost needed a guide to get me through, Mike. It doesn’t look the same even from 2011.
Dr. Mike Patrick: Yeah, and we have a great way-finding system though to really help people navigate the hospital.
Dr. Donna Caniano: I find myself looking at the floor and following the path.
Dr. Donna Caniano: The river, I guess.
Dr. Mike Patrick: Yes, yes, exactly.
Let’s start with… I mentioned the Accreditation Council for Graduate Medical Education, also known as ACGME, what exactly is that organization?
Dr. Donna Caniano: It’s the organization that really has one mission, which is the quality of graduate medical education in the United States and also now, we are accrediting a couple of countries in Singapore and a couple of the countries in the Middle East. It’s the organization that really decides, is a graduate medical education program — a residency, such as the residency in pediatrics — meeting the appropriate standard?
Dr. Mike Patrick: So really, this is the accountability to the public in terms of we are producing doctors who know and are up to the task of what we expect them to do.
Dr. Donna Caniano: Absolutely. So right now, there are almost 10,000 graduate medical education programs that we accredit and that translates, believe it or not, to about a 116,000 residents and fellows.
Dr. Mike Patrick: Wow. And I think there’s been enough medical shows on TV, and I think people just have a general sense of how doctors are educated in this country to know you don’t come out of medical school a competent physician. I mean, you really need training beyond that.
Dr. Donna Caniano: Absolutely. So what we really look at is, does this residency or fellowship program allow a person who may come in sort of an advanced beginner progress along a continuum? So that by the time the individual is graduating from that program, they have achieved a level of competence in which they’re independent, meaning that they can practice their field of specialty independently, without being directly supervised as they were during their training,
Dr. Mike Patrick: So as we move from an advanced beginner to being confident to being more of an expert, it even takes beyond residency and fellowship than to really to master being a doctor. Talk a little bit about why it’s important to continue learning even after training.
Dr. Donna Caniano: When an individual finish his training, you really are confident, meaning that you have mastered most of the information, the knowledge skills and attitude to practice in whatever field you’ve trained in. But that’s just that level. And so the expectation is, over the course of your next so many years in practice, you will become an expert or a master. That will only happen if you’re in a clinical milieu with adequate patients to take care of, and then you stay current in your field.
Dr. Mike Patrick: Which is really important because things change so quickly.
Can you describe your role as an accreditation field representative? What exactly do you do for this organization?
Dr. Donna Caniano: So what we do — we are 30 individuals. Most of us are retired academic physicians. There are couple of PhDs who do this who are all involved in medical education. And what we do, we have documentation that’s submitted in an online way. We review that documentation which has to do with what kind of conferences are the residents having? Are they achieving the appropriate milestones for what the faculty has judged to be appropriate for their discipline?
We look at all of those pieces during a site visit. A site visit is usually about eight hours. We meet with the majority of the residents or fellows. We meet with the core faculty who are most involved with the residency program, typically the chairman of the department, the designated institutional officer who is responsible for maintaining the program viability. We interview all of the stockholders, and then we issue a report.
Dr. Mike Patrick: How often do you do a site visit to any particular program?
Dr. Donna Caniano: So the system is now undergoing chance. it’s now what’s called the next accreditation system. It used to be a program receive a cycle length anywhere from one year to five years. You want it to be a five-year because we wouldn’t bother you for five years. The problem with that system is it was static. So we came and you look great that day we issued a report. The Residency Review Committee for your specialty read the report and said, “This program is fine. We’ll come back in five years.” Nobody was looking at what was happening between the letter and the five-year visit, so any number of things could happen.
Now, the system is annual inputting of data from your program. it’s looked at by your Residency Review Committee. There’s a committee of experts, your peers in every field. So pediatrics has a group of pediatricians who are academic, and they review all the programs.
And if you fall out — let’s say that for some reasons, residents are not passing their board, let’s say your faculty is not publishing enough papers in the medical literature — you could be targeted as a problem, and we as site visitors could come in and do what’s the focus visit, which is like a diagnostic visit. Go see what happened. They have a five-year cycle. They look like a good program, and they’re down. Or did something happen?
Dr. Mike Patrick: So this really injects more year-to-year accountability into the system.
Dr. Donna Caniano: It’s not too dissimilar from how physicians maintain certification. They’re expected to stay current in literature. This is very similar to that. The programs will also do what’s called the self-study visit every ten years.
Dr. Mike Patrick: Now, going beyond residency and fellowship and really looking at the academic faculty that exists, there’s a term that I want to introduce called ‘faculty development’. What is faculty development? What does that mean?
Dr. Donna Caniano: It has been defined and I took the liberty since you were kind enough to share that question, I’m going to give the professional definition. It’s a systematic approach in which faculty improve continuously their educational skills, their leadership skills, in which they engage in scholarship. Scholarship could be writing papers. It could be doing bench research in the laboratory, in problems that have a clinical interest. It’s in a way that a faculty member implements what we call a professional development plan.
We typically say faculty member should have a five-year plan that looks toward promotion and tenure. Most young faculty come in as assistant professors, and then they go up to associate professor, and if everything goes well, full professor, which is the height of success in the academic community.
Dr. Mike Patrick: I think this is kind of an obvious answer to this, but worth saying again — why is it important to continue learning and growing after that initial medical training throughout one’s career?
Dr. Donna Caniano: I really think that’s the basis of professionalism, that we have an obligation ethically to our patients to maintain life-long learning. And we live at a time when the accrual of information is so amazingly on a trajectory upward. That unless you become accustomed to doing this right from the beginning of your practice, you would be behind. The information is so rapidly coming at you that it requires an ongoing effort to stay current.
Dr. Mike Patrick: I think part of that staying current is not only seeing what the new research is out there, but having a basis for being able to evaluate what makes good research and what makes not so good research. Because there’s a lot of things that do get published that aren’t necessarily statistically significant or not necessarily what the folks who do the research claim that it’s going to do. So it’s good to become a discerning doctor when you’re coming across new research that’s out there.
Dr. Donna Caniano: I think one of the features that most residencies have now added is helping residents read the medical literature. So we’re seeing so many studies, but is this a study that you should adopt in your practice, yes or no?
Dr. Mike Patrick: In what ways has learning and growing changed with digital technology? So really, this is quite a bit different than when you were training back in the 80s. There wasn’t really a lot of digital technology back then. How are things different now?
Dr. Donna Caniano: Well, let me give you the first thing that I noticed. And that was that at least in surgery, we have very formal professor rounds. This would happen once a week. Typically it looked like the duck with her ducklings, so the duck was the professor, and the duckling were in row from the chief fellow to the medical student at the very end. And the questions would become increasingly more difficult, so the medical student would know the first one, and then you got to the one that the chief fellow couldn’t answer. And the professor would look to the medical student or the first year resident student and say, “Why don’t you go to the library, develop an answer and come tomorrow and present.”
Now, as the professor’s starting to say that, the medical student has clicked on their smartphone or their iPad and they already have all the answer. So it’s fast information, it’s mobile. It comes with you. You don’t have to go to the library. In fact, they’re not quite sure where the library is. So it’s instantaneous information.
Dr. Mike Patrick: And again, you have to be discriminating about what source of information that you’re going to use.
Dr. Donna Caniano: Yes, it’s wonderful in the sense of being free, available. You can have in the operating room. You can have it in the office in the clinic. It has one downside, and that is that there is a tendency to almost believe it as truth when it comes up on your smartphone or on the iPad. When we had to go to the library and sift through, we sort parceled out and we have time to reflect and analyze. We have to teach the residents and the students how to do that.
Dr. Mike Patrick: Yeah. I’m sure there’s research on memory even, and just the act of really digging into something is going to put that into your brain in a more concrete way for recall later, whereas if you can just pull it up on the screen, the next day, you may forget what pulled up.
Dr. Donna Caniano: Yes, but I think one of the things we have to realize is being in the older generation, when we went to medical school, we memorize everything. And you’re judged about how skillful you were because you had a great memory. That may not be such an essential skill now, because the information is changing, and what we really need to add to the education is how to find information, how to ask the right question, and how to analyze it, and judge if it’s appropriate in your practice for your patient.
Now, even with regard to continuing medical education and sort of more formal programs that you’re going to get, your information to stay current, there’s just so many. Digital technology has made it so easy to really come across so many different kinds of programs and so many different places to get continuing medical education. Whereas, before, it was pretty much you’d go to a conference or read journal articles and answer some questions about it, but there’s so much more available today.
Dr. Donna Caniano: I think you’re right. What I see as a practicing surgeon is that our pediatric surgical association has continuing surgical education. So you log in and there are discussions on a whole range of issues. People can have conversations, so we have conversations with our colleagues around the world, how would you handle this issue in the child? It’s a wonderful learning opportunity. And the great thing about it, it helps prevent burnout.
So I think that physicians in academic practice, you’re a community of people, and you’re seeing each other; you’re excited. But if you’re a practitioner in private practice, you might not have that camaraderie. And being able to link in with a community of your fellow pediatricians or surgeons, you’re part of that conversation. And you bring a huge piece to that, because you have a lot of practical information. And you see a different set of patients sometimes.
Dr. Mike Patrick: Absolutely.
The remainder of this conversation, we’re going to talk about academic medicine, and then we’re going to focus on community medicine a little bit. In thinking about academic medicine, why is it important to have a mentor when embarking on an academic research career?
Dr. Donna Caniano: I think all of the studies that had been done, not only in medicine but in business and in other fields, they all say the same thing. If you’re not appropriately mentored, the path to being successful in your career is much more difficult and challenging.
So if you believe that and I do, because I have seen many talented people sort of fall by the wayside, not because they lack the talent or drive or desire but they fell off because they didn’t have sort of a trusted guide. An individual had gone that path before to help guide the career. And a career is so hugely valuable, but it needs to be nurtured and fostered. So a mentor help do that, because the mentor has walked in the path.
Dr. Mike Patrick: Because, really, you don’t want to have to recreate the wheel, with every person. There’s a lot of lessons that someone can help you out with.
Dr. Donna Caniano: Well, sometimes, particularly if you had a long period of training. So if we look at what physicians do now, they do their core residency, and then most of them do a fellowship. Then, they’re up to say, “I’m done.” But you’re not done. And the next step which a mentor can help with is the five-year plan.
Dr. Mike Patrick: And if you’re doing research and you’re trying to figure out how to get a grant, how do I do proposals, how do I write those things up, that’s something you don’t want to have to figure out on your own. You really need someone who’s gone that path before you.
Dr. Donna Caniano: Absolutely. So I think what the mentor does, you have to write out the five-year plan on paper, which is not an easy exercise necessarily, and it has to have pieces. So what are my goals clinically? What is my clinical focus going to be? Because no matter what field you’re in, you need to sort of pare down to some focus that you can have prominence in, and become a true expert and master. If you’re going to be doing basic science and get grants, you need lots of assistance in that path.
What organizations should I join? The other thing that the mentor will help you do is figure out what your strengths are and, even more importantly, what your weaknesses are. And I think many adults don’t want to face the fact that we all have weaknesses — and where does that fit in my professional life?
Dr. Mike Patrick: So when you’re choosing a mentor, you do want someone who knows a little something about you.
Dr. Donna Caniano: Yes.
Dr. Mike Patrick: How do you go about finding that person?
Dr. Donna Caniano: I think it depends on the institution. As I’ve gone around with the ACGME, I see that some medical schools have assigned mentors for incoming faculty, because you’re most vulnerable when you first come in. That’s, I think, very helpful. Sometimes, the assigned mentor doesn’t click. And so, they have the pathway that you then, after you to get to know the other faculty members, can choose that you’ve self-identify.
Dr. Mike Patrick: And that kind of even happens at the undergraduate level where you may have just be assigned an academic adviser, but then as you progress, you’re going to really click with the faculty member and probably switch over to them being your adviser.
Dr. Donna Caniano: And they do all sorts of things, so when you come in, you’re generally in an academic appointment or an assistant professor. The mentor will give you a copy of the promotion, a tenure guidelines, at your medical school, and you’ll go over that with the mentor to say, “Oh, I’m going this much scholarship if I want to…” So they’ll help you figure out each step.
Dr. Mike Patrick: And like you said, there’s so many different facets to it. There’s the clinical practice, but there’s also the academic part of it. There’s the research part of it. You really have to hit the sweet point of taking care of all those things.
Dr. Donna Caniano: Each thing. So there is the teaching component which I think many faculty forget that this needs to be quantified. So keeping track of all of your teaching engagements with medical students and residents is a key thing. Have you developed a course? Maybe you’re the person responsible for simulation in your department — a very important piece. Do you want to develop a new simulation module? And that’s something you can own and that needs to take a centerpiece in your CV.
Dr. Mike Patrick: I will say that we have a very rich faculty development program here at Nationwide Children’s Hospital and with the Ohio State University, College of Medicine. I just want to give a shoutout to Dr. Karyn Kassis because she is really I think taking us to the next level in terms of having a faculty development program in place.
How would you say that our development program compares to other institution that you see?
Dr. Donna Caniano: I think it’s very robust. I was part of it when it was developed years ago. I think that if we were to look back, and I suggested this to Karyn, on the drive over today, that we should look back at all of the individuals who participated to see how it positively impacted on their careers, and how many of them are in leadership positions because of that, of the program.
Dr. Mike Patrick: Yup, absolutely. For moms and dads out there who are listening, they may seem very foreign to them, what types of traditional opportunities exist throughout one’s academic and research career? So you talk about climbing that ladder from assistant professor to associate professor to full professor, but what sort of opportunities are out there to traditional ones and academic medicine?
Dr. Donna Caniano: So if we think about probably the most basic, it’s what we call basic science. So here at Nationwide Children’s, we have a beautiful laboratory facilities where very important research is being done in a number of areas that hopefully will get translated to the bedside. So this is a key for obtaining new information with the goal of translating it to the bedside, so that your child could potentially benefit from something that was learned in the laboratory here on campus.
That avenue is sort of a smaller percentage of faculty, because these are individuals who spend time in basic research, typically funded by the NIH. It’s a highly competitive field and it requires extraordinary discipline. And many of those individuals do the majority of their time in the lab in a very small fraction in clinical practice.
I think the more traditional is the clinician who does clinical research, and that can take many forms. It can be prospective studies. Let’s say that in the emergency department, they wish to evaluate a certain type of intervention for children with asthma, so they get approval to do from a human subjects and parental approval. They embark on a study prospectively, to see if this intervention is beneficial. That would then be submitted to a journal or presented at a national meeting, and it would have what we call peer review, which is essential. So peers would look at it and say, “This is very important research,” “This is good research but it’s not there yet. We need more.” And eventually, it could translate to the bedside.
Dr. Mike Patrick: Really, all the different components of that sort of system, there’s places for people in every stage of their careers. Like if you’re doing a clinical research study, there’s going to be new faculty who could contribute to it and would get some sort of authorship. But then, I know here in PediaCast, when we talk about different journal articles, we will quote different people who are involved. You have the lead investigators, and you got co-authors. So there’s a lot of names on there. So there’s lots of opportunities along the way to kind of step up that even in clinical research.
Dr. Donna Caniano: There is. And I think one of the advantage of being new is that you ask questions that other might not have asked. Particularly when you come to a new institution, and you say, “Why do you do it that way?” And they say, “We always did it that way.”
Dr. Donna Caniano: And then, you say, “How do you know it works?”
Dr. Mike Patrick: Yeah.
Dr. Donna Caniano: That’s the beginning of the next clinical study.
Dr. Mike Patrick: Absolutely, that’s great. What types of non-traditional opportunities exist? I think really with the advent of technology, in that space, there’s some unique roles and things that people can get into that weren’t available back in the 80s and 90s.
Dr. Donna Caniano: I’ll use myself as an example. When I finished practice, I was very interested in Hirschsprung’s disease, and I really thought I would be a bench researcher. There’s an animal model of Hirschsprung’s disease and I was going to use that and study it.
And then, in the first month of practice, a baby came my way who was the 13th case of having no nerve innervation to its entire intestinal tract, which in the 1980s was fatal, because we didn’t have a mechanism to support nutrition intravenously at home. That baby taught me a huge lesson, and I thought I don’t know enough about ethics. Fortunately, I was in Baltimore, and I picked up the phone and I called the Georgetown Institute of Bioethics, and found out I could do advanced training in ethics, and it changed my career.
So I had a non-traditional approach. I was very involved in surgical ethics. I sat on the Committee on Bioethics for the Academy of Pediatrics. That was non-traditional at that time. And now, we have even more things, Clinical Informatics, for example, a whole field that didn’t exist 20 years ago. We have individuals who are involved in all kinds of things that are non-traditional, and they are pathways to tenure.
Dr. Mike Patrick: Podcasting.
Dr. Donna Caniano: Podcasting. Absolutely.
Dr. Donna Caniano: Simulation. So when I do site visits, half of what we look at depending on specialty is the curriculum for simulation. And these are typically home-grown modules that a dedicated faculty member has written, piloted, and then, they’ve used it academically by studying it. So pre and post-testing, and have generated a whole new literature that didn’t exist before.
Dr. Mike Patrick: Really, just when we think about medical education and the fact that there are these emerging technologies, really you want doctors to be the ones sort of leading the way. There’s going to be folks in the digital world who try to put these things together, but without the input of people who are inside of medicine, it doesn’t make quite the same impact, does it?
Dr. Donna Caniano: Absolutely. I was doing a site visit at a very prestigious institution on the East Coast and it happened to be in the field of anesthesiology. They said to me, “You happen to be here the day that a number of practicing anesthesiologist are coming in to do simulation to maintain their certification. Would you like to see it?” So we walked over, and it was mind-boggling because they were reproducing real life situations that I saw as a surgeon, in simulation-safe environment.
So that if you did make a mistake, it was safe. And then you could correct it and move on. So that’s a whole learning opportunity that I think we got from the airline industry, that has had tremendous impact. I think it’s going to change training over the next decade.
Dr. Mike Patrick: Absolutely.
What are some of the particular challenges of advancement for women in medicine? I know this is one of your passions and something that you’ve spoke to some of the women faculty here. What are some of the particular challenges there?
Dr. Donna Caniano: So if we look at the studies, what we see is that women and men come in at the assistant professor level at the same numbers, the same talent. If you look at appointment to associate professor, it’s almost the same. Not quite, men still outpace women, and where the real falloff is the advancement to professor. You’re seeing men promoted far more often than women. They seem to fall off mid-career.
I think there are a variety of reasons for that. I think our faculty development hasn’t progressed enough to really help mid-career, which I personally think is the hardest challenge, because you’ve hit the associate professor level, and then you say “What’s next?” And that’ the period when you really need to progress to have national or international prominence in your field so you have to have a focus. You have to be on the leadership path. So in your professional organizations, you need to be chair of the committee, perhaps elected official as the president of a professional organization, beyond an editorial board of a journal in your field.
Women often don’t promote themselves and put themselves in the position to get those appointments.
Dr. Mike Patrick: And I’m saying this from being man, it must also be difficult in terms of dividing time between your career and family, because for women and for moms in our culture, it seems there’s more place upon them inside the home. I would imagine that also could cause some difficulty, and we may be having a mentor who has traveled that path before and been able to juggle those things could help.
Dr. Donna Caniano: I think you’re right. I think that women tend to take on a lot. The word ‘no’ doesn’t come as easily. Yes is a much easier thing. And part of what has to be learned is the ability to compartmentalize when an opportunity is correct to accept and when it is simply going to be a drag on your time commitment. The mentor can help tremendously with the work-life balance.
Dr. Mike Patrick: Let’s talk about that translation of research into practice. In what ways can academic and research physicians improve the quality of medicine that’s practiced in the community? How do you get from bench research, clinical research to actually making a difference in the family practice doctor’s exam room.
Dr. Donna Caniano: I’m going to take a couple of examples about how this can happen. So, there is a very prominent pediatric surgeon by the name of Dr. Barbara Barlow who practiced for a long number of years at the Harlem Hospital in New York City. Early in her practice, she began to notice that children were coming in either dead on arrival or with serious injuries because they fell out of windows in their apartment buildings. And she embarked with local officials in Harlem on a campaign to put bars on windows. We take it for granted now, but it wasn’t that way 20 years ago. A major public health campaign and significantly reduced falls from windows in Harlem.
So that’s one example coming from a hospital. I think the other example is right here at Nationwide Children’s and that’s the Healthy Weight Program. A tremendous effort was made a number of years ago in the school systems getting soda out of the school. Healthy snacks. So what we know about childhood obesity and all of its negative ramifications for a long-term health, taking that to schools, to parents to say “Substitute an apple for Cheetos or some other snack,” very important.
The research that’s being done of various vaccines and how they could impact easy infections.
Dr. Mike Patrick: In the space of social media, I think this hospital really is taking some big steps in terms of the blog that we have. Some hospital, they have one blog author, and here everybody in each division, people are coming to the marketing folks, saying “Hey, I want to write a blogpost, and I think that being able to take whatever area of clinical medicine that they’re impassioned about, then write to consumers in the form of blog. And of course, in the form of a podcast, getting this information out to the doctors and to parents, I think, is kind of emerging ways to do this.
Dr. Donna Caniano: Yes, I think so. I think that having many hospitals have health fairs, which is critical where they can tell parents, “This is sort of a healthy way to deal with a temper tantrum.” Things that parents can do so as to discipline a child in positive way without causing physical harm.
Dr. Mike Patrick: Yeah, yeah. It was one of our blog post.
Dr. Donna Caniano: And it’s very important.
Dr. Mike Patrick: Yeah, absolutely.
Why is it important for community physicians. You had mentioned that for community doctors, it’s a little bit easier for them to become isolated because they don’t have that camaraderie of folks around them. Of course, it’s important for community doctors to remain up to date because they are the ones who are taking care of a very large patient population. So what barriers are out there that keep them from staying up to date and from having relationships with their peers?
Dr. Donna Caniano: I would think probably just being overworked and the time. Fortunately, I think technology has breached that barrier because it’s mobile. But being linked prevents the isolation. So being part of something I think is key.
In my own field of pediatric surgery, 51% of American pediatric surgeons are in the private sector, and yet they’re intimately involved in our professional organizations and they sit on our committees, and are very involved with policy. And they are the link to sort of what’s happening what they like to say is the real world. This is what parents are concerned about. These are what we’re really seeing.
So being involved in podcasts, in online communities I think is key.
The other thing that’s important at Nationwide Children’s is that the pediatric community of private practitioners are very involved in the hospital. They’re involved in continuing medical education, activities. They’re involved in committees and they feel that this is their hospital.
Dr. Mike Patrick: Having been in private practice for ten years, really, when you’re in a busy practice, there is a tendency to get burned out, because you just go, go, go and doing a lot of the same things over and over and over again. And so, I agree. I think it’s so important to have an outlet, get involved in some hospital committees, really try to get some protected time from your practice when you’re doing some different things, and I think that would help with burnout, too. Like you say, it’s a symbiotic relationship in terms of helping each other there.
Dr. Donna Caniano: The other thing that I think is wonderful is agreeing to have a medical student or a resident in your office. Because nothing keeps you on your toes like the medical student who says, “Why?”
Dr. Mike Patrick: Yes.
Dr. Donna Caniano: “Why did you do that?” Then comes the research and then they pull out the smartphone and then the studies and, “This is why we do it. This is the success I had.” And I’ve been told by a lot of physicians in private practice, “The best thing I did was agreed to have that student or resident in my office. I thought it would be a burden. It was so much fun. I’m signing up to do it again.”
Dr. Mike Patrick: Absolutely. And even if you’re an hour away from an academic medical center, I know medical students who travel that far, so don’t think that just because you practice a little bit farther out, the opportunities still exist.
Dr. Donna Caniano: Right. I actually think that might be the best antidotes to burnout. There’s something about having a fresh young face who’s so eager to learn, and the benefit of your years of experience. And the other advantage is that for the most part, they’re receiving a lot of their education from doctors who’ve only been in academics. That’s fine, but the knowledge and the skills of someone who’s been in the private sector, dealing with families over many years, so generations of families, it’s enormous opportunity for both sides to benefit.
Dr. Mike Patrick: Yeah, absolutely. And then, in terms of the networking part of it, it seems that digital technology is making it so much easier for physicians to network. A couple of examples, there are physicians social networks out there. Sort of like LinkedIn or Facebook, but for doctors, like Doximity and Sermo and the other one. I’ll put links to those in the Show Notes so people who aren’t familiar with those can check them out.
Dr. Donna Caniano: Right. And I know that all the professional organizations have ongoing sort of discussion links.
Dr. Mike Patrick: Sure, yeah.
Dr. Donna Caniano: So we have it in pediatric surgery, and someone will put out, “How did you manage this child’s problem?” And then, within a day, you’ll have 20-some replies, “I do it this way,” “This has worked for me.” it’s a wonderful opportunity.
Dr. Mike Patrick: That’s how we found out as a country that this Enterovirus D68 thing was going around, because people in emergency rooms in Kansas City, and then Chicago, and then here in Columbus. When you start saying, “Hey, we’re seeing the same thing,” and so you’re, again, not in isolation.
Dr. Donna Caniano: Right.
Dr. Mike Patrick: And then, what role can community physicians play in translating that academic work. So it’s really a two-way street here. I mean, if we’re going to have clinical research, bench research and have it make a difference in how patients are treated, it’s not just the responsibility of the physicians who are doing the academic work. It’s also the responsibility of the community doctors to be involved in translating research to clinical care.
Dr. Donna Caniano: I think they can do it in a number of ways. I think they can embrace new ideas. Some of these studies require patient recruitment, so they can offer to these sites to test some of these trials. They can very supportive families who want to participate in research. Sometimes, you go in and you see the signs that there’s a new trial for a vaccine or a medication if you’re child has asthma.
Dr. Mike Patrick: Yup, absolutely. And it’s not only the academic doctors and the community doctors. I mean, really, patients and families need to take an active role in making sure that the latest research is being translated into clinical practice of whatever doctor that they see. How can families play a role there in making sure that the latest research is being translated into clinical proactive of whatever doctor that they see? How can families play a role there?
Dr. Donna Caniano: So once again, technology has made it so convenient for parents to log in to any number of sites. So if we look at the American Academy of Pediatric for examples. Their HealthyChildren.org site offers a variety of pieces of information on everything. The Pediatric Surgical Association, same thing for parents — what do I do if my child has a hernia? What is appendicitis? Those kinds of things, and that’s tried and tested; we know it’s accurate and reliable.
Dr. Mike Patrick: And really going to be the standard of care across multiple communities. This is really what the professional organizations thinks need to be done for this particular problem.
Dr. Donna Caniano: Parent can trust this. it’s not a commercial in television that has a for-profit notion attached to it.
Dr. Mike Patrick: One token of accountability is that your doctor is board certified. So just as the accreditation process for training programs for individual physicians, we want to maintain board certification because it shows — it’s accountability — that we’re keeping current and we know the things that we say that we know. So that’s something that parents can use. And I’ll put links in the Show Notes, for this as well over at PediaCast.org. But the American Board of Medical Specialties, and in particular, the American Board of Pediatrics mean folks can actually look up their doctor and make sure that they’re up to date.
Dr. Donna Caniano: And parents should feel, I think, relieved. You know that if your pediatrician has maintained board certification, that that individual is acquiring new knowledge that’s current, because when you re-certify, you take a written examination. It’s not old information; it’s the more current information that’s been acquired since you completed training.
Dr. Mike Patrick: And for the doctors out there who may be hesitant to do that, you can get up to speed and you should get up to speed. It shouldn’t be something that you’re afraid of doing. You really want to learn and be tested at that level.
Dr. Donna Caniano: Yes.
Dr. Mike Patrick: I will say, for parents in particular out there, one thing I would avoid is those online rating sites that you see popping up all over the place. My experience has been the people who go there are the ones who have a grief that they want to express, and so you really see a lot more negative comments on those kind of sites than positive ones. I wonder if you’ve come across those.
Dr. Donna Caniano: Well, I have the opportunity. When we left Columbus, we moved to Williamsburg, Virginia, so my husband and I had to get new physicians. So you might think it’s, “Well, it should be easy, you’re a doctor.” And so I called the pediatric surgeons who practice in that part of Virginia and said I need to have a primary care physician. They recommended someone, and I went. Board certified, and I thought this isn’t going to work. We didn’t click. And I thought, OK, and I went off and I spoke to my neighbors. I went to the health club, asked around, got a couple of recommendations.
I think it’s fine to interview your primary care physician. Your primary care physician is probably your most important physician, and you have to click on both sides. And that was how I got my current primary physician who is online in LinkedIn. I can email her and she can respond.
Dr. Mike Patrick: There’s nothing wrong with that, because we all have different personality traits. There’s going to be some folks who’ll come in with a notebook full of questions, and there’s going to be doctors who are absolutely fine with that, and they want to take the time to make sure all your questions are answered. On the other hand there’s going to be some parents that are just like, “Tell me the facts, I want in and I want out.” They’re not going to pair well with the doctor who wants to go in everything. So it really kind of matching up personalities and that doesn’t make a bad doctor or a good doctor.
Dr. Donna Caniano: No, when our sons and their wives were starting families, I suggested, “Interview a couple of pediatric practices where you live.” And they said, “What do you mean?” I said, “Well, you have to be comfortable. You need to ask the following set of questions. When you walk in, is this the place you’re going to feel comfortable, because you’re probably going to be there a lot in the first few years. Are you comfortable with the other partners? Do they have providers like physician assistants or nurse practitioners? Who will your child be seeing? What are their hours? Is it convenient ?”
And they did that. I think it’s important. Physicians should not feel offended if you’re interviewed and you’re not chosen.
Dr. Mike Patrick: Absolutely. It doesn’t reflect upon your ability to be a good doctor.
Dr. Donna Caniano: No.
Dr. Mike Patrick: It’s really more that interaction component to it. Absolutely.
Well, I really appreciate you taking time. Because everyone that I know who has heard that you’re on campus, everybody wants to meet with you and talk to you and say hi. And I just feel honored that you took some time to stop by the studio today, to talk about doctors teaching doctors.
Dr. Donna Caniano: Well, thank you. I do have one quote I wanted to give you in the end.
Dr. Mike Patrick: Yeah, sure.
Dr. Donna Caniano: There was a very well-known physician named Dr. Francis Peabody, an extremely wise physician who practice in the early part of the 20th century. And he gave a lecture in 1926 to a group of medical students at the Harvard Medical School. And he said the following, which I really think is the heart of professionalism, “For the secret of the care of the patient is in caring for the patient.”
I think like everything that we’ve talked about today, the professional responsibility to stay current in your field, it’s about caring for the patient.
Dr. Mike Patrick: Absolutely.
Dr. Donna Caniano: And he said that in 1926, and it’s still true.
Dr. Mike Patrick: It’s some things never change. Even with digital technology, it doesn’t matter.
Dr. Donna Caniano: No. The secret of being a physician is still the joy of taking care of patients.
Dr. Mike Patrick: Thanks for stopping by. We really appreciate it.
Dr. Donna Caniano: You’re welcome. Thanks.
Dr. Mike Patrick: All right, we are going to take a quick break and I will be back to wrap up the show, right after this.
Dr. Mike Patrick: All right, we have just enough time for me to say thank you to all my listeners out there. Really appreciate you taking time out of your day to make PediaCast a part of it.
Also, thanks to Dr. Donna Caniano, pediatric surgeon and field representative with the Accreditation Council for Graduate Medical Education.
That does wrap up our time together. PediaCast is a production of Nationwide Children’s Hospital. Don’t forget, PediaCast and our single-topic short-format program, PediaBytes, are both available on iHeart Radio Talk which you’ll find on the Web at iHeart.com and the iHeart Radio app for mobile devices.
We’re also on iTunes, under the Kids and Family Section of their podcast directory. You’ll find PediaCast on Stitcher, TuneIn, Downcast, iCatcher, Pod Bay and most other podcasting apps for iPhone and Android.
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We also appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids, or anyone who takes care of children. As always, be sure to tell your child’s doctor about the program. Posters are available under the Resources tab at PediaCast.org.
Until next time, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long, everyone.
Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.