Podcasts about mednet

In this episode of The Brand Called You, Omkar Nakade, co-founder of MEDNET Labs, discusses his journey inspired by his mother's cancer treatment, leading to the founding of MEDNET Labs in 2008. Initially focusing on clinical data management, MEDNET expanded to cover billing and procurement. Nakade emphasizes the importance of user-friendly interfaces, particularly for non-tech-savvy healthcare professionals, and highlights MEDNET's adherence to international standards like HIPAA. He also discusses integrating emerging technologies like AI, ML, and IoT into their systems. Nakade stresses the need for robust data privacy and security, noting India's progress with Ayushman Bharat and NHA guidelines. 00:38- About Omkar Nakade Omkar Nakade is the co-founder and director of MEDNET Labs, a leading healthcare technology company specializing in health management information systems. He has an engineering background and previously worked at IT companies like IBM.  Under his leadership, MEDNET Labs has expanded globally, with a presence in the US and UAE. The company focuses on developing user-friendly, clinician-centric healthcare IT solutions that leverage emerging technologies like AI, ML, and IoT to enhance clinical decision-making and patient care.

Dr. Trisha Larkin is the Director of Pediatric Neuro-Oncology at St. Joseph's Children's Hospital. She is dual-board certified in pediatrics and pediatric hematology-oncology. Dr. Larkin earned her medical degree from Florida International University College of Medicine, followed by a Master of Business Administration in healthcare. She completed her postdoctoral training at Nicklaus Children's Hospital and at the University of Florida Shands Children's Hospital, where she completed a fellowship in pediatric hematology-oncology and bone marrow transplantation. She went on to complete a prestigious advanced fellowship in neuro-oncology at St. Jude Children's Research Hospital in Tennessee. While at St. Jude, she worked on a team of world-renowned physicians to care for children diagnosed with complex brain and spinal tumors. Dr. Larkin is passionate about discovering innovative strategies to improve the care of children with brain tumors and serves as a lead investigator for the Sunshine Project consortium through the National Pediatric Cancer Foundation.  She has been awarded numerous grants for her research in early-phase clinical trials and has authored several peer-reviewed publications in leading oncology journals such as the Journal of Clinical Oncology and Neuro-Oncology. Dr. Larkin has been invited to present her research around the world, including in Germany and Japan.  She serves as associate editor for Neuro-Oncology on the MedNet, an interactive platform for physicians around the world to gather insight about treating complex oncologic diagnoses.  Dr. Larkin is deeply involved in the pediatric cancer community and enjoys volunteering her time to support childhood cancer.for more information on how to be involved go to noraswarriors.com or nationalpcf.org

Our OSU MedNet21 podcast has a new home. To find our new podcast home, search for “OSU MedNet21” in your podcast app. You can also visit our blog or the Apple Podcast directory to access the new location. Both links are below and in the podcast summary for this recording. To ensure you receive updates for our latest podcasts, subscribe by September 7th. URL to our blog post for the podcast: https://u.osu.edu/mednet21/2014/12/01/listen-to-audio-only-cme-podcasts Where to find our new podcast in the Apple Podcast directory: https://podcasts.apple.com/us/podcast/osu-mednet21/id1697524510 Link to transcript: https://drive.google.com/file/d/1dq165OvaYQTWrINB9NSdFrcKXgCp_Ovc/view?usp=sharing

This webcast will discuss Infertility.

This webcast will discuss Lymphoma.

This webcast will discuss Addiction, Stigma, & Person-First Language.

This webcast will discuss Prostate Cancer Screening.

Today on MedNet21, we're going to discuss Leukemia.

This webcast will discuss COVID-19 Impact on Pediatrics.

Today on MedNet21, we're going to discuss Value Based Care and Reimbursement.

This program will discuss COVID-19 Vaccine Updates.

This program will discuss Osteoporosis.

This webcast will discuss Remote Patient Monitoring.

This webcast will discuss Physician Burnout.

Today on MedNet21, we're going to discuss Lifestyle Medicine.

Oncology is a rapidly evolving medical field. So how do you keep up with all the advances and updates that are delivered through publications, conferences, and social media? This ASCO Education podcast explores how three oncologists in various settings and stages of their career manage this issue. Our moderator Dr. Adriana Alvarez, a medical oncologist at Cleveland Clinic in Ohio is joined by Dr. Sharad Goyal, a professor and division chief of Radiation Oncology at George Washington University in Washington, DC; Dr. Shruti Patel, an oncology fellow at Stanford University in California; and Dr. Banu Symington, a medical oncologist at Memorial Hospital of Sweetwater County in Wyoming, and adjunct professor in the University of Utah College of Nursing. Each will describe what they do to keep up to date on research advances and guidelines (3:25), how they find time to stay current in their field (7:25) and how they follow developments outside of their area of concentration (13:57).  The speakers have no relevant disclosures.  Resources: Podcast: Cancer Topics - Burned Out? Here's What You Can Do About It (Part 1)  Podcast: Cancer Topics - Burned Out? Here's What You Can Do About It (Part 2)  Podcast: Cancer Topics - Burnout in Oncology: Trainee Perspective  If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed on the podcast page.  Dr. Adriana Alvarez: An oncologist recently described that while sitting on a couch to write an article, by the time he finished his first paragraph, he received six notifications on his iPhone from WhatsApp, Twitter, and other messages. He knows what the dilemma is; you can shut down your phone, but you become worried about missing an urgent call or important update. The oncologist knows that social media is a place to follow friends and colleagues, to discover new presentations, and even debate about them. However, he understands the overload of information that is part of the rapidly evolving field of oncology. On any given day or week, there are research advances and updates in the management of cancer being shared through journal publications, conference presentations, newsletters, social media, and other methods. How does one keep up to date with these advances in oncology?  I'm Dr. Adriana Alvarez, a medical oncologist at Cleveland Clinic in Ohio. In this ASCO Education Podcast, we will examine what various oncology professionals at different stages in their careers and working in different practice settings, namely academic versus community and urban versus rural, are doing to manage the large amount of information influx regarding advances in oncology.  Joining me are Dr. Sharad Goyal, a professor and division chief of radiation oncology at George Washington University in Washington, DC; Dr. Shruti Patel, an oncology fellow at Stanford University; and Dr. Banu Symington, a medical oncologist at Memorial Hospital of Sweetwater County in Wyoming, and adjunct professor in the University of Utah College of Nursing.  Let's start. One of the first questions I have here is how you can describe your current field of focus in oncology. Dr. Patel? Dr. Shruti Patel: My current clinical focus in oncology is in thoracic and gastrointestinal malignancies, while my research interests include clinical trials, liquid biopsy, and diversity, and equity and inclusion.  Dr. Sharad Goyal: My current clinical and research focus is on breast cancer, radiation therapy, as well as radiation therapy with respect to neuro-oncology in the neuro-oncology space. Dr. Adriana Alvarez: What about you, Dr. Symington? Dr. Banu Symington: I'm a general oncologist, medical oncologist, in an extreme rural, I'm considered a frontier practice. I have a special interest in eliminating the social disparity that is represented by rurality, and I'm interested in clinical trials. We are the only Wyoming Cancer Center that opened clinical trials. Dr. Adriana Alvarez: Well, it's all wonderful to hear about you and know a little bit about what your focus of work is, and we come from a variety of backgrounds. How do you feel like you keep up to date with the clinical practice, the research parts with new drugs approval in oncology? You are still in training Dr. Patel. How do you do that? Dr. Shruti Patel: As a millennial, it may come as no surprise that I primarily stay up to date on clinical practice guidelines via Twitter on my phone. I find Twitter to be the best place to learn new information. Just because you don't just get information about the new approvals, but typically experts in the field will weigh in on the trial design, their thoughts on whether it truly will replace the current standard of care or what situations they might use the new approval for, which can really be helpful, especially as a fellow in training. It's helpful context beyond just the information that you get from the approval itself. And then, I also learn about the applications of these new guidelines in the clinic with my mentors, because I am, of course, lucky enough to still be in training where I can gather that information from my attendings. Dr. Adriana Alvarez: Dr. Goyal, what is your preferred method of keeping up to date and learning more about the new treatments and research in your area of interest?  Dr. Sharad Goyal: As opposed to Dr. Patel, I am not part of social media in medicine. Actually, I'm not a part of any social media, whether it's personal or work-related. So I tend to be a little more “old school” with respect to how I ingest information. So, in terms of clinical practice guidelines and new drug approvals, which is somewhat peripheral to my field in radiation oncology, I tend to rely on NCCN guidelines and attendance at tumor boards to receive that information from my colleagues in medical oncology. I believe that with any patient that I see with a malignancy, I do tend to refer to the NCCN guidelines on a regular basis. And if it's a malignancy that I do not see, I have to reference PubMed, UpToDate, and the NCCN guidelines to determine the best course of treatment for that patient. Dr. Adriana Alvarez: What about you, Dr. Symington? Being in the rural area, I can see that you have a variety of situations. How do you keep up to date? Dr. Banu Symington: I guess I'm midway between Doctors Patel and Goyal. I do not follow Twitter, but I belong to a 5000-member online hematology/oncology support group, and we post questions, and local thought leaders will reply. I am in such an isolated location. I don't get the stimulation or the benefit of walking down the hall to a colleague to say ‘What would you do?' So I am affiliated with the Huntsman and the University of Utah. I've made an effort to join every organ-specific tumor board so that I can hear discussions by disease thought leaders about how they're going to take care of each type of cancer and hearing that week after week, I do absorb it.  Medical oncology is a challenging field because things move so rapidly. I took an 18-month, mostly Sabbatical, as I functioned as a chief of staff at a larger hospital. And in that 18-month period, where I volunteered in a clinic, immune checkpoint therapy arose, and targeted therapies for lung cancer arose and I felt like Sleeping Beauty. I went to sleep in one world, and I woke up in a completely different world of oncology. And it was hard to get back into the drift until I connected with colleagues. I'm an avid reader. I don't sleep much. So I am a member of AMA, ASCO, and ACP, so I get all the print journals. And I have a disorder, an obsessive-compulsive disorder, that makes me have to look through every single journal I get. So print and tumor boards and colleagues.  Dr. Adriana Alvarez: So we are very busy, and the work that we do, the clinical work, trying to keep up to date and training and all that, how do you schedule time to do this, to learn about the research advances and to keep going? Dr. Goyal, how do you find the time? Dr. Sharad Goyal: In general, I do think that in my realm, in my head, I think that there are three processes that have to occur when I incorporate research into my practice. So number one, I have to learn about it. Number two, I have to determine if that's going to help change my practice. And then number three, if I do end up changing practice, I have to implement it. And that involves dealing with my staff. So I'm going to delve into each of those in a little bit more detail. So learning about the advance typically, I learn about things through CME activities. So in one of my roles in our cancer center, I help organize our grand rounds and some oncology-specific courses. Being involved in the organization, helping find speakers really keeps me engaged not only in the organization process, but also in the learning process because I have a vested interest in making sure that the trainees and other faculty that attend my courses are learning and are happy.  Dr. Adriana Alvarez: To organize all these, do you schedule time during your job, outside work hours? Dr. Sharad Goyal: Yes, that is part of my job, which extends outside of work hours. Dr. Adriana Alvarez: Sounds good. Dr. Symington, well, you mentioned that you don't sleep much, you keep up to date, looks more at night. But do you find the time in between patients or during your workday to keep up to date, or is more like a solitude type of time?  Dr. Banu Symington: I forgot to mention a resource that I feel like people should know about, MedNet, which is presented daily with three clinical cases and thought leaders mentioning what they would do. They often introduce research ideas that are not adopted into practice. Since I read, I read about new innovative treatments, but I am not an early adopter, so I wait until they become an NCCN guideline before I would adopt it. So that might be different from Dr. Goyal, who's in an academic center. But I see patients five days a week, 10 hours a day, so it has to be all scheduled outside of those hours. It's fortunate that my kids are grown, and I don't sleep much.  Dr. Adriana Alvarez: What about you, Dr. Patel? On the go, I can imagine. I remember not long ago, being fellow and a millennial, so I guess on your iPhone. Dr. Shruti Patel: Even though I'm a fellow, I do like sleep. And now that I'm in my research years, I actually get sleep, which is lovely. I can't say that I schedule time to learn about research advances, but rather it's– Usually, I take the train to work, and so I'm scrolling on my Twitter on the Caltrain down to Palo Alto, monitoring for medical news or updates. Really, that's how I gather information. I also partake in CME activity, creating CME educational materials on Twitter as well. And so that's another way in which I learn because if I'm creating the information, then I have to go through the trials and go through all of these things, side effects. And so it's a really great way, additionally, for me to learn. But none of that stuff is really scheduled. It's kind of really when I have time, on my to-do list, usually outside of business hours. Part of the job is staying up to date with things outside of business hours. And I think we all knew that when we signed up for the job. And it's only gotten more as all of these advances are kind of coming out at us like drinking out of a fire hydrant. Dr. Adriana Alvarez: The most recent moment that you found new information related to your practice, how did you learn about it? Not about everything that you do, but the last time, the most recent one that you did that. Dr. Goyal? Dr. Sharad Goyal: I recently referenced the NCCN guidelines. I was treating a gentleman with male breast cancer, and he told me he had some half-brothers and that they were going to get tested, but he was inquiring about the screening guidelines for men with BRCA mutations, and I had to look that up. I knew what they were for women, but I actually did not know what they were for men. Dr. Adriana Alvarez: What about you, Dr. Symington? Dr. Banu Symington: So last Thursday morning at 7:00, I joined the Huntsman Tumor Board for Breast. And one of the breast-specific oncologists actually said something that defies the NCCN guidelines, but it sounded like it made sense. He said he regularly gets PET scans for staging lymph node-positive HER2-positive breast cancer because he finds, and apparently the breast cancer community finds, that other scans can give you a false-negative result. And there are enough patients with metastatic disease in the lymph node-positive setting that he recommended PET scans for staging of HER2-positive breast cancer patients but not for ER-positive breast cancer patients. So that was just five days ago. Dr. Adriana Alvarez: Wow. And what about you, Dr. Patel? When was the most recent time that you found something that was good information for your practice?  Dr. Shruti Patel: Yeah, as a fellow, I love learning about new information when I'm able to learn how to integrate it into the practice with someone that's more experienced than I am. So, of course, I've already mentioned that Twitter can be a great place. But also a few weeks ago, I was attending GI ASCO up in San Francisco, and they presented the latest results from NAPOLI-3, which was a phase 3 study looking at first-line liposomal irinotecan 5FU and oxaliplatin versus gem-Abraxane. And they presented that it was shown to improve overall survival compared to gem-Abraxane in first-line metastatic pancreatic cancer. And I was actually sitting next to my clinic mentor at the time, and during the break, I got to hear about his thoughts on whether this is going to be integrated into clinical practice, given that the control arm was gem-Abraxane, and not FOLFOXIRI. And we ended up discussing it again during our weekly GI trials meetings, just when we're thinking about opening new trials and what the control arm should be. And so I just thought that was like a new piece of information. Thought about it in the clinic, thought about it in the trial meeting, and it was pretty cool. Dr. Adriana Alvarez: Great. So different settings, different ways to gain information. So, Dr. Symington, you have to see a little bit of everything. So you have to be an expert in everything. And I wonder how you, Dr. Goyal, and Dr. Patel, that you are kind of more subspecialized. How do you usually follow advances in other cancers that are not in your particular area of interest or just focus on your disease group? I'm going to let Dr. Goyal go first. Dr. Sharad Goyal: Thank you. So I find that I tend to go to conferences to learn about advances outside of my disease focus. I prefer going to the educational sessions at major conferences like ASTRO or ASCO to keep up on things. On a more local level, I do find when I cover tumor boards for my colleagues that I do have to prep their patients and learn about different treatment paradigms within those disease sites. And in doing so, I feel like I'm able to gain really a deeper understanding about oncology in general, and I do very much appreciate that. Dr. Adriana Alvarez: And Dr. Patel, well, you're in training, so you have to see a little bit of everything, even though you have the focus of your specialty that you are looking forward to do. But do you follow those too, as well? Other areas that might not take your interest right away but you want to be updated? Dr. Shruti Patel: That's exactly it. I have to have a working knowledge of all the areas of oncology that are not my focus area. But really, for the most up-to-date information, the reality is that there are so many new advances in all of these disease types that I find myself leaning on my colleagues. If I come across a lymphoma patient on consults, I'll usually reach out to my lymphoma specialized colleagues, whether that's my co-fellows or attendings, just to kind of run the patient by them, get their insight, get their input, because they're just a lot more up to date on those things than I am. But really, regardless of the subspecialty within oncology, I do think that understanding the basics of all the oncology subspecialties is important in medical oncology. Because most of us will, or are, will for me because I'm a fellow, will be spending time on the inpatient service, which is not tumor type specific, and you really do have to make decisions for patients. And while, of course, you always have your colleagues to rely on and call on, some of those decisions are being made in the middle of the night. And so having a working knowledge of all of them, I think, is important. Dr. Adriana Alvarez: We are lucky to live in a time that we have so many options, right? As a practicing oncologist myself, I rely also on all the resources that you're mentioning. The fear I have sometimes is, okay, I'm relying on the NCCN guidelines, but what if I'm missing something? The fear of missing something, right? It's like if I'm not on Twitter or in another social media; I'm missing the most recent data, that may affect my patient care or things like that. But if I have to ask one of you, if you have to pick one, what would be your preferred method or format of receiving updated information if you have to decide where you could go for it? What about you, Dr. Symington? Dr. Banu Symington: So, although I have made the case that I love reading, I actually absorb information better if someone is talking to me. So if I had the freedom to take time off, I would prefer to hear it at one-day specialty seminars where a thought leader is describing their work. That is not what I do in practice, but that would be my preferred way of getting new information.  Dr. Adriana Alvarez: Dr. Goyal? Dr. Sharad Goyal: I'm very much aligned with Dr. Symington in that. I prefer a less active role in the learning process, and I prefer to be spoken to. My preferred method is via podcast, but I also do prefer the in-person or virtual learning through a conference as well. Dr. Adriana Alvarez: What about you, Dr. Patel? Dr. Shruti Patel: I promise you that Elon Musk is not paying me to say all of this because I've probably mentioned Twitter in every single answer. But my preferred method, as you guys probably can guess, is Twitter. It doesn't require too much dedicated time. Information is delivered in small doses. Like I said, I do it on my commute, so it makes me feel like my commute is actually part of my work, which is just wonderful. I do like to attend these smaller meetings to be kind of, like both Dr. Symington and Dr. Goyal said, to be spoken to and really learn additional information. I would say that I don't necessarily always get that experience at the bigger meetings where the focus is more networking. But ‘Best of ASCO', those are kind of some types of meetings where the information is kind of told to you. It's distilled down into bite-sized pieces and really understandable. Dr. Adriana Alvarez: Well, all amazing experiences. And I'm glad that we have different points of view, different settings, different career paths. Someone mentioned before is that we're always learning. I feel like here; everybody's very humble to recognize that we're on the learning curve all the time and that we have a real interest in our patient care. Because we are trying to catch the moment, try to make sure that we deliver the best care to our patients, like keeping up to date and listening to the new information. Dr. Goyal, any advice for your colleagues in terms of how to best keep up to date? Dr. Sharad Goyal: My personal philosophy is that as a physician, the learning never stops. And if you do stop learning, maybe you should find a different field. During the pandemic, I started scheduling time with colleagues, friends in my field, and I would set up a meeting with them via our assistants every two or three months. And we would not only socialize but we would kind of catch up on the current state of affairs in our field. And it was an opportunity to also network, and it was very helpful, especially during COVID. It really helped me gain some normalcy and kind of keep me attached to the field of radiation oncology during that time. Dr. Adriana Alvarez: How do you navigate clinic work, keeping up to date, and work-life balance? Dr. Goyal? Dr. Sharad Goyal: Like Dr. Symington, I probably work about 50 hours a week in the office, so I tend to work from 7:00 to 5:00, and I'm out of the office at 5:00 on the dot. I have two small children at home, and I want to see them at least for two hours in the evening before they go to bed. As a radiation oncologist, we take HomeCall, and there are very few emergencies, so I have the weekends to not only spend time with my family but also catch up on any work that needs to be done.  Dr. Adriana Alvarez: I'm so glad to hear that. Congratulations on your family.  Dr. Symington? Dr. Banu Symington: Well, I rescue small dogs, so at the moment, I have five small dogs, and they get a walk a day when weather permits. We're in the middle of a blizzard in Wyoming, so weather hasn't been permitting for the past four days, so the love and attention of those dogs keep me grounded. I also regularly go to the gym. I dread it every time I go, but I go at least four times a week, and I leave the gym and leave some of my problems behind. When I was younger, people would comment on the fact that I was slender and didn't need to go to the gym and would ask me why I did it, and I would say it's so I don't beat my children. That was obviously a joke, but I could shed the problems of the day by running on the treadmill or using the StairMaster. So I guess that's how I keep work-life balance.  Dr. Adriana Alvarez: What about you, Dr. Patel? Dr. Shruti Patel: I would say that my work-life balance has improved greatly in the last eight months since I started the research portion of my fellowship. I'm not writing papers at 2:00 a.m. anymore, so that's like a huge upgrade. But really, I think, prioritizing when you're at work, you're at work, but then when you're at home, really trying to prioritize the things that are important to you. I am currently in my parents' home, while I'm recording this podcast, I get to spend time with them. I get to spend time with my family, my friends. I like to make time for those things because they provide me joy. I think a huge part of our work is being there for people in really, really tough times in their life, and that can be extremely emotionally draining, even though it's exactly what we want to do. And I think making sure that you have things outside of work that really provide you a lot of joy is extremely important. And so I think now that I have the time to do it, I really am trying to capitalize on it. Dr. Adriana Alvarez: Well, I really want to thank you, all of you, Dr. Goyal, Dr. Patel, and Dr. Symington, for a lively discussion. I learned a lot from you and a little bit about your personal life. Thank you for sharing that and sharing how you navigate to be a physician in oncology.  So this ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncology well-being and professional development. If you have an idea for a topic or guest you would like to see on the show, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit education.asco.org. Thank you very much.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.              

This webcast with provide an update on Moderate and Deep Sedation.

Today on MedNet21, we're going to discuss Dementia.

Today on MedNet21, we're going to discuss Common Knee Complaints.

Today on MedNet21, we're going to discuss Travel Medicine.

Today on MedNet21, we're going to discuss Autism Spectrum Disorder.

Today on MedNet21, we're going to discuss Pancreatic Cancer.

Today on MedNet21, we're going to discuss we're going to discuss Recurrent Urinary Tract Infections.

Today on MedNet21, we're going to discuss Polycystic Ovary Syndrome.

Today on MedNet21, we're going to discuss Hepatocellular Carcinoma.

Today on MedNet21, we're going to discuss Atrial Fibrillation Overview and Updates.

Today on MedNet21, we're going to discuss Insomnia.

Today on MedNet21, we're going to discuss Tick Borne Diseases.

Today on MedNet21, we're going to discuss Care of Patients with Intellectual and Developmental Disabilities

Today on MedNet21, we're going to discuss Cancer Survivorship.

Today on MedNet21, we're going to discuss Social Determinants of Health.

Getting into oncology requires a lot of education and training. How does one deal with the success and stress of such a journey? In Part Two of this ASCO Education Podcast, moderator Dr. Aakash Desai – fellow at the Mayo Clinic along with guests Dr. Madison Conces – fellow at Cleveland Clinic, and Hematology/Oncology fellowship program directors Dr. Lori J. Rosenstein (Gundersen Health System) and Dr. Deepa Rangachari (Beth Israel Deaconess Medical Center) explore the past, present, and future of Oncology Training. They discuss the transition from training to clinical practice (1:02), how to stay current with new treatments and guidelines (6:39) and what oncology training should look like in the future (12:12). Resources: ASCO Education Podcast: Cancer Topics - Burnout in Oncology: Trainee Perspective ASCO Education Podcast: Cancer Topics – Career Paths in Oncology (Part 1) ASCO Education Podcast: Cancer Topics – Career Paths in Oncology (Part 2) If you liked this episode, please subscribe. Learn more at education.asco.org, or email us at education@asco.org. TRANSCRIPT  Dr. Deepa Rangachari: I think really this idea of what I call work-life negotiation, is present very much during training, and one continues to be very present in your ongoing clinical practice. Aakash Desai: Hello, everyone, this is Dr. Aakash Desai, I am currently a Hematology and Oncology fellow at Mayo Clinic, in Rochester, and this is part two of our discussion on the past, present, and future of Oncology training. My guests are, Dr. Madison Conces, Hematology/Oncology fellow at Cleveland Clinic, Dr. Lori Rosenstein, Hematology, and Oncology Fellowship Program Director, at Gundersen Health System, and Dr. Deepa Rangachari, Fellowship Program Director, at Fellowship Program Director, at Beth Israel Deaconess Medical Center. In part one, we gave our insight into what motivated us to get into Oncology, along with spotlighting the rewards and stresses of going through fellowship. Today, we're going to look at what the future of Oncology should look like. But first, I and my guests will explore the challenges of transitioning from training to clinical practice in Oncology. Lori, gives us her answer. Dr. Lori Rosenstein: You know, I think part of it is, you are in that final stage, this is the rest of your life. So, I think a lot of my fellows feel like when they're leaving fellowship, they have to find the perfect job, because it's where they're going to be for the rest of their life, and I think everybody who is out in practice knows that it's very unlikely you stay in the first job out of fellowship. And so, having less stress on yourself, of finding that perfect experience, I think, finding an experience that fits with your goals and aspirations, and what you see your life being like, is good enough. And then if you go there, and it turns out it's not a great situation for you, feeling free to go somewhere else, that's a different paradigm than I think fellows expect. They put so much stress on themselves. We're all type-A people, right? And you just want to make the right choice.  I've now had a couple of jobs. Each of them was the right choice for me at the time, and each of them taught me really important lessons that I have carried on to my next role. When I started my first job out of fellowship, I had no idea medical education was going to be a huge part of my life and career. I like to teach - that was what I knew about myself, but as I got more involved in medical education as a career, as a research opportunity, as probably the most important part of what I do in work, it changed where I was going to go. It changed what I ended up doing. You know, I ended up as a program director, and when I talked to my fellows and I say, you know, my job is research and taking care of patients, and teaching, and then medical education. To me, medical education is at the top, and that would not have been what I said as I left fellowship. So, having that openness to say, "I'm going to take in experiences and continue to grow and develop," is huge. Aakash Desai: Madison, what challenges do you think you are going to have to face when you start clinical practice from training? Dr. Madison Conces: I think for me right now, the main things on my mind are making sure I have the support I need after I graduate. I don't think I'll be abandoned anywhere, but I just want to make sure I join a supportive practice. And I think the second kind of big stress on my mind is doing research as a staff. Obviously, have mentorship, but as a fellow, I feel like there's a little bit more of a structure maybe with that, and so again, I'm not sure how that will be as a staff, but you'll be kind of more of the PI right on the project rather than a co-PI necessarily, and kind of going with patient care, like all the details, and making sure all T's are crossed and I's are dotted, and I know I'll be ready when it's time, but I just feel like it's kind of always in the back of my mind, like that it's coming - exciting, and I think one thing I try to reflect on, is I have made it; I'm literally the 10th year of my medical training. If I've made it this far, and I have problem solved, and helped patients, and worked as a team, and been a leader when I needed t0 this far, then I have to have faith that I can figure it out as a staff as well. Aakash Desai: Deepa, can you answer next? Dr. Deepa Rangachari: Couple of recurring themes: one, appreciating the interdisciplinary nature of the care that we give, and just recognizing that the need for help, whether it's help with regard to clinical decision making, or intuition, or best practice, or the need for help just in terms of supporting the needs of your patients, those things never, ever go away. That sort of segues very nicely into this idea of consistent and ongoing rapidity of the growth and knowledge that doesn't end when you come out of fellowship. Those things continue to evolve and change well after your fellowship training. You need to know when and how, and who to ask for help. You also need to develop paradigms for lifelong learning. What will it mean to you to be a learner during career span journey, where not only will the knowledge change, but the way in which you access that knowledge will change? And I think those are important things to recognize as challenges of making us transition. I think really this idea of what I call work-life negotiation is present very much during training, and one continues to be very present in your ongoing clinical practice. And what I mean by work-life negotiation is, on any given day or any given week, or any given month, the way in which you organize these relative priorities at home and at work certainly can change dramatically. And this idea that you can be in charge of refining, and reorganizing, and defining, and turning up or down the dial at home or at work, according to what's going on in your life, is very important to recognize, and so, I think that idea of paying attention to the need to continue to negotiate those factors on a regular basis is something that is very important as you transition from training to clinical practice. I would not go so far as to say that it necessarily ever becomes easier, but I absolutely think it becomes more manageable for two main reasons; one, you have more control over your career and your life as you move from training to practice, and two-- and I think we should be open and honest about this, you have more resources to do so - whether there's financial resources, or supportive resources. But both of those things, I think, make it more manageable, even if the challenges never go away. Aakash Desai: And now we'll move on to the next question. I think this is a question I think most fellows have in mind because they realize that as and when they go out to clinical practice, the treatments you learned during fellowship and what ends up happening when you're actually interactive, there's going to be a lot of difference because of all the new updates, and the new drugs, and others that come out. But how do you stay current with new treatments and guidelines, and what would you advise current fellows and future Oncologists, the resources to use for these kinds of updates? So, Madison, I'll start with you. Dr. Madison Conces: That's a tough question, I think because some groups, the field is changing so fast. I would say if I'm dealing with something I've not seen before, or I don't know in depth as much as maybe, you know, GI malignancies, which is mostly my interest right now, we'll start out with the NCCN guidelines, and I'm well aware there are plenty of people who don't follow those verbatim and all of that, and there is some interpretation with those, but at least, it gives you a structure to work with. And so, I like to start there, and they usually have at least updated, you know, genetic mutations and some drugs that are, you know, used for those mutations, and so any targeted therapy might be listed on that guidelines. And so, I usually start there and then go beyond there. I mean, I'm obviously talking in a very general sense here, because patients with a really rare cancer, you're just going to have to read up more and look at case reports, you know, see if there's any recent trials. That's kind of where I start, and I just kind of read from there. It's almost like a trickle-down effect in a way. Dr. Lori Rosenstein: So, Madison, I think that is also where I start - NCCN guidelines, up to date, those sorts of things. I will tell you that as I have gone along, I have become much more likely to phone a friend than I used to be. I used to be, as a fellow, like, "I'm not going to call that person." I still remember, as a fellow, I called somebody at MD Anderson to ask about Mantle Cell lymphoma, and he was absolutely lovely, but I was petrified. I was like, "Oh, he's going to think I'm an idiot, and why am I calling him?" Now, I know that people are out there and they're experts for a reason, and they're experts because they want to share their expertise, and it's very rare that someone is just completely not interested in helping you. But reaching out, I think there's lots of ways on social media that you can reach out, and my fellows, they think I'm silly because I tell them, "Look what I just found on Twitter." Like, if you're following the right people on Twitter, and people who you trust their opinions, and you know they're experts in their fields, and they say, "Hey, I was just at ESMO, and here's the slide from what I think is really important." That helps guide me to like, "Hey, this is something." Now, obviously, social media is what it is, and you have to take it with a grain of salt - I try not to trust complete strangers, but at least it leads me to new articles that I wouldn't necessarily have seen. Currently, on my desk, I probably have about 30 "Bloods" because I just am so behind in looking through those, so, knowing that someone who I know in Hematology said, "Hey, this is a really great review article on X, Y, or Z," I'm texting that to my fellows at night when that comes across Twitter. And likewise, there's some really good groups on Facebook that are specifically for Hem/Onc, that provide support, you know who the experts are, they're willing to help. ASCO and ASH both have ‘phone a friends' where you can present difficult cases and MedNet -- I have no financial disclosures for any of these, by the way. MedNet is a really interesting ‘phone a friends' where you can put in a question around a general concept with a clinical case, and get experts in the field to reply back. So, all of those things, I'm much more likely to do now, than I was when I was a fellow, just because I'm now less concerned that people would think I don't know what I'm doing; I'm much more likely to say, "Hey, I don't know what I'm doing, and I need help in this situation." Aakash Desai: That is so great to hear because social media really has become one of the primary sources of updates that we get. It's definitely not the ideal resource, but I think in a fast-paced world, I think having a few things on updates, I think definitely has been very helpful. How about you, Deepa? What are your thoughts on this? Dr. Deepa Rangachari: Yeah, being, staying current, it's really a challenge and I think lifelong learning is often interpreted as sort of like being willing to continue to learn over time. The trickiest thing about this is learning how to adapt the ways in which you learn over time, and so, I'm a very pen-and-paper sort of a person, I've had to really learn how to be savvy with using digital resources. I keep a very brisk PDF library of key literature, not only that I like to read and save to re-review myself, but also in terms of a lot of the teaching, and presentations, and talks, that I'm invited to give. And so, I think I've gone from a very pen-and-paper modality, and I still have the notebooks that I kept during my residency and fellowship training, and I still remember at the quarter left hand of a page, I wrote something that I really wanted to remember, but I've had to move away from that because I can't be walking around with pen and notebooks all the time. And so, I've developed PDF libraries and things that are available leveraging the technological support provided by my institution to maintain things on the cloud. I've incorporated podcasts into my lengthy commute time to, and from work, to sort of have a chance to keep up. And I think the honest truth is that everybody has to develop a system, and you have to be willing to be flexible and iterative with that system, and modify it, and grow it as time goes along. So, I don't have any simple equation for this other than a willingness to recognize the importance of being organized, and a willingness to be willing to change as the ways in which we learn and get information change, and a willingness to ask - that's the most important thing, is to be willing to ask others, and have others in your realm, who you know and trust, and can get candid and accurate answers from. Aakash Desai: So, now I have a very simple question, I think, to which you'll all have to give straightforward answers: What do you think Oncology training should look like in the future? What are your thoughts, Deepa? Dr. Deepa Rangachari: I think two of the things that we really have to acknowledge are; one, it has never been possible, nor will it be possible in the future, to think that three years of clinical training can prepare you for all of the questions, and nuances, and advancements that our discipline is fortunate to witness, or that we are fortunate to be a part of, and contribute to. So, really, fellowship training then has to be about developing a very rigorous infrastructure for critical thinking, and lifelong learning, and recognizing general frameworks and scripts for illness, and wellness, and therapeutic intervention, and understanding when are moments to push, and when are moments to sort of take a step back, and sort of revisit or refine the care trajectory along with our patients. I think that's one thing - sort of really just acknowledging there's no way we're going to be able to train people to see everything and know everything, so to really make sure that our training programs provide each trainee, and the program at large, with that sort of rigorous infrastructure and framework for thinking about complex problems, and really for working in complex interdisciplinary teams. I think the second thing that conceptually, I think, training program leaders should be thinking about is, helping make connections between different disease entities so that we're not training folks to think in disease-specific silos, but really think about emphasizing concepts that are shared across disease entities; thinking about making connections between common disease biologies, and things that may be similar or different, rather than memorizing a series of therapeutic pathways in stage III non-small cell lung cancer versus locally advanced breast cancer, versus early stage pancreatic cancer, but really thinking, what are the things that these different disease entities, at the biological level, or at the care coordination level, what are the things that are similar or different? I think this serves a couple of different things. From a learning science perspective, it sort of reinforces what we know are effective strategies for knowledge acquisition and retention, but I think also part of our obligation as training program leaders, is to make sure that we're training people to be thought leaders and innovators in their respective clinical and scholarly domains, and that really requires a lot of cross pollination of ideas - what is something that we know works well in lung cancer? How might that same way of thinking or science be applied to a patient in breast cancer? And how could we use those insights to innovate across different diseases? And I think a lot of this comes down to just acknowledging that this finite amount of training time will never be enough to fully expose people to every aspect of the breadth and depth of the discipline, let alone, how we're practicing now, or even thinking about the future. And so, really thinking about making sure that training programs create paradigms of thinking and collaborating, and lifelong learning that will go the distance rather than just emphasizing very specific content. Aakash Desai: Lori, what are your thoughts on this? Dr. Lori Rosenstein: From my standpoint, I think if I could totally change fellowship-- the thing that I'm most worried about with my fellows is trying to have all the medical knowledge for Hem and Onc by the time you finish three years. ACGME is so useful, as a program director, to help me guide what I need to be helping my fellows learn during that time. But for any of you who are program directors all know, there continues to be more and more things that we need to show that we're doing - we need to show that we're teaching our fellows multidisciplinary approaches to care of patients, they need to know about patient safety and quality improvement, they need to do research, they need to have all this medical knowledge. And as more and more things kind of come on the plate of what we need to turn out in three years, and more and more knowledge is out there, it becomes this point where we're not going to be able to do that. And if I had my choice, I would drop the medical knowledge part of knowing every esoteric drug mechanism and pathway, and having testing for that, and more, can we prove that they can critically think and take care of patients who are very complex? It's hard to test on that, and it's hard to just check that box and say, "Complete." But when you're a program director, and you're working very closely with fellows during that three years, you learn that - is this someone you want to take care of your patients or not? And they may be extremely able to take tests and answer questions correctly, and still not the Hem/Onc doctor that we would want them to be. In general, I would just say, less and less emphasis on test taking, and you know, regurgitating medical knowledge, and more and more emphasis on, where can you find the knowledge, and how do you apply it? Aakash Desai: So, as currently the programs are structured, I think most programs in the country are dual Hem and Onc boarded. Some programs do allow for single boarding, but I guess I want to ask thoughts on the future. There'll be more and more programs who will opt for singular boarding Hem or Onc, rather than a dual board. Dr. Lori Rosenstein: Yeah, so this is Lori. I think that single boarding is extremely challenging with the way our healthcare structure is laid out. So, you know, we all have to be very realistic that most of our fellows are going to leave fellowship, and are going to practice both Hematology and Oncology, and they're going to take care of the broad spectrum of all of those diseases. And in order to do so, their hospital is going to require they're credentialed, and certified in both of those. So, I think if we start to either only have Hem, or only have Onc, people are going to have extended training, and it's going to become less and less attractive. It's already a really long slog to be a medical oncologist and hematologist, and making that longer, I really don't think it's the way to go. Aakash Desai: Madison? Dr. Madison Conces: I'll jump back to the prior question of where do I see fellowship training in the future. I definitely think that the critical thinking aspect will still be there. I think there'll have to be more of an emphasis on thinking through patient care, and not so much the regurgitation medical knowledge of memorization. I think, you know, core lectures, like I'm sure a lot of fellowships we do here, which I think are really important to have, maybe at the beginning of the year, just to kind of lay out the basics for first-year fellows, but I think beyond that, doing case conferences where it's not crystal clear what even the subject is going to be and walking through it, and making people answer questions even in more of an interactive manner is another way we could go about the conferences. Other than maybe some very obvious information, I think a lot of this we just need to make sure we know how to find it - like we've already mentioned the NCCN, up to date, I think probably a lot of us got used to doing some of that in residency, in terms of where to find information. We've all been-- I think most people who are in fellowship right now have trained through all their training with computer and the internet, so you know, I think a lot of us are very familiar with it. Aakash Desai: Yeah, I think completely agree. And I think, you know like Lori mentioned, fellowship should be more than just preparing for Boards. And especially, I think as we move on in our fellowships Madison, and I think I've realized that you know, to know what your blind spots are and when to ask for help is also a critical part of actually training during fellowship. And I think as I come towards the end of my fellowship journey, I think I've realized now that it's a continuation of a longer journey. You know, three years is just the tip of the iceberg, and there's obviously a whole lot of you know, things that I'm going to see in the future. So, that, to me, I think in the future, needs to be kind of emphasized for the fellows to kind of really be okay with the idea of not knowing it all at the end of three years. And as we've geared more towards-- and we talked a little bit about work-life negotiation rather than balance, I think will be also very important. Thank you. I think those are phenomenal points, and I really appreciate everyone's time today. So, that is all what we have for today. Thank you so much, Dr. Conces, Rangachari, an Dr. Rosenstein, for this candid and vivacious conversation on Oncology training. I'm sure our listeners will appreciate and be able to relate to many of the personal anecdotes that you've shared, and the insights that you have shared today. Thank you also to our listeners, we appreciate you tuning in to this episode of the ASCO Education podcast. Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click, "subscribe". Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at: education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.  

This webcast will discuss Updates in the Management of Prediabetes and Type II Diabetes

Today on MedNet21, we're going to discuss Depression & Anxiety in the Young.

Today on MedNet21, we're going to discuss Contraception.

Today on MedNet21, we're going to discuss Thyroid and Parathyroid Tumors.

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Today on MedNet21, we're going to discuss Psychiatric and Behavioral Health Management in Chronic Health Conditions.

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Today on MedNet21, we're going to discuss Diabetic Retinopathy.

01:00:06

00:57:49 The Ohio State University W