Leading the Rounds

Dr. Lindsey A. Criswell, is the director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Prior to joining NIAMS, Dr. Criswell was vice chancellor of research at the University of California, San Francisco. 

She has a bachelor’s degree in genetics and a master’s degree in public health from the University of California, Berkeley, and an M.D. from UCSF. 

As the NIAMS director, Dr. Criswell oversees the Institute’s annual budget of nearly $625 million, which supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases. 

Between 1994 and the time she became NIAMS director, Criswell was a principal investigator on multiple NIH grants and published more than 250 peer-reviewed journal papers. 

In this episode, we discuss her journey as a leader in medicine and science. Welcome to Leading the Rounds. 

Questions We Asked: 

• When did you start to see yourself as a leader? 
• What experiences helped you build your leadership style? 
• When you stepped into your current role, did you feel ready? 
• What are the greatest challenges you face in your current leadership? 
• When do you know when a good opportunity comes along to pursue? 
• Were there things in your training that weren’t addressed?
• How do you avoid being “scooped” in medical research? 
• How does one decide what leadership route to choose? 
• How has failure impacted you as a physician, scientist and leader? 

Quotes and Ideas: 

• My leadership style reflects my own personality 
• “It really does take a team effort to be successful in science and medicine” 
• “There’s no one way to be an effective leader” 
• You can learn a lot by observing people you respect in positions of leadership 
• “I’m in a stage in my career where I really want to make an impact” 
• “As an investigator, if you can’t communicate effectively at the appropriate level… you’re not going to be successful.” 
• Most, if not all, of the impactful research done is a team effort 
• “Just say no” 

Dan Dworkis, MD PhD FACEP is the Chief Medical Officer at the Mission Critical Team Institute, a board-certified emergency physician, and an assistant professor of emergency medicine at the Keck School of Medicine of USC where he works at LAC+USC. He performed his emergency medicine residency with Harvard Medical School at the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital / Brigham Health, and holds an MD and PhD in molecular medicine from the Boston University School of Medicine. Dr. Dworkis is the founder of The  Emergency Mind Podcast , and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure. 

Questions We Asked: 

• Why did you feel the need to create The Emergency Mind? 
• Is poise under pressure a learned skill or innate? 
• What are valuable skills you have learned creating The Emergency Mind? 
• How does someone successfully improve through a performance loop? 
• What are ways to decrease stress while performing procedures? 
• How does the Emergency Mind address team dynamics? 
• How do you build a well functioning solid team?
• How do you run a successful debrief?  
• Advice for medical leaders under pressure? 
• Book Suggestions? 

Quotes & Ideas: 

• Applying knowledge under pressure is a separate learned skill 
• What happens when you are trying to intubate a patient and miss the first time? How do you recover and make the second attempt? 
• Prepare-> Perform-> Recover-> Evolve 
• “Create an environment that sets you up for success” 
• Experiment and be a scientist of yourself: Build->measure->learn 
• Exposing yourself to stressful scenarios outside of the hospital can help you build skills to help clinically 
• Use self-talk to help yourself manage acute stress 
• When debriefing, learn to separate outcome from performance. You can sometimes have a poor outcome with perfect performance and also a good outcome with poor performance. 
• Debriefs can use outcome vs. performance on a 2x2 matrix. 
• Never Waste Suffering. Both ours as providers and the patients. 
• Harness the wisdom in the room around you 
• Practice when you are outside of pressure and then slowly introduce it to stressful situations 

Book Suggestions: 

• Thinking Fast and Slow by Daniel 
• Sources of Power by Gary Klein 
  • “A Failure to Disagree” paper by both 
• Ghosts of the Fireground by Peter Leschak 

Intro: 

Dr. Thomas Varghese Jr. is the Associate Chief Medical Quality Officer and Chief Value Officer at the Huntsman Cancer Institute, and Chief of General Thoracic Surgery at the University of Utah. 

Dr. Varghese is a national leader in minimally invasive applications for general thoracic surgery, recognized by Castle Connolly as one of America’s “Top Docs”, and is ranked in the top 10% of the nation by Press Ganey for patient satisfaction scores. 

His research interests bridge the world of Educational Research and Health Services Research, specifically in the arena of optimizing performance at the patient, surgeon and system levels. He created the Strong for Surgery program, which is now a formal Quality Improvement program of the American College of Surgeons, and active at 331 clinical sites across the nation and 3 state surgical collaboratives.

Dr. Varghese holds national leadership positions in the Society of Thoracic Surgeons, Thoracic Surgery Directors Association, American College of Surgeons, and the Society of University Surgeons. Dr. Varghese is active on social media and is the Deputy Editor of Digital Media and Digital Scholarship for the Annals of Thoracic Surgery.

Questions We Asked: 

• Where did your passion for leadership come from? 
• Who were your mentors and what made that relationship special? 
• Have you found your mentors formally or informally? 
• How can you create a good formalized mentorship program? 
• How do mentors effectively help their mentees find their career path? 
• How do you create a good mentor/mentee relationship? 
• How can those in the majority be allies to minority groups in medicine and science? 
• How do you be comfortable saying “I don’t know”? 

Quotes & Ideas: 

• “Never stop looking for best practices” 
• You can and should have different mentors for the various areas of your life (academic, career, social, spiritual, etc.) 
• “Mentorship is someone with a particular knowledge or skills that shares them with someone else who does not have it on their own.” 
• “A mentor does not always have to be older than you.” 
• Identify OKR (objectives and key results) and set a time deadline for it 
• “An ally is someone who builds a culture of inclusion” and “A leader is someone who betters the culture of those they lead”. Leaders need to be allies. 
• “Are we better today than we were yesterday, and are we going to be better tomorrow than we were today and how do we achieve that.” 
• “Diversity doesn’t end because you hire the next diverse faculty. You have to make sure they thrive in their position.” 
• “You don’t know, doesn’t necessarily mean you don’t act.” 
• “MD means make decisions.” 
• “We are living in the greatest time in history.” 
• “Seek your tribe members” 

Books Suggestions: 

• The 4 Disciplines of Execution by Sean Covey 
• Peter Drucker 
• Start With Why by Simon Sinek 
• Adam Grant 

COL (Dr.) Cristin Mount is an Army Critical Care Medicine physician currently stationed at Madigan Army Medical Center in Tacoma, WA. She graduated magna cum laude from the University of Scranton and completed medical school at the Uniformed Services University in Bethesda, Maryland in 2003. She did an Internal Medicine Internship and Residency at Madigan and moved to Walter Reed Army Medical Center in Washington, D.C., for Critical Care Medicine fellowship. 

After fellowship, she returned to Madigan as the Director, Critical Care Services and promptly deployed with the 28th Combat Support Hospital to Baghdad, Iraq where she served as the sole Intensivist and the theater consultant for Critical Care and Internal Medicine. She is the only woman to serve as Chief, Department of Medicine and the Deputy Commander of Medical Services.  Currently she serves as the Critical Care Medicine Consultant to the Army Surgeon General.

She is a Master of the American College of Physicians, and past Governor of the Army Chapter of the ACP. She is married to COL George Mount, an Army Rheumatologist, and they have three small boys under the age of 7.

Any views expressed during this interview reflect those of Dr. Mount and do not represent official views of the Army Medical Department, Department of the Army or Defense Health Agency. 

We hope you enjoy this episode where we discuss her journey through medicine and leadership as well as leadership in the ICU. Welcome to Leading the Rounds. 

Questions We Asked: 

• How did you become involved in medical leadership? 
• How did you adjust to becoming a leader out of training? 
• What are some things that help you lead in stressful situations? 
• Can you discuss your article Ten Leadership Principles from the Military Applied to Critical Care and why you felt writing it was important? 
• What is unique about leadership in the Intensive Care Unit? 
• How do you develop a good care team? 
• How do you balance being firm in a stressful leadership moment vs. being aggressive and condescending? 
• How do you practice adaptive leadership? 
• Advice for medical leaders? 
• Books? 

Quotes & Ideas: 

• When taking a new leadership position, “recognize that you’re going to feel overwhelmed, and then sit back, learn, and ask questions.” 
• In moments of panic, “put your helmet on, put your kevlar on, and march in a straight line.” 
• You can study leadership, but you also need to practice. Look for everyday small moments where you can practice your leadership skills so they are ready when you need them. 
• “Every day there's an opportunity to practice a leadership technique in your personal or work life.” 
• Ten Leadership Principles from the Military Applied to Critical Care
• Leadership in the ICU: contrasts between problem solving without assessment of why things are happening vs. paralysis by analysis 
• To be a great leader in the ICU, you have to be able to make decisions without having all of the information. 
• “The success of the team means the success of the patient.” 
• In addition to placing yourself in stressful situations, you can rehearse in your mind what you would do if you would have been placed into that environment. 
• “As you are in a position to set boundaries to which work is not allowed, you have to set them.” 

Book Suggestions: 

• Complications by Atul Gawande 
• We Were Soldiers Once and Young by Lt. Gen. Harold G. Moore and Joseph L. Galloway
• The Liberation Trilogy by Rick Atkinson 

Intro: In this episode we interview Dr. Karla Williams and Dr. KeAndrea Titer. They are assistant professors of Internal Medicine at The University of Alabama at Birmingham. They are passionate about diversity, equity, and inclusion and both work to design initiatives and curriculum focused on recruitment, education, and building community. This includes the AIRR initiative, which we discuss in the episode. In this episode, we discuss creating a welcoming culture in medicine and working to drive cultural change through seeking to understand others. Welcome to Leading the Rounds. 

Questions We Asked: 

• What inspired you to develop the Clear the AIRR initiative? 
• What’s the difference between a macro and microaggression? 
• How should physicians deal with microaggressions? 
• What does your program look like practically? 
• How can leaders manage microaggressions?
• How do you create a culture of occupational wellness? 
• What advice do you have for medical leaders? 
• Book suggestions? 

Quotes & Ideas: 

• Microaggression initiative (AIRR): Assessing, Identifying, Responding and Reporting 
• As a leader, it is important to develop a culture where problems can be discussed openly and solutions can be made. As a trainee, it is important to seek out mentors who will feed into your career aspirations. 
• Diversity and Inclusion programs should highlight mentorship, sponsorship and support 
• “You have not been selected to this program because someone felt sorry for you. You have worked incredibly hard for this.”
• Occupational Wellness: Being in a career that you enjoy, providing value to those you are serving, and having a space to balance your own self care 
• “You should work to see the best in everyone, but never be afraid to challenge them as well.” -Dr. Williams 
• Enter to Learn, Depart to Serve 
• Don’t be afraid to go against the grain and change the culture of medicine. 

Books: 

• Dr. Williams & Titer suggested reading The Bible as a way to learn leadership 
• 7 Habits of Highly Effective People by Steven Covey 

Today we have the privilege of having a panel of three guests for this episode. Today’s guests are the Chief Residents in Internal Medicine at Walter Reed National Military Medical Center. They include John Blickle, Melanie Wiseman, and Rainey Johnson. All three of them have dedicated time to the study and practice of medical leadership and we look forward to following them as they continue to grow as leaders. In this episode we discuss the transition from trainee to leader, how to make leadership training a priority, and lessons from their time as chief residents. Welcome to leading the rounds. 

Questions We Asked: 

• When did you first recognise the importance of medical leadership?
• What valuable things did you learn from the leadership curriculum at Walter Reed?
• What is something that you learned you were initially doing poorly? 
• What can someone do to improve as a leader if they don’t have a formal training program? 
• What surprised you transitioning into a leadership position as a chief resident?
• What were the little things that you did to change the culture of your residency program?
• What advice would you have for medical trainees? 

Quotes & Ideas: 

• You won’t have extra time during residency for leadership training, you have to make the time -John 
• “To take care of our patients best, we have to learn these [leadership] skills.” -Melanie 
• Listen Aggressively -Melanie 
• The way that you set an example has an impact on the expectations of the group, even if they are not explicitly said - Rainey 
• Create a culture of feedback and make sure there aren’t barriers preventing you from obtaining honest feedback -John 
• When you get feedback, take a moment to accept it before you begin to defend yourself -Melanie 
• As leaders, we should continuously be looking for opportunities to grow -Rainey 
• A leadership training activity: contrasting a great attending and a terrible attending and reflecting on why 
• “Culture is difficult to change… because it’s changed by lots of little acts that show what the leadership values” -Rainey 
  • They chose the value that they were going to care 
• “If a message can be misinterpreted, it will be misinterpreted.”-John 
• “Don’t just do something, stand there.” -John 
• “You can’t change the culture if you don’t understand the people in it and what they value.” -John 
• “If you haven't read hundreds of books, you are functionally illiterate, and you will be incompetent, because your personal experiences alone aren't broad enough to sustain you.” -Jim Mattis 

Books: 

• The Culture Code by Dan Coyle 
• It’s Your Ship by D. Michael Abrashoff
• Call Sign Chaos: Learning to Lead by Jim Mattis 

James (Jim) Wright obtained his MD from the University of Alberta in 1968, his FRCP(C) in Internal Medicine in 1975 and his Ph.D. in Pharmacology from McGill University in 1976. He is a practicing specialist in Internal Medicine and Clinical Pharmacology. He is also Co-Managing Director of the Therapeutics Initiative, Editor-in-Chief of the Therapeutics Letter and Coordinating Editor of the Cochrane Hypertension Review Group. He sits on the Editorial Boards of PLoS One and the Cochrane Library.

Questions We Asked:
•How did you become involved with pharmacology and drug prescription?
•How would you define appropriate use?
•Does financial implications to the patient play into appropriate use?
•What do most physicians not know when they prescribe medications?
•How does overprescribing play into medical waste?
•Why is there a disconnect between systematic reviews and clinical guidelines?
•How does bias play into drug testing?
•How can we successfully collaborate with pharmaceutical companies without including bias into research?
•How do everyday clinicians decide how to treat patients based on guidelines vs systematic reviews?
•What makes a good systematic review?
•What advice do you have for trainees who want to do good for their patients?
•Book Suggestions?

Quotes and Ideas:
•Appropriate use of medications means that the benefits outweigh the harms of the medication
•Every time a patient takes a medication, they are reminded of their medical condition that needs treatment.
•Many psychiatric medications get onto market only due to short term medical trials, but many are prescribed for long term conditions.
•Leaders should push for non-industry funded trials that evaluate the long term effectiveness of medications.
•ALLHAT trial as an effectively run drug testing study 
•We don’t want a situation where marketing is the driving force and not research
•Choosing Wisely Campaign

Book Suggestions:
•Sickening by John Abramson
•Our Daily Meds by Melody Petersen
•Anatomy of an Epidemic by Robert Whitakers  

Dr. Paul Thomas is a board-certified family medicine physician practicing in Detroit, Michigan. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. 

He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of three books: Direct Primary Care: The Cure for Our Broken Healthcare System, Startup DPC: How to Start and Grow Your Direct Primary Care Practice, and Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine. 

We hope you enjoy this episode with Dr. Paul Thomas about how to dress and present yourself as a leader. 

Questions We Asked: 

• You just released a new book, Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine. What inspired you to write about this? 
• How should you dress for a medical school or residency interview? 
• How does virtual interviewing change things? 
  • How should you set up your background? 
• Where do you draw the line between standing out and blending in with your dress and attire? 
• How does appearance play into effectiveness leading teams and organizations? 
• Is there a way to dress well when you have to wear scrubs? 
• How do patient expectations change your dress? 
• How much of dress is reading the room vs. holding yourself to a higher standard? 
• You talk about house calls as a DPC physician, how does this change the interaction? 
• How did you learn how to dress and carry yourself well? 
• Book Suggestions? 

Quotes and Ideas: 

• Medical School Interview: Blue or gray suit, white shirt with a colored tie. Leather shoes and a belt that matches. 
• If you have a choice between a solid or swivel chair, choose the solid chair so you don’t fidget. 
• Virtually: face a light, make sure the camera is eye level, set up and test your microphone. Make your tech setup pristine. 
• Sprezzatura: When everything is perfect, you can introduce a splash of personality that highlights a creative part of yourself 
• You should dress with the goal of looking professional so you can instill confidence and better care for your patients. 
• Wear clothing that makes you look mature and confident. 
• If you are a physician in a leadership role, you should take the time to dress well and change if needed. 
• “If you want to be a leader… you should look the part and lean into dressing your best.” 
• “If dressing well makes you stand up straighter, speak more clearly and develop trusting relationships with your patients, then do it.” 

Book Suggestions: 

• Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine by Dr. Paul Thomas 
• Atomic Habits by James Clear 

Dr. Peter Pronovost is a world-renowned patient safety champion, innovator, critical care physician, researcher, and entrepreneur. His scientific work leveraging checklists to reduce catheter-related bloodstream infections has saved thousands of lives and earned him high-profile accolades, including being named one of TIme’s 100 most influential people
and receiving a coveted MacArthur Foundation “genius grant” in 2008.

As Chief Quality & Clinical Transformation Officer at University Hospitals, Dr. Pronovost is charged with fostering ideation and implementation for new protocols to eliminate defects in value and thereby enhance quality of care.

Previously, Dr. Pronovost served as the Senior Vice President for Patient Safety and Quality at Johns Hopkins Medicine as well as the founder and director of the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality.

Dr. Pronovost was elected to the National Academy of Medicine in 2011, elected as Fellow of the American Academy of Nursing and has received multiple honorary degrees. Dr. Pronovost is an advisor to the World Health Organizations’ World Alliance for Patient Safety and regularly addresses the U.S. Congress on patient safety issues. In response to a White House executive order, Dr. Pronovost co-chaired the Healthcare Quality Summit to modernize the Department of Health and Human Services quality measurement s

Questions We Asked:
•How do you like the nickname Mr. Checklist?
•How do you inspire those on your team to believe in themselves?
•How do trainees fit into the safety paradigm?
•How do we make quality something that everyone wants to be a part of?
•What advice do you have for young leaders in healthcare?
•Book Suggestions?

Quotes & Ideas:
•“Stories are the most potent force for change in the world.”
•Steps that go before checklists: believing and belonging
•Everyone is a part of the healthcare team and involved in patient care
•“The secret of great care is love”
•“If you have to drive change you have to believe in people and you have to love people.”
•Stop believing that you’re just a _____ and start believing that you can make a difference
•Teams that make good decisions are diverse and have independent input
•Healthcare teams play “shorthanded” because we marginalize members of the care team
•Experiential wisdom or time with the patient is often inversely correlated to medical wisdom
•In 90% of sentinel events, someone knew something was wrong before the event happened
•Three ways we change behavior: Regulate it, use economic incentives, and use the network effect
•“Change progresses at the speed of trust, and trust grows when we do things with rather than to people.”
•As an executive, your job is to illustrate why we are doing something, and then inspire others to figure out how to do it.
•“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. -Margaret Mead
•Be scientifically sound and ruthfully practical
•Change is almost always transdisciplinary so it pays to be curious and learn about other fields
•Be humble, curious and compassionate
•Large scale change is half evangelism and half science. It pays to communicate and write well.

Book Suggestions:
•Love 2.0 by Barbara Fredrickson
•The Advantage by Patrick Lencioni
•Multipliers by Greg McKeown and Liz Wiseman
•Everybody Matters by Bob Chapman and Rajendra Sisodia 

We wanted to start by saying thank you to all our listeners for their feedback and the comments over the past two years and everyone who has played a role in helping us launch and produce this podcast. This marks our 50th episode of Leading the Rounds and we couldn’t have asked for a better guest!

Today we have the Vice President of Performance Science at WHOOP, Kristen Holmes. Kristen drives thought leadership by engaging with industry leading researchers and partners to better understand performance data across high stakes verticals. 

Before joining WHOOP in 2016, Kristen was a 3x All American, 2 x Big 10 Athlete of the year at the University of Iowa competing in both Field Hockey and Basketball and recently inducted into the Hall of Fame Class of 2021 and was a 7-year member of the U.S. National Field Hockey Team.Kristen was then Head Field Hockey Coach at Princeton University where she was one of the most successful coaches in Ivy League history, having won 12 league titles in 13 seasons and a National Championship.

Kristen blends her academic and applied background in athletics, coaching, performance technology, psychology, and exercise physiology to drive research, partnership, and product development initiatives to strengthen WHOOP as a leader in Human Performance.

Please enjoy this wonderful discussion about health optimization, WHOOP’s work with front line healthcare workers and insights into maximizing human performance.

Welcome to Leading the rRounds!

Questions We Asked: 

• How did you transition from a player to a coach and leader? 
• Did you feel like creating team buy-in was something you could do naturally or have to learn? 
• What did you learn as a player and coach that has helped you now as vice president of performance at WHOOP? 
• What behavior have you found is most correlated with performance and health? 
• What are the biggest barriers to performance in front line healthcare workers? 
• Can you lead us through some breath work? 
• Have you studied cold immersion for autonomic health? 
• How can a resident physician optimize their sleep in a state of chronic sleep debt? 
• What is your goal with bringing WHOOP to healthcare? 

Quotes and Ideas: 

• If you want to perform at your best, you have to know your physiology and what your body needs to be at its best. 
• For an athlete, it’s often not the 2 hours of training that determines next day training capacity, but what the athlete does within the other 22 hours of the day. 
• We will be much better as a society if we can understand our physiology and how we modulate stress. 
• Stability of sleep cycles may be the most important metric for health and recovery. 
• Leaders who are underslept lead teams who report poor psychological safety. Managers rated with higher psychological safety bring in an average of 4.3 million dollars more of revenue each year. 
• Breathing protocol for decreasing sympathetic drive “the physiologic sigh”: Two inhales followed by a longer exhale 
• You can see the benefits of cold immersion with only 12 minutes of exposure per week. 
• Tips for better sleep: 
  • Keep your sleep environment cold, dark, and quiet 
  • Avoid nigh time meals
  • Avoid alcohol
  • Keep a regular sleep schedule and nighttime routine 
  • Avoid blue light before bed 

Book Suggestions: 

• Awareness by Anthony De Mello 
• Waking Up & Making Sense by Sam Harris 
• Tools of Titans by Tim Ferris 
• Thinking Fast and Slow by Daniel Kahneman