Stimulus - Learn Tools to Crush It in Your Medical Career

Most of us don’t give a lot of thought to how and when we listen to podcasts. But like most of life, an intentional approach can reap benefits. In this episode, Josh Russell walks us through: strategies for maximizing retention, listening based on brain state, new data on listening while driving, the value of silence.

Guest Bio:  Joshua Russell, MD is clinician, writer, and educator.  Since completing residency training in Emergency Medicine, Dr. Russell has had a varied career including supervising PAs and NPs as a medical director for a regional Urgent Care network, contributing to various Hippo Education podcasts, and serving as the Editor-in-Chief of the Journal of Urgent Care Medicine (JUCM). Most recently, he has completed fellowship training in Hospice and Palliative Medicine at the University of Chicago Medical Center.

This episode is in support of the I AM ALS. I AM ALS was founded by Brian Wallach and his wife Sandra shortly after his diagnosis at the age of 37. He was given 6 months to live, and now 4 years later he is leading a revolution to find a cure. People often refer to ALS as rare, which is not really so. The lifetime risk is around 1 in 300. Since Lou Gehrig was diagnosed 80 years ago, available treatments have been shown to extend life a mere 3 months. I AM ALS supports research, legislation to fast track therapies, and provides critical resources to patients and caregivers. ALS is relentless, and so are they. The question is no longer if we'll find a cure for ALS, but when. This is an underfunded disease and every little bit makes a difference. We will match donations to I AM ALS up to $5000 -- get started here on our Stimulus Donation Page. And for your daily dose of positivity, follow Brian on Twitter.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

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🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:  

• Strategies for maximizing retention of podcast content [04:20];
• How your working memory is like the RAM of your brain [08:40];
• Why Josh prefers to listen to podcasts in the morning as this is when he is best able to focus [10:20];
• The importance of using your brain for tasks that are appropriate for the state that it’s in [12:45];
• Not every interstitial moment needs to be occupied by something educational or entertaining [15:55];
• How Rob consumes podcasts [17:10];
• A recent study which evaluated the knowledge gained from listening to podcasts while driving compared to that gained from undistracted listening [20:40];
• The value of silence [24:10];
• A functional MRI study which shows that listening to a story-based podcast lights up huge areas of the brain [28:35];    
• A study in mice which found that 2 hours of silence per day led to neurogenesis whereas background or white noise didn't [29:00];
• And more.

Pediatric surgeon Ross Fisher, the mind behind p cubed presentations, breaks down how to finish a talk (teaser, it’s not a random vacation slide or you saying, “Thank you,” and walking off stage). As a bonus, he also discusses structuring a lecture with spaced repetition so your audience truly understands your message, fielding questions, staying on message, and how to (and how not to) use a script in lecture preparation.

Guest Bio: Dr. Ross Fisher is a UK based pediatric surgeon and the creator of p cubed presentations.  The p cubed philosophy, based on three core principles of message, supporting media, and delivery, has fundamentally changed the delivery and quality of medical lectures. 

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

• Presentation feedback can be hard to take and hard to give. What is the best way to do it? [03:00]; What’s the best strategy for ending a talk? [08:59];
• Tactics for handling listener questions [13:15]; Scripts are helpful when structuring and rehearsing a talk. But what is the best way to use them and avoid making the delivery sound robotic? [17:33];
• What is the best way to present data? [23:44]; Spaced repetition of the message helps people remember the important points. [26:36];
• What is meant by, “Message, not story, is the basis of a good presentation”? [28:20];
• And More.

Investigative journalist and bestselling author Scott Carney is our guest as we discuss: what it means to be human, going deep in the Wim Hof method, benefits of cold exposure, climbing Kilimanjaro without a shirt, using The Wedge to change conversations with your limbic system, kettlebell throwing, and why you might want to embrace failure.

Guest Bio: Scott Carney is an anthropologist, investigative journalist, author, and a seeker of both the fringes of human experience and the core of what makes us human. Scott has written four books to date, including The Enlightenment Trap, The Red Market, and What Doesn't Kill Us.  Most recently, he authored The Wedge, which dives deeply into understanding the space between stimulus and response. Scott's work has been featured in many different magazines -- Wired, Mother Jones, Playboy, Foreign Policy, Men's Journal, National Public Radio. He has won the Payne Award for Ethics in Journalism and is a multi-finalist for the Livingston Award for International Journalism.

This episode is in support of the Altruism in Medicine Institute, an organization founded by Barry Kerzin, a physician, teacher, author, and Tibetan Buddhist monk. The mission is to increase compassion and resilience among health care professionals and their patients. Compassion fatigue is a very real thing, especially in health care. Building your compassion muscle is one of the most potent tools not only for avoiding burnout, but for finding joy in what you do.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:  

• The common theme of Scott’s books -- what does it mean to be human? [05:00];
• Who is “The Iceman” Wim Hof and and why might cold water immersion lead to general resilience [09:10];
• The three elements of the Wim Hof method and how they relate to the wedge [15:10];
• An advantage of the Wim Hof method vs. other mind-body connection practices (like Tuomo) -- it’s fast and you can learn it in about 3 days [20:00];
• Scott’s weekly cold water immersion practice with benefits that last 4-5 days [22:20];
• Why ‘gritting it out’ is not an effective strategy for prolonged cold exposure [27:30];
• Climbing up to Gilman’s Point on Kilimanjaro shirtless and without oxygen [30:15];
• Scott’s sauna routine and the value of giving his body contrasts to adapt to new environments [33:25];
• His latest book, The Wedge, and how the wedge is activating something within yourself in order to thrive in a difficult moment [36:25];
• Using a library as a metaphor for the limbic system [39:20];
• The philosophical question -- do we experience a shared reality? [44:20];
• Applying the wedge in the emergency department when your heart is racing and you’re profusely sweating because you’re having difficulty with a critical procedure[49:25];
• The solution (or wedge) for the mental irritation that often comes with reading opinions on social media [58:30];
• And more.

Recent evidence suggests that sex to orgasm can improve nasal airflow equal in degree to nasal decongestant spray. We break down the literature (which totals 1 article).

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

High demand jobs (like fighter pilot, emergency medicine, trauma surgery, etc.) require continued exposure to the field of operations for maintenance of top level sharpness. In today’s episode we explore the phenomenon of skill decay and ways to mitigate its effects. 

Guest Bio:  Joshua Russell, MD is clinician, writer, and educator.  Since completing residency training in Emergency Medicine, Dr. Russell has had a varied career including supervising PAs and NPs as a medical director for a regional Urgent Care network, contributing to various Hippo Education podcasts, and serving as the Editor-in-Chief of the Journal of Urgent Care Medicine (JUCM). Most recently, he has completed fellowship training in Hospice and Palliative Medicine at the University of Chicago Medical Center.

This episode is in support of World Bicycle Relief -- delivering specially designed, locally assembled, rugged bicycles for people in need. They’ve developed an efficient, innovative, and scalable model to empower students, health workers, and entrepreneurs in rural developing regions with life-changing mobility. Donate here. 

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:  

• Skill decay sets in rather quickly following an absence from the emergency department [03:50];
• Motor skills, like riding a bike, decay much more slowly than cognitive skills [05:20];  
• The principles behind skill decay: cognitive load theory and cognitive overload [07:66];
• Strategies for combating skill decay [09:30];
• Rob’s approach after a short absence which centered around visualization [12:50];
• And more.

New data this week has shed light on risks associated with COVID infection and the safety profile of mRNA vaccines in pregnant patients. 

Listen on:

• iTunes
• Spotify
• Stitcher

References

Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr. Published online April 22, 2021. doi:10.1001/jamapediatrics.2021.1050 Full Text

Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England Journal of Medicine: Apr 21, 2021. Full Text

 

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We are often witness to, or sometimes in the middle of, traumatic events. Whether it’s a mass casualty or cumulative stress over time, our nervous system can get stuck in an upregulated state. In this episode, we break down: training to handle stressful events, protective strategies to employ during and after traumatic events, the physiology of PTSD, specific techniques to downregulate your nervous system and getting to a place of equanimity.

Guest Bio:  Ryan Cheney is a mental health therapist, breath work, and performance coach based in Bend Oregon. Our guest on Stimulus Episode 5: The Art of Breathing, Ryan is a thought leader in the field of wellness for health care professions. You can contact him here for further questions and consultations.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:  

• The Las Vegas mass casualty and the wide range of emotional responses of those who were involved [03:50];
• Trauma is different for every nervous system -What’s traumatic for one person may not be for another [05:50];
• Training to handle stressful events in a better way [08:15];
• What’s happening physiologically when you have PTSD after a traumatic event [10:40];
• Strategies that are protective of your nervous system DURING a traumatic event [14:20];
• The importance of PRE-TRAINING so that you have tools to down-regulate your nervous system in the moment [19:20];
• Protective, positive strategies that can be used AFTER a traumatic event to reduce the risk of PTSD [25:50];
• The role movement plays in down-regulation and why dosage matters [31:40];
• The benefit of EMDR (Eye Movement Desensitization and Reprocessing) and other body-based therapies for processing acute trauma [35:10];
• The process of intentionally letting go, or “cutting strings”, when something is weighing heavily on you (such as a client, patient, etc.) [37:30];
• And more.

The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed an underlying mechanism, CDC and NHS recommendations, and a primer on cerebral venous thrombosis -- the primary clot site associated with VITT.

We Discuss:

  Vaccine induced thrombotic thrombocytopenia (VITT)   The similar mechanism of AstraZeneca's and Johnson & Johnson's COVID-19 vaccines [01:00];   Proposed mechanism of VITT [03:20];

• Greinacher, Andreas, et al. "Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination." New England Journal of Medicine (2021). PDF
• Brief Report: Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination PDF

  Types of clots associated with VITT [04:00];  

• Below is a breakdown of the first 6 US patients with reported VITT. Note that they all ended up having cerebral venous thrombosis, but half of them had additional clot locations. Image source CDC.

  Incidence of VITT in the US and UK [05:00];  

• A frequent question in the conversation of this newly recognized phenomenon is, "How is this different than the regular background rate of disease? Isn't this consistent with the number of people who would get it anyway?" This CDC graphic suggests not.

     

• In the UK, there have been 79 reported cases of VITT, over half with CVT. Like the US, there is female predominance.

  The CDC rallying cry to treat this differently that other causes of cerebral venous thrombosis (CVT) [06:30];  

• Image source CDC

CDC and FDA Statement Here   The Guy and St. Thomas UK algorithm for evaluating and managing patients with suspected VITT [08:00];     Thank you to St. Emlyn’s for posting this doc!   A primer on CVT   Why CVT can cause problems [10:30]

• Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).

  Presenting symptoms of CVT [11:00]

• Headache is present in 90%, meaning it's common, but also means that 10% won't have headache (at least initially).
• 25% present with headache alone, but the majority also have another sign or symptom.

• Image source Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).

  Physical exam findings and the sensitivity of papilledema [15:00]   Using D-dimer in the evaluation of CVT [16:50];

• Ferro, José M., et al. "European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis–endorsed by the European Academy of Neurology." European stroke journal 2.3 (2017): 195-221.
• Tanislav, Christian, et al. "Cerebral vein thrombosis: clinical manifestation and diagnosis." BMC neurology 11.1 (2011): 1-5.

A new clinical score for CVT [19:00];

• Heldner, Mirjam R., et al. "Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels." Neurology 95.7 (2020): e898-e909. Full Text
• Image source Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).

Utility of spinal tap as a rule out test [21:00];     Imaging options (CT venogram vs MR venogram) [22:00];     CDC treatment recommendations for VITT associated CVT and how it’s different than most other CVT’s [25:00];

• CDC full slide deck Here

  Testing patients with VITT for heparin-PF4 antibodies and how that may guide whether or not to use IVIG [26:35].  

• PF4 HIT antibodies are a common finding in VITT, consistent with the current thinking that VITT is a variant of HIT. Image source CDC

• CDC recs for testing and IV IG treatment

  Refs Padmanabhan, Anand, et al. "IVIg for treatment of severe refractory heparin-induced thrombocytopenia." Chest 152.3 (2017): 478-48

The August 4, 2020 explosion in Beirut, Lebanon is thought to be one of the most powerful artificial, non-nuclear explosions ever, causing over 200 deaths and 7500 injuries. In today’s episode, we walk through a firsthand account of what happened during this mass casualty event from the lens of an emergency physician who was there.

Guest Bio: Sarah Abdul-Nabi, MD is an emergency medicine resident at the American University of Beirut Medical Center.  She is the author of Airway Breathing Circulation: An Emergency Medicine Resident's Experience of the Beirut Explosion.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

• The moment of the Beirut explosion, when the ceiling started to fall in, the room started to shake, and then everything went dark [04:40];
• Sarah’s first patient, and then the deluge that arrived within 2 minutes [07:10];
• The initial chaos of managing a mass casualty with minimal light, no electricity, and a damaged ED [11:10];
• Being unable to stop chest compressions on a young woman with a brain hemorrhage, even after your attending tells you it’s futile [16:15];
• What it was like to go back to work 2 days later and why Sarah needed to take a couple weeks off to recover emotionally [21:10];
• The catharsis of debriefing, staring at nature, and journaling [23:30];
• The unbearable fear and self-doubt that were part of her recovery [29:00];
• Reflective solitude vs. isolation [31:30];
• And more.

Our ego is always on patrol and, when it’s insulted, watch out! That is the core of what it means to take things personally. In this episode, we break down: how to not take things personally, sustainable happiness, using body language to transform our internal state, why some insults hurt and others do not, and specific scenarios where you might feel insulted (but don’t need to be).

Guest Bio:  Frederik Imbo is the founder and head of Imboorling, a company dedicated to improving communication on both the micro and macro levels. Frederik is a formally trained actor with a masters in dramatic arts from the Royal Conservancy in Ghent and was a prolific actor on numerous television series.  During his acting career, he began taking roles working in training videos for interpersonal communication. The insights from those role-plays resonated with him and set him on a path of many years of study and training in neurolinguistic programming and nonviolent communication. Over time, fostering communication has become his life focus and led to the founding of Imboorling.

Frederik’s TED talk on how to not take things personally has been viewed 6 million times.

Awake + Aware | Our 2026 Retreat

Join us at Awake and Aware, our 3-day retreat in Scottsdale, AZ. March 1-4, 2026. Space is limited.

Learn More Here

🎓 P.S. This is a CME event.

The Flameproof Course

The hidden anti-burnout curriculum we all should have learned in training. Cohort 3 begins Sept 10, 2024. Get the deets

For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

• The barrier to sustainable happiness and the technique to overcome that [04:15];
•  Frederik’s strategies for preparing to speak publicly [06:40];
• How becoming a soccer referee helped him strengthen his muscle of not taking things personally [12:04];
• What it means if you feel hurt after receiving criticism [15:44];
• The fact that thinking negatively is natural [22:46]; 
• What you can do if you’re being dragged down by negative thoughts [24:10];
•  Body language and how that can affect your mood and self-confidence [26:30];
• The difference between being called an orange and being told you’re selfish [28:36]; How Frederik reframes when he feels himself taking something personally [30:20];
• A choice -- Do you want to be right, or do you want to be happy? [36:05]; Using empathy to manage conflict with a consultant in the emergency department [39:45]; Strategies for not taking it personally when you receive a poor patient satisfaction score or Yelp review [44:00]; Handling a scenario where your best friend forgets your birthday [48:45];
• Why when giving gifts, be more like of the sun -- not expecting anything in return [52:25];
• If Frederik were to design a bumper sticker [55:30];
• And More