Good afternoon, everyone. Welcome to our in-training sections session on the first job curriculum, moving from a trainee to faculty member. This is one of the most taunting tasks that face trainees as they're moving into a faculty position and they're trying to find a job that fits you best. So we have a fantastic panel of speakers today to kind of give their thoughts and guide us through this process. Our first speaker today is Dr. Wendy Green. She is an Associate Professor of Surgery at the Emory University School of Medicine. And she is the Director of Acute and Critical Care Surgery Service at the Emory University Hospital. And she is going to talk to us about identifying your niche, whether it's quality, safety, research, education, or administration. Dr. Green, thank you so much for joining us today and welcome. Thank you very much. Thank you. So I'm going to start off by, one, thanking the program committee for this opportunity to present before the in-training section. I'd like to see which in-training people who are here, are you associated with a medical, pulmonary, surgical field? Anybody? Pharmacy? APP? OK. Nursing? OK. So everybody, I think, can use this information as we make transitions. And you can imagine, you're making transitions all throughout your life and your career. So I feel like this is apropos. And you'll be using this information over and over again. One of the things about identifying your niche is, if you start thinking about quality and safety as your backdrop for how you want to improve patient care, it then could lead you into opportunities to study the problem. And that's where research could come in. And as your research becomes consolidated and you find ways to implement your research in changing the outcomes for your patients, that's where you educate others around you. And as your education of others, your peers, then needs to rise up to the level of the system, you now have become an administrator. So you can take one idea and one set of passions that can lead you along a continuum into many different directions. So which career choice fits your personality? Are you a nurse, a physician, an advanced practice provider? Where are you in your career? Are you somebody who likes to communicate? Communication is key in any position that you're in. And working on those skills and having a trusted mentor who can give you that feedback or a peer who can hopefully pull your coattails and say, you could have maybe said this in this way and gotten a better result. You may be interested in learning medical and business vocabulary. And these sets of skills are also helpful. You may have a bent towards data and analytics and using that to drive care plans. You may just like to ease pain and suffering, which is a noble profession, which is why we got into medicine in the first place. Everybody wants to try to ease pain and suffering. And maybe you like the hands-on interaction, patient interaction. And so maybe the administrative piece right now may not be the place for you. But eventually, as your personality style develops or changes, you may grow into these different professions. So why quality? Well, if you invest in quality, improvement, and education, you can minimize diagnostic errors, minimize therapeutic harm. You can improve the value and outcomes of care. It also allows for efficient critical care delivery and immediate benefits to patients. We realized back in the early 1990s, the late 1990s, that we are human and we are prone to error. So if we want to be more deliberate about our care delivery, we may want to have more precise and use precision medicine or use our novel artificial intelligence algorithms or big data to try to help bring together as much information as possible to help in those areas between the train platform and the train station, those gaps in knowledge so that we don't misstep and accidentally injure and harm our patients. What should we study? Mortality? Maybe not so much. Mortality sometimes is so elusive. And making big changes in that area may be a little harder. But there may be some other things that are just important. Just like the young lady who sang this morning. It wasn't just living or dying, but maybe it was keeping her vocal quality. Maybe it was being able to go back to school and enjoy living with her family and having a better quality of life. Maybe it's truly identifying and providing a quality of death experience that is also meaningful for patients and their families, more importantly, as patients transition from here to the next. Quality of relationships. That's something else that we forget sometimes, whether it's the relationships between the patient and the practitioner. But what about the relationships of the patient and their family and those who are working in the health care environment? Or the health care workers, how we interact with one another? How do we work on those relationships? And there's other things that we can study like variations in practice of care and trying to limit and minimize that. There's so much data about what we should do, but we have not been able to permeate enough of those barriers and actually get everybody to do it. So we keep talking about it and talking about it and talking about it, come up with another guideline, and then we talk about it some more. But it's like, OK, at some point in time, when are we just going to stop and say, let's work on trying to actually get it from the papers and the journals to bedside practice. Let's just think about doing that. So if you think about the Center for Translational Research and Implementation Science, their goal is to foster and support research to identify best strategies for successful integration of evidence-based interventions, quality improvement, dissemination, and implementation. And this is a good way for you to get your arms around and get involved in organizations that can help fund your research ideas and you to be around different thought leaders who are trying to work on this implementation science to reduce the length of stay, medical errors, preventable adverse drug events, omission, and limit and decrease waste. So what have we learned from the anesthesia literature? Despite them having, over a 50-year period, only one negative randomized controlled trial, a negative trial, they have been able to improve their safety standards. So it wasn't that you have to get a randomized controlled trial out there. You can use other ways of methodology to try to introduce safety standards, improve training, integration of the human factor. And they were able to decrease their mortality from 64 to 0.4 deaths per 100,000 cases over a 50-year period. And none of it was because there was a randomized controlled trial that led them in this direction. So you can look at problems every single day. You're complaining about it anyway. You see all the problems, right? So take it away from the water cooler and bring it into action. Get a few friends involved. Make it multidisciplinary. Make sure that it can gain feet and energy because of your interest in this. Be the champion for change. It's a time for a revolution. It's a time for a revolution. We have reached a dead end. We need new thought ideas. It needs to be interdisciplinary. And we need to determine the best methods of clinical practice. There are opportunities in health services research, pragmatic clinical trials. You can develop a culture of safety through teamwork, communication, compassionate, and patient-centered care. It does begin with a process, case review, peer review. You can look at databases and registries, clinical practice guidelines, and try to implement them. So as you take this information, you can now think about, OK, I'm going to start my implementation science career. Well, maybe I want to use that and then become a health educator. I want to share this information. There are ways to get educator certificates. You can lecture locally and at national courses, be involved in the course development, getting on the program committee, making sure that you get your submission in before the March deadline to apply. And then the incoming president will, over the summer, then put your name into different committees. So first, nobody's going to know that you want to do something unless you actually apply. So make sure you get your application in to the Society of Critical Care Medicine so that you can get on these different committees and have a voice and be heard at the table. There's also opportunities for team training and simulation at your institution or on different SCCM committees. Simulation-based education is a really great opportunity where you can teach teams and technical and non-technical skills. And this is an important one as you transition of your practice, that you have a safe environment and allows you to increase your preparedness in a safe way. So you can go, if your institution has that, and practice your simulation. Like, how are you going to talk to your team member or your non-team member in a way that gets the job done when you're in a critical event setting? Think about that and how you would like to have practiced that maybe a few times before you were just let out. Or now that you're transitioning to your next level and you're the team leader and everybody's coming to you and everybody has demands of you, how are you going to keep your buttons from being pushed if you haven't practiced it? How are you going to practice? Let me just take a step back before I address somebody in a way that may burn a bridge down the road. So these are all opportunities to think about as you transition to your new role of authority how you will be, or leadership, how you will be evaluated and judged. You want to try to look, as a health educator, how you can deconstruct clinical work patterns and problems. You want to focus, help people focus on a mastery of skill sets, whether it's communication in a multidisciplinary team, speaking up, prioritizing patients, handovers, and breaking bad news. Those all give the new transition practitioner a little raising up of hair on their back sometimes when the buck stops with them. So you want to be able to practice these scenarios and talk with a more senior colleague to try to help you through those different scenarios. As you develop these different opportunities, you want to, if you're developing a simulation opportunity for this training, you want to be able to measure their performance. You want to provide focus, educational attention for areas that need more attention. As a global health educator, there's opportunities for you also. You can take your, through SCCM or through your own institution, you can become a global or regional health educator. You can take the knowledge that you have and share it with others. Use that implementation science to permeate into the community. Increase an awareness and appreciation of cultural differences at the same time. As we work with people who are under-resourced and often may not have had as much of exposure to some of the things that we take for granted, it's an opportunity for you to give back and have an appreciation for what you do have. It also will allow you to prioritize your professional values and provide a lens for addressing global health care challenges through public health policy and advocacy. So this may be another opportunity for you as you look at your national societies how you can get involved. They are always, all organizations, are looking for somebody who will be an advocate to help raise funds. They're also looking for the next generation of people to communicate what's going on through different modes of technology. So that may be your informational technology, being social media aware, and being a part of that gap or that deficiency that some societies have. So let's talk about now the health care administrator as a profession. Well, there's certain skills or assets and non-clinical skills that you should have. As you're going to develop as being a supervisor, you're going to have to handle complaints, a lot of decision making, delegation of duties, managing conflict, and then providing feedback. Assimilation can help you with that as you practice these complex team-based activities. Now, health care administration has been around for a long time. And it has moved from the physician-based to a lot of nursing leadership and advanced practice provider leadership because they're working, we're all working in the system together, and they can see, we can all see, opportunities for improvement. So as we communicate as a health care administrator, you have to be able to communicate with your peers and patients and be able to talk that language. So when you're talking with a patient who is non-clinical, you need to be able to change the jargon to something that people can receive. Communication is based upon the person who's receiving, because if they don't receive it, they don't get it. You also have to be knowledgeable about health care law. You have to be able to implement regulations, keep up with evolving technology, plan, direct, and coordinate health services, data analysis skills, and business development. As you provide maybe department oversight or system oversight, you have to coordinate and lead meetings. You'll be the face of the organization oftentimes and have to have good communication skills through email and verbally. The qualities of an effective administrator is often nimble in their communication styles between these different groups. So as you build on your clinical expertise, you want to learn about the business of health care and consider executive leadership courses that may help improve your opportunities and exposure to these areas. So maybe you don't want to go into health care administration, but maybe you want to look at health care science and research. These people will examine how people get access to health care, how much care costs, and what happens to patients as a result of care. They'll gather empirical data, develop research instruments, methodologies, policies, and operational decision making. Their goal, hopefully, is to organize, manage, finance, and deliver high quality care that reduces medical errors and improves patient safety. And your focus can be, once again, international, national, state, county. It can be very broad or to a specific subgroup of patients that you're interested in studying. Be mindful that when you go to your next job or you're transitioning, look for opportunities to collaborate. You can't do it on your own. Find out who already has funding. Go to them. It may be the epidemiologists, the engineering department, education sociologists, health economists, technology or biostatisticians. These people need to be a part of your team, and you need to seek them out. Go on the website from where you're going to be working if it's an academic environment, and look at their web pages and see what they're doing within their departments. And as you reach out to those people to see what collaborations, because they need you because you are often at the bedside, and they need your knowledge. So they are looking for your collaboration as much as you need them. So don't be afraid to go outside your health care box and look for other collaborators in other areas. Other agencies that can help you, the Agency for Health Care Research and Quality is a great resource. So as you look at what health care career path may fit your personality, there's a couple of questions that you may want to ask. There's no wrong answers unless you don't answer truthfully. Some of these tests allow for a 360 degree evaluation and feedback from others, because you have one vision of yourself, and others may have another vision of you. So it's helpful to get somebody else to kind of come back around and give feedback and answer questions about you, hopefully in a truthful manner also. So these are some of the personality tests. The one that I'm just going to focus on briefly is the DISC profile, where you look for, is your personality more of a dominance, influence, steadiness, or conscientious type of person? And these are some sample questions that you can answer for yourself right now. I can be pretty forceful with my opinions, graded on a scale of 1 to 10. I love meeting new people. People think of me as a really good listener. Accuracy is a priority for me. I am bold. So as we look at the dominance, this is a person who places emphasis on accomplishing results, the bottom line, and has a lot of confidence. They see the big picture. They're blunt. They accept challenges, and they get straight to the point. If you're an influencer, more so, in your personality, this person places emphasis on influencing or persuading others. They're open, and they like relationships. Their behavior is such that they show enthusiasm. They're optimistic, likes to collaborate, and dislikes being ignored. Steadiness. This person places an emphasis on cooperation, sincerity, and dependability. They don't like to be rushed. They have a calm manner and a very calm approach and very supportive in their actions. In the conscientious part of the DISC profile, this person places emphasis on quality and accuracy, expertise, and competency. They enjoy independence, objective reasoning. They want the details, and they fear being wrong. So as you think about these different personality types, where you lean towards in your transitions, just remember that communication is key in whichever career transition path you decide upon, and I wish you all the best. We'll take questions at the end of the presentations. Thank you very much. Thank you. Thank you, Dr. Green. That was a fantastic talk, in fact. I have a lot of questions myself, but like Dr. Green mentioned, we'll save them all towards the end so that we give all our speakers a chance to be done with their presentations. Next up, we have Tony Gerlach, who is our speaker from Ohio State University College of Pharmacy. He received his BS in PharmD from there and a specialty residency in cardiology. He moved to the surgical ICU over there and maintains an active clinical practice. Dr. Gerlach is a clinical associate professor and has published over 50 articles in peer-reviewed journals, three book chapters, and contributed to over 70 abstracts. He serves as a reviewer to multiple journals and it is truly our privilege to have him here to share his thoughts with us and to take this conversation forward. Welcome. Thank you, everyone, for having me here. It's a great honor and pleasure. And it's nice that Wendy gave her talk because I'm sure all my friends and colleagues on council over there know what personality type I am. I'm the silent one, right? That's a big, fat lie right there, right? Am I missing? Let me just go over here. Oh, am I going? Oh, there, I went the wrong way. Sorry. So the first thing is I really have nothing to disclose other than I started traveling and this was Portugal last year. And kind of the blue sky reminds me of what it's actually like today. So I want to thank you guys all for being here because I know we'd rather be outside. But I think as we get out there and really try to figure out where we want to be in the next five years, we do really have to take a hard look. And if you also know me, I do like to laugh. So the other thing I would like to disclose is for the past 20 years, I've worked at an academic medical center. And I tend to think of an academic medical center as like an onion. It has a lot of layers and you have to learn how to cut through the layers to get things done. And sometimes when you cut through the layers, that makes you cry and sometimes it's sweet. And so hopefully we can learn how to make our onions sweet. But working at these medical centers out there, it can be disheartening because I'm not going to say it's all rainbows and puppy dogs at my job. And some days are a lot harder than others. So as we get out, I think it's good to go eyes wide open and really look at what you want to do and what your goals are. But before we start, I want to see how many, with a raise of hands, are actually physicians in this room. And I know there's some of my pharmacy colleagues. So how many are people in pharmacy training? Very good. Are there any nurse practitioners or PA, advanced practice providers in here besides Lauren? Because I did want it to be inclusive as well and have some slides out there. I think since the majority is physicians, which is one of the ideas, I think there's mounting pressures going now of what you're seeing in the last 20 years or so. When you see these small medical practices or groups are actually starting to go away. And I'm sure on the graph on your left, you see there's a significant decrease in these either two-person or solo medical groups. And at the same time, for a variety of reasons, you see that having a hospital or a medical group and really seeing that a lot of the bigger institutions are buying up practices is continuing to rise. So I think that's also the question. Do you want to be your own boss and manage a lot of people under you? Or do you want to be part of a group? And I think that there's pros and cons to both any sort of academic or private practice when you look at that. And I think especially for the private practice, you have to balance independence and balance. And I think one of the things that goes to me is relate to other people. And one of my friends, he actually is a law partner. But I do think it makes sense. His law partnership was originally three people and went to two. But as they went down to two and with the balance, he's had to become the IT person for their small business and pick up all the spots. And so if you're in some of these small practices, although you might have more control over a lot of the decisions, there's a lot of time restraints and stuff that you might not want to do, including payroll. Who's going to be doing some of those issues? Who's going to be managing all your IT scheduling and stuff that you need to think about? The nice thing about private practice is there tends to be, and especially in the area of pharmacy starting out, there's a higher ceiling and pay growth potential to keep in mind. And unfortunately, going to school nowadays is a lot more expensive than what it used to be when I went out there. So that's something to think in time. But you also have to balance that with the high cost of time that you might have to put in, especially as you're starting out and growing in your position. So it's something to keep in mind. And I think, too, in the private practice, you might have a little shallot you have to learn to cut through versus a big two-headed onion that I tend to have to cut through some days at work in Ohio. So there might be a little bit better with the lack of institutional controls that you see there versus an academic medical center. In addition, I think for all of us, one of the things is how is this going to affect payment and major changes in health care? And are we going to see changes in actually our health care in the near future with what's going on in Washington? And I think that's going to probably put those small and private practices at a little bit more disadvantage, at least because they're going to have to be constantly changing and might not have some of the support that the bigger academic medical centers do. In addition, with the academic medical centers, you have this growth and stability of them, which is nice. You have more infrastructure. And I think that's going to have these less time constraints on doing some of those parts. But the infrastructure is not really constant across all, even departments within your hospital. And so some things I can say that affect the physicians or the surgeons that I normally work with don't get transmitted to the APPs or the pharmacy or even the pulmonologists. So all that infrastructure sometimes isn't consistent. And while salary is more consistent, there's also a big push for other funding. And is that something that you really want to look at or not? And then I think balancing all your time for your clinical care, doing your research, doing your scholarship, and everything, and teaching, as Wendy said, is also a major constraint. For my pharmacy colleagues here, I think there's a little bit difference in this community medical center versus the academic medical center that we tend to see, too. But it has some of these issues as well. Community hospitals tend to be less saturated, which right now is going to make it easier to get a job. But there's also less mentorship opportunities. And I believe Jeff is going to be speaking on mentorship in a little bit. So I'll let him talk a little bit more about it. And there's a much bigger clinical focus. But as you get out, and we were just talking a little bit ago, as you get out in this five to seven year period, you have to grow with your job for the most part, because you kind of get a seven year itch. And the smaller community hospitals might not have the resources to help you grow into your profession over time. The community hospitals, though, might have a little bit more interaction with a variety of health care providers, but less educational opportunities. And when you look at an academic medical center, the nice thing is there's a lot of education and resources. We have a lot of resources, but I think it's a lot more saturated, especially for ICU pharmacists. And sometimes, if you don't have this dominant personality like I probably do, you might be a little bit easier to get lost in the crowd. I think at the academic medical centers, there's research opportunities, but you have to combat with all your precepting and teaching activities as well. And it's one of the big questions to keep in mind is, how much do you have to precept and teach, and when does that start? I think resources and time constraint are very appropriate, too. Now, when you talk about the advanced practice providers, sorry, Lauren, since you're really the only one in this room, and I'm pretty sure you have a job, it's really very similar to what's out there, but I know there's on demand. Out there with the pharmacists, I think that there are a little bit different opportunities, too. I think in a community hospital, it is less saturated, but the downside is the less mentorship opportunities. And then the academic medical center, I think you have a lot more resources, but on the downside, it's the difficulty in your own decision making, because there's a lot of committee structures associated with that. And as especially a lot of advanced practice providers are relatively new, there's sometimes difficulties in affecting the practice model there, and how to actually evolve that practice model, and really cutting through that onion and learning how to navigate it so you can make it sweet and not make you cry. Now that kind of comes back, and what can you do? And unfortunately, I can't tell some of our residents over here what jobs they can look at. Only you can decide. I think one of the best things is really look at what makes you happy, and where you really do want to see yourself in the next five to 10 years. And really look at what is the best for you. And I think when I was looking for advice, my good friend and preceptor actually said, Tony, you know you have this job, but go out with an open mind and see what's best for you. And I think that was one of the things that I did take to heart. And go out and see what opportunities you have, and do they align with where you want to be. And Kerry gave me the best advice when I was actually looking for a job. And I think some of the things to keep in mind is really assess your long-term career goals. Where do you want to be in the next five to 10 years? And really, what are your needs and interests? I think this will also help align with burnout that's starting to be more and more recognized, is we need to make sure that what we do really corresponds to our values and our visions. Assess what are musts for your career. I think it was interesting when we were listening to the pharmacy forum yesterday, at least 20% of the time you have to do stuff that you really do like, and you can put away with at least 80%. But assess what are the 20% of why you went to school, why you went to be a healthcare provider, and focus on those. Go out and take some tours, and really meet with other healthcare providers. Not only people in your own area, pharmacy and pharmacy, but the other people you're working with as well. The nurses, the pharmacists, the respiratory therapists, and to really assess the culture at that institution. And really write down the pros and cons of each job. Unfortunately, there's no perfect job, and I think most of my colleagues will say that, but what works best for you? I'd like to acknowledge my friend Cindy Bird, who helped me a lot with the APP section of that. And I think I'm all done, and it'll be up for our next speaker. So thank you very much. Thank you. Thank you, Tony. Our next talk, it's a great segue into our next talk, it's about mentorship. We can all agree that mentors play a very, very important role in the success and careers for all of us. So our next speaker today is Jeff Barletta, and he's going to talk to us about how do I identify the correct mentor for me and how do you build a successful mentor-mentee relationship. Jeff is a tenured professor and he's a vice chair of pharmacy practice at the Midwestern University of Phoenix, Arizona, and he's a current member of the ACCM Council. Thank you so much for joining us here and giving us this talk. Welcome. Well, thank you for having me here today. You know, I've been lucky over the course of my career that I've had several great mentors and I've also had several great mentees. So my plan today is to kind of share some of my experiences and provide some insight on identifying a mentor, but then more so how do I build and maintain that relationship over the course of your academic career. So the origin of mentorship actually begins over 3,000 years ago with Homer's epic poem The Odyssey, and if you can recall from The Odyssey when Odysseus goes to fight in the Trojan War, he entrusts the care of his son to his good friend and colleague whose name was Mentor, and unexpectedly Odysseus is gone for over ten years, so Mentor becomes sort of this father figure and the two build a very strong relationship built on the foundation of guidance and support. And if we look throughout history, there are many, many examples of successful mentorship relationships. So here you see Socrates and Plato, Bach and Mozart. If we move to more modern times, Warren Buffet and Bill Gates, and then in my opinion what I think the textbook example is of a mentor-mentee relationship, Mr. Miyagi and Danielson. But there are also some examples of what I would call not-so-successful relationships. So pictured here are Drs. J. McLean and William Henry Howell. Does anybody know who these individuals are? One of these two is the discoverer of the anticoagulant heparin. So as the story goes, J. McLean was a medical student at Johns Hopkins University and he was working in Dr. Howell's laboratory. He was working with canine liver and he discovered a substance that had very strong anticoagulant properties. Well, he then went to leave Howell's laboratory, went to University of Pennsylvania, and then a few years later came back to Johns Hopkins. But his research focus had shifted from anticoagulants to procoagulants. But in the meantime, Howell and his laboratory continued along the anticoagulation pathway and he claims to have discovered a different compound that had strong anticoagulant properties, which is now known as heparin. So prior to the 1940s, Howell was credited as the discoverer of heparin. But when he died, J. McLean launched this campaign that it was actually he who discovered it. So to this day, I don't think we really know who was the true discoverer of heparin. You can see how this relationship became somewhat messy. So how do we define mentorship? If we look at the simplest definition from the dictionary, it's just a trusted counselor or guide. But I think the whole concept of mentorship goes far beyond that. It's much more complex. In fact, if we look at the literature, there's more than 50 different definitions of mentorship. If you take all of these definitions, however, and compare them, you'll find that they're all built on the following three pillars. They're focused on the growth of the individual. They include broad forms of support, not only professional and career advancement, but psychosocial as well. And these relationships are reciprocal. So this is one of the definitions that you'll find of mentoring. It's one of the more common definitions and it's rather long. You can read through this, but what I would like to do is highlight what I feel are some of the important phrases in this definition that really distinguish mentoring from some other forms of guidance. So mentoring is informal transmission of knowledge, social capital, and psychosocial support. So it's not formal. That would be direct instruction or teaching. It's informal. Here we see knowledge, social capital, and psychosocial support. So not just knowledge. It's maintained over a sustained period of time. So it's not just a short relationship where that would be more coaching. And then finally it involves two people where one has a greater relevant knowledge, wisdom, or experience. So not necessarily somebody that's older because age doesn't necessarily define mentorship. It's more so related to knowledge and many folks in your peer group can serve as mentors depending on the area of mentorship that you're seeking. So there are two primary functions or categories of mentoring. I like to divide these into career functions and then psychosocial functions. In order to have mentoring, you have to have both. If all you have are career functions, well, that would be something like a program director. If all you have are the psychosocial functions, well, that's more like a friend. So let's look at the different phases of mentorship beginning with initiation. That lasts about six months to a year. And this is your honeymoon period per se. Everything is sunshine and rainbows. The mentor is really excited because they have somebody that they can bestow their wisdom on. The mentee is excited because they really want to work hard to impress their mentor. After about two to five years, we see the cultivation period. And during this time is when reality sets in and the two build their relationship, but the goals are somewhat realistic. Their relationship grows in terms of strength. At first we see the development of some of the career functions and then later on some of the psychosocial functions of mentorship. Now the third phase is the separation phase. And separation can happen for a lot of reasons, but this is typically where the mentee wants their independence. They feel that perhaps I don't really have anything to learn from this mentor and it's time to move on. I would caution you during this phase, I think it's important to recognize that independence is important, but we need to power through and get to the fourth phase, redefinition. Because one thing you'll find is that early in your career your needs for mentorship are going to be in vastly different areas than what you'll find later on in your career. So you really want to work hard to not sever these relationships. Again I understand independence is important and it's one of the four phases, but we've got to move on to that fourth phase, which is redefinition, and that's where you assume more of a peer-to-peer type relationship or a friendship. So here's an example of the continuum of mentorship. So when you're in training, your mentors largely serve as academic advisors, helping you with clinical problem solving and decision making. We're going to hear in a minute about selecting your first job. Mentors can be useful once you start your career with certain challenges, dealing with different personalities. Largely they'll fulfill the role of helping you build your portfolio, so you're ready for promotion. Now let's say you're promoted to a terminal rank and you're tenured, is there any need for mentorship? Again, we talked about independence, but you'll find that your needs moving forward in your career are going to be very, very different. And just like the game of life where you have different twists and turns, your career will do the same thing. Oh, that's a board game by the way. My reference here may be a little outdated. At least for myself, when I started as a clinician, again, it was all the career building. And then the longer you do something, you'll find that your responsibilities change and maybe you pick up more administrative responsibilities. You're asked to chair a group or maybe you become a program director. So then you need mentorship more so on the administrative front. All of us speaking today are highly active with the society. So I know for myself, mentorship was an important part with just navigating that pathway. And if you would have asked me 20 years ago would I have ever needed mentorship in something like this, it wasn't even on the forefront. I didn't think about it, but obviously now it's very, very important. So the point of this is your needs will change as your career evolves. So don't sever those relationships. Keep them moving forward. And you may not have to rely on your mentor as much in the latter phases of your career, but they're very, very, very important. So when you're searching for a mentor, it's important to know what you're looking for. And there are five different types of mentors. The first is the master of craft. And this is your go-to person for all clinical decision making. Since we're in Walt Disney World, this is your Yoda, per se. The second type of mentor is the champion of your cause. This is the person that's shouting your claims from the highest mountain. And all of your speaking opportunities, all of your opportunities to serve on different committees and professional societies, well, that comes from that individual. And often, the champion and the master of craft are one in the same. The third type of mentor is the co-pilot, and that's your BFF. This is somebody that you go to vent, and this person fulfills more of the psychosocial roles of mentorship, as does the anchor. And the anchor is the person that kind of gets you through some of those tough times. So now we see a transition from the career functions of mentorship to more of the psychosocial roles. And most people have multiple mentors that will fulfill each of these, but it's important to consider all of these functions and exactly what you're looking for. The last type is the reverse mentor, and this is simply the devil's advocate, the person that gives you that constructive criticism so you can improve and become better. So here's a list of some of the qualities of the ideal mentor, and you'll find laundry lists of qualities of the ideal mentor. I kind of like this one because it spells mentor. And I always thought this was a good starting point when you're trying to develop that short list of people to choose for a mentor. If you had to ask me which one of these do I feel is most important, they're all important, but I would say empowerment and encouragement. So once you have that short list, we need to narrow it down and make a final decision. So here are some tips for finding that mentor. You have to know what you want. If you're looking for a research mentor, well then obviously you want to find somebody that has a mutual interest. Now that being said, it's important that your mentor supplements your needs, but also complements. So don't necessarily look for a carbon copy of yourself. Look up, but then also look to your left and to your right. Remember, you have the career functions of the mentor, but then also the psychosocial, and they're both equally important. A good mentor should be an effective listener. And then finally, it's about the person and not necessarily their position. So you want your mentor to be accessible. You want them to have the time to spend with you. And again, if you're looking for a research mentor, you want somebody that has actually done research and is knowledgeable, but it's not always the person with the thickest CV or with the most publications or the most grant dollars that serves as the best mentor, because you've got to think about it. How did that person get to that point? Because they're very, very busy. And are they too busy that they're not going to have any time for you? So although they might have that knowledge, they might have the respect, and they're trusted, they have to be accessible. I think if you break it down and you ask these four questions, this can be very helpful with making that final selection. So once you've chosen your mentor, you have to have your initial meeting. This is very, very important because it really establishes guidelines for the relationship. So when are you going to meet? How often is that going to be? What's the best method for communication? If your mentor uses a flip phone, texting may not be the best form of communication. It's important to ask, are drop-ins acceptable? And I think here's where you really have to navigate some of the generational gaps with what's considered to be acceptable because some people have an open-door policy, other people prefer appointments, and again, you want to make sure that you start off on the right foot with that relationship. So establishing boundaries and expectations is very, very important. When you have that first meeting, you have to discuss, are we going to have a fixed agenda and what's that going to be? And I'm an advocate of fixed agendas because I think when you just get together and you start talking, your conversations can be kind of all over the place. And then at the end of the meeting, you sit down and it's like, well, what did we really accomplish here? And it's like, well, you know, we talked about football and baseball and then I saw this movie and it was really good, but it didn't really amount to anything. So there's a lot of different ways to make an agenda here. Perhaps you can start out with the first five minutes of your meeting being more of the check-in, how are things going, focus on some of the psychosocial issues with mentorship, and then moving on, short-term goals, long-term goals, and then any actionable items. It's important to discuss expectations. Usually when relationships fall apart, it's because the expectations for one party are very different than the expectations of the other party. And then finally, how will success be measured? What are your goals and objectives? And if you have a goal, write it down, okay, and put it somewhere where you have to look at it every day as a reminder, because, you know, we all say we're going to do things and then you get busy and guess what, it kind of falls by the wayside. But if you write it down, this is my goal, and every day you look at it as a reminder, you're more likely to get it accomplished. Now maintaining that relationship often falls on the mentee because there's not a lot of mentors that are going to go running around asking you, is everything okay? So the mentees are very, very important in this aspect. The best thing that I can tell you is just respect each other's time, right, and that goes both ways. Come prepared to meetings. Follow through on commitments and assignments. Be flexible. You know, things happen, and if we have to cancel a meeting, it's not the end of the world. That being said, if there's nothing to talk about, it's okay to cancel the meeting and say, listen, no, I don't really have anything to discuss. You've got the gift of time. So be respectful of each other's time. Be open to criticism. You know, your mentor, remember the five roles of the mentor, and one of them is to play the devil's advocate and provide you some constructive criticism. And then most important, maintain confidentiality, right? You and your mentor, you enter that circle of trust, right? And this is the one thing that can completely destroy a relationship because you want to be able to open up to your mentor and have very important, privileged conversations. So maintain confidentiality. I thought this was kind of interesting when I found it. There's actually scoring systems out there to measure and assess your relationship with your mentor. Now, I'm showing you this not because I think it's a good idea to go and grade all your relationships. I don't know how I would feel if one of my mentees came up and said, you know, Jeff, listen, you know, we're at about a 30 with our relationship, and I really think we should be at a 40 or a 45. But I'm showing you this because I think you can read through some of these qualities and characteristics here, and this can be used more so for structure and establishing expectations. So when you meet with your mentor, you can have a conversation about, you know, this is what I would like to get out of the relationship and come to some agreement with regards to, you know, what is practical and important. But again, don't go scoring the people that you work with, but more so use this as a guide moving forward. So in closing, I would just like to give a quick little plug-in for the CPP Mentorship Program. This is a program that we've had in the pharmacy section for quite some time, since 2006. And the way it works is we have mentees and we have mentors, and we match them using a lot of different criteria. We've had over 200 people go through this program, and there's a lot of different areas where people can seek mentorship. And I know most of you are not in the CPP section here, but I'll tell you that recently they created a toolkit for other sections in the society to use to kind of build their own mentorship program. So this is available for anybody in the society. This is hard to see in this slide here, but it's available on the website, or you can contact CPP leadership. And again, you can use this as a framework for developing mentorship programs within your own sections. So thanks for listening to me, and I guess we're up for the next speaker. That was a phenomenal presentation. Thank you so much. I certainly learned a lot, for one. Next up, we have Lauren Sorcey. She is a nurse and one of our few nursing colleagues in the audience today. She's a founder board nurse scientist at the Ann and Robert H. Lurie Children's Hospital of Chicago. She's an assistant professor at the Department of Pediatrics at the Feinberg School of Medicine at Northwestern University. She practices as a nurse practitioner in the Pediatric Critical Care ICU. Her current research is the association of mothers' own milk feeding and severity of illness during critical illness and the development of the microbiome. In addition to a passion for research, she enjoys working with others to pursue their passions as they travel down their professional road. So perfect segue from our talk on mentorship. Welcome Lauren. This is fun. But I'm going to talk about something that makes me really uncomfortable. So how many of you love the idea of networking? Three, four, five. Anybody else? Okay. Say it again? Networking with friends. That doesn't count. Okay. Not for the purposes of this meeting anyway. So I have nothing to disclose. And this is what we're going to do. I'm going to try and make this not as boring as possible. So when you just Google networking, you get over 2 billion hits. So who's got time to go through that? So nobody does. So I'm going to take us through a little more quickly. So this is really how Miriam Webster defines networking. It's the sharing of information for professional purposes. But we know that that's really what professional networking is. But there's also social networking that we all engage in routinely. So how many of you are on Instagram, Facebook, MySpace is defunct? Anybody? Anybody on those things? All those things? Okay, great. So everybody participates in social networking. So then why is professional networking so hard? So there actually is this psychology behind professional networking that I was fascinated to find when I was looking at writing this talk. There's these feelings of dirtiness that require cleansing for certain people about professional networking. And there was this study of attorneys that those who experienced feelings of dirtiness engaged in networking less often and were less successful in their roles as attorneys when they compared them to those who did not feel dirty and in the need of a shower. And it then should be no surprise to any of us that the people in this study who were in greater positions of power felt less dirty when they were professionally networking. I know, it's a little creepy, right? So there was another study that looked at the association of emotional distress and professional social networking. And they looked at people who used LinkedIn at least once a week and compared to other people who didn't. And some of the things that we've been hearing about social media all along is the findings associated with depression and with anxiety. And you can see up on the screen that some of those findings were associated with, they looked at age, race, income, education level. So this group, Wolf and Moser, did four studies actually over time. And they wanted to look at networking and career success and they measured networking using six different scales. And they were able to identify, similar to the study about attorneys, that networking was related to greater salary and career satisfaction in four of the six scales. So then Raj, Fast, and Fisher, I'm sorry, they're the ones with the four studies, series of four studies with people and they were looking at self-identity and self-interest. And in the end of their four studies, they identified that who you are, how you self-identify was associated with how you network and the networks that you build. So that just seems obvious, right? But it's also really about what your interests are. So really, building networks professionally are also related to your interests, which we've talked about, like where are you going to work, who's going to mentor you. Those things need to be aligned with who you are as a person and what your interests are. So there's a bunch of barriers to networking, I think, that some of us feel on regular occasion. So there's these negative feelings of feeling dirty, that it's not who I am as a person, I'm very uncomfortable doing that, I score an I on the Myers-Briggs, which means introvert, and I don't really have a lot of self-confidence, what do I really have to offer to this group of people, why would anyone want to network with me? And the whole introvert, extrovert thing, to the people who know me, it's obvious I'm an extrovert. But you may find me in a room and I'm not saying a whole lot. I know that surprises the people who know me, but sometimes being in a room can be overwhelming to any of us, right? And so what gives you energy, what your personality type is, can be a barrier to networking. If you don't have resources, that could be a barrier to networking. For example, people who don't have the financial resource to be here at this meeting are not available then to network with all these great minds of people that come here. And then of course there's cultural differences, and that could be a talk unto itself. So why would we network? Well there's all kinds of reasons why we network up there, and really I just want to focus on seeking opportunities for professional advancement, right? So there's lots of reasons to network. You network to find a mentor, and to be innovative. And everyone has their own reason for networking, professionally and socially. So I'll leave that for some more conversation later. So Harvard Business Review, which I had not found that journal until I had a role as a manager, actually has lots of great information for us that we can avail ourselves to on all the different things that we do in healthcare. And there's this article on learning to love networking, and these are some of the effective strategies that they talk about in their paper. Focusing on learning, identifying common interests with people that you want to meet. Even though you're just starting out in your career, you have something to offer. Who thinks that here? Okay, a few of you do. I'm proud. Very good. And then finding a higher purpose, like what am I going to get to? What is my goal here as part of this? So there's lots of opportunities to network, right? This being here is one of them. People often don't think about networking actually at work, okay? So for those of you who are still in training, your workspace is associated probably with a university somewhere, and getting together and meeting with the other trainees in different areas of the university is an opportunity to network. I know some universities have fellow meetings across their departments. So even if you're, say, pediatric critical care, and your department of pediatrics has a fellowship meeting, you might want to meet and network with the GI people, the ID people, the ED people, because you might have a research interest or a program interest, say sepsis, that spans a lot of things, and you need some people to come on that train with you. We talked about networking here at SCCM, at any meeting that you go to, while you're volunteering. So you have no idea who the person standing next to you is at the soup line while you're volunteering to participate in helping the homeless with Thanksgiving dinner. You might be surprised to learn that they've got a million dollars to give a researcher. Or you might be surprised to learn that they have this incredible intellectual property that you can avail yourself to. And then, of course, any of your academic or alumni events. So preparing to network. I think some of us have to get ourselves psyched up. How do we do this? Okay, so one of the first things you need is a business card. And even though you're in training, you can have your own business cards. They're kind of cheap to have made. Or you can ask your program and have those available, because the ability to hand that out and write something on it, like sepsis, and hand it to the person that you're networking with will remind them who was that person, who you were. Making sure you know what you're thinking about heading into the event, so that you can be a little bit more strategic when you're at the event. Obviously, dressing appropriately. And then preparing some icebreaker questions and having neutral language. So remember that, like, where do you get your energy from being a people person or being an introvert? So this is about really getting into this, okay, I'm going to a networking thing. I need to learn how to manage the energy that I'm going to need to do this, okay? I could tell you a story about my very first SCCM on council, that I was completely unprepared for the busyness of what was going to happen. And had somebody told me that I needed to focus on my energy, it would have been a whole different story. So think about focusing on your energy, as opposed to how much time you're spending. And then when you're engaged in something that you're not feeling like is where you want to be, figure out how you're going to get out of that discussion gracefully and graciously. You need to recharge and be social in a way that's comfortable for you. So how do you actually start it, right? So you want some icebreaker questions, so, oh, where are you from? And that can then lead to more conversation, where do you work? Tell me, how would you handle the... So we had a kid that came in that looked like this, and our processes did this, and I kind of feel like maybe there's some other ideas out there. Tell me about how you do it at your place. Actually providing an invitation. I would love to hear more about your research. Do you think that we can talk about it over coffee? Okay, it's strategic, it's purposeful, it gives an opportunity for over coffee, a very direct question. And, oh, I noticed when I walked in that the restaurant next door wasn't very busy. If you have time for lunch, perhaps we could go talk about this over lunch. And have your elevator pitch. Just prepare it. Smile, ask your questions, and when speaking, use the person's name. These are things that... There are programs that teach you how to do this, and you're getting it here for the price of SCCM in addition to all the other things that you're getting, and they're really simple things to learn to do, but it can be terrifying. You're like, oh my God, don't forget to smile. Okay, neutral body language, smile, be gracious, but you can do this. And Richard Branson, who I think everybody knows, is the guy from Virgin, he says, listen more than you talk. Nobody learning anything, nobody learns anything by hearing themselves speak. So many of us know that there are other people who would benefit from the conversation that you may be involved in at some time, right? So you may identify a group, and you're talking, and then all of a sudden they start talking about your co-fellow's area of interest. Bring that person's name into the conversation. It would be great. So you're not just networking for you, but you're bringing in others, and that demonstrates professional generosity on your part. Ask people for introductions, or introduce yourself. I can't emphasize the last one enough. Keep your phone away, right? When you're, I could tell you that as a manager, I was on an interview with a candidate who came in, and we sat down to lunch, and she immediately got on her phone, and I'm like, okay, this is not going to go well for me today, slash her. And so we had our lunch, and then we're walking back from lunch, and she's back on her phone, and I'm like, okay, didn't anyone tell this person, leave the phone away? It was disturbing to me, and then I'm thinking, okay, maybe I'm just an old fart, and maybe this is really just regular routine, and maybe my expectations are too high to keep the phone away. And in the end, this person was not successful at our place, and it wasn't really because of her phone. And in the end, what I learned from the recruiter is actually she manages her insulin pump on her phone. So we all need to be aware of our own biases when we're engaged in something like this, but I'm just telling you, any time you've got your phone out and you're like this, you're actually sending a message that this is more important than this. So just keep that in mind. After you're finished, these are very practical tips, make sure you write yourself a note about the person. I can't tell you how many times I have a card in my bag, and I'm like, oh, no, which one was this person? Because they didn't write something down on it when they handed it to me. And if somebody doesn't, perhaps you can remember to jot something down on the card that someone gives you. Follow up with them with an email or a call, and you can say, oh, thank you very much, I met you at such and such, would you have some time to email, you know, answer these questions or whatever? And then in doing so, you continue to cultivate a relationship, and then you can also connect on professional social media like LinkedIn. So professional versus personal social media. So many of you are on Twitter, yes? Yes? Okay. Do you use Twitter for personal use or professional use, or both? Professional. Okay, anybody mix it up? Okay. All right, so when I started my Twitter account, the advice that was given to me was that I should have a professional account and a personal account. And I'm like, oh, that's really good, because there are some tweets out there that I would just like to unleash on, you know, for me personally, the anti-vaxxers, that hurts me as a pediatric person when kids die of things that we could have them avoid. So I maintain only a professional Twitter account and not a personal one, and that can be really challenging. So I pose to you that perhaps you consider how to keep those separate if that's important to you, making sure then if you're mixing your accounts, how much of your own privacy you want to maintain, and who you follow and connect with, and using it as an education tool, which can be very good. So in the end, networking can be really invigorating, and it can be really scary, but anybody in this room can network. And of course, you're going to make mistakes. We all make mistakes every day, and you're going to make them in networking. But learning from others and giving back really contributes to our community and to our science. So that's it. Thanks. Thank you. Thank you so much, Lauren. That was a fantastic talk, and we're all going to be much better prepared the next time we come to Congress, and actually even when we get back to work. So thank you so much. And our next speaker, he needs no introduction. It's Dr. Vinay Nakkarni. He has been a huge ally for the in-training section since the time that this section has started. It was started, I want to say, now probably about 10 years ago. He has had a lot of experience with both academic and with private practice, and he is the Endo Chair in the Departments of Anesthesia, Pediatrics, and Critical Care. Am I correct? Yes. And he has mentored over 400 fellows over his career that's spanning over 14 years. So we are so lucky to have him be on our panel this year, and thank you so much for this. And he's going to talk about a topic which kind of ties all of this in together, and about the first job. It's about the interview. The first job interview. What are the things we should look for? And that's what he's going to enlighten us about. Thank you so much. Great. Well, thanks. And this is just going to be a few minutes, and then we'll get a little more interactive. And I want to just pull together. So Wendy was talking, you've already now selected sort of whether you're going to focus on quality and safety, whether you're going to be more education or research, where your scholarly output is going to be, how administrative you're going to be. So you've sort of decided that. And I really resonated with, as you're preparing for your interview, or you're thinking about your job, going on the web, identifying who's there. When you're thinking about your first job, I think you're really thinking about the people that you'll be working with. Because probably the most important thing in that early part, and I'm going to ask you guys as we get to the end of this next 10 minutes or so, to sort of talk about, it's really the people that you'll be working with that you want to ferret out as you're selecting that first job, because it's probably the most important thing. Not just people within the hospital, but your support outside of the hospital, how that's going to work. And then it's not just the people, but it's the place. What are the expectations of the place, and what are your expectations or needs, and can it provide that? Is it in a location that's near family or far enough away from family, depending on what you're doing, friends, support systems, et cetera. And then it's about the plan. And so as she was talking about it, it's like, what is your short-slash-long-term plan? And you can expect that you're going to be talking in your interview about how do you see yourself in the next three or five years, or seven years, or ultimately. And so your plan, but how does that plan fit in, and how do you listen to what the plan of the organization is? And then the last P is perpetuity. How is it going to be maintained? Do you have a spouse or significant other that's going to that region, so you're sort of forced to be looking at a job in this region, and are you just looking for a two- or three-year job while your spouse or significant other or somebody is doing their fellowship or their residency while you're sort of doing it? Are you going to advance your career, how are you going to do that? Or are you really looking, like Tony, to go to a job that you're going to do for the next 20 years and you really want to find the place that you're going to be and develop and sort of morph into? But I want to come back to the first P, or people. So as you're sort of preparing and looking at a place, I think some of the things over the years that have been really important are looking at the, let's say, looking at the faculty. Who is the chair? Who is the division chief? Who is going to be your direct supervisor? Are they somebody that you know? Are they somebody that has a reputation of supporting young faculty? And also, what's the balance of the faculty? What's the balance of the group that you're coming into? Is it two senior people, two middle-level people, and a flood of young faculty? Or is it the opposite? Because that balance and the plan that they have in place is something to explore, potentially explore in your interview. If it's a flood, if it's a huge amount of young faculty and very few senior, as Jeff was talking about, what is the mentorship plan? Is it expected that you'll have a mentor within the critical care group? Or are they supportive of having various mentors outside of the critical care group? When I started, there were very few senior mentors in research in critical care. And so getting mentorship in the research aspect of what I wanted to do required going outside of the department and needed support of the people within that department to say, yes, that's something that we encourage, we support, et cetera. And maybe to even negotiate for as you come in. When you think about the colleagues, the peer mentors, and Jeff, when you were talking about mentors, some of the slides kind of looked or sounded as if there was a single mentor, that there's a single mentor. And I think all of us would probably agree, maybe, but we never truly agree on everything, do we? But I think most people would agree that they have many or several mentors, that perhaps their clinical mentor or their research mentor is different from their work-life balance mentor, or their women in medicine mentor, or their whatever it is that they're sort of dealing with, that it's important to identify and create expectations around mentors. And it's rare to find a single mentor that's going to meet all of your needs. And so when you're looking, and you're discussing, and you're interviewing, and if you know your plan, so sort of the plan is the third P, then you want to make sure that each of the aspects of your plan, of what you want to be and do, has the option for mentorship a path forward. And exploring that a little bit in an interview, without being overly concerned about me, yourself, what I would say is that young facultyhood, as you're a young attending, as you're getting your first job, it's all about you. Really, your mentors should be focusing on you, and you should feel as if the world kind of revolves around you. But you also don't want to necessarily project that. It's not all me, me, me, me, right? It's also, what do you bring? What is it that a job would want? What are they looking for? What are they needing? How are they going to morph? And if we think about looking at the hierarchy, the supervisor, the division chief, the department chair, it's also sort of important to know, are they going to be there when you get there? Are they going to be there if they are in a position? Are they looking to be moving or changing? Because the personality of the division, the personality of the group may change a lot if the leadership at the top changes. So getting a feel during your interview, as you're talking to them, what are your plans to discuss? Are you anticipating that there'll be a change in leadership, a change in direction, et cetera? It's very difficult to go to a place that has no identified division. If they're in a search process for their department chair or the division chief, it's a little difficult to know what you're going to be going into, because who can make promises, who can guarantee, et cetera? And as we were thinking about the aspects of private versus academic, et cetera, I don't think there's as much of a line anymore between private and academic, et cetera. You can be academic-private, there are many different combinations. I'm going to sort of finish, and I'm going to ask the other panel members to come on up now, if you don't mind, and sort of sit down, and we're going to just finish up before we turn it back over to the moderators to get your questions. I'm going to tell you a little bit about my first job. So when I trained, which was a little while ago, quite a while ago, my wife is a PD&T surgeon. She was very clinically oriented, and she was looking for a job at the same time. I had trained at that point, there were sort of a few sort of academic pediatric critical care programs in the country, relatively few, and most were very clinically oriented. My fellow research projects were at the NIH and the National Naval Medical Center in the Pig Lab, working with Joe Carcillo and Pat Kohanek, et cetera. So I had sort of a laboratory-based research focus at that time, but I wasn't quite sure what I wanted to do. And also, I had had exposure to international medicine with Operation Smile, had gone on several missions, and I knew that that was something that I wanted to continue doing. But the jobs that were available at that time were either sort of solo, like you can come and start a pediatric critical care program, or you can potentially join a larger academic program. And so when we looked regionally, our family was all in the East Coast, near Washington, DC, et cetera. And so we wanted to stay in a relatively regional program. We had young children at that time, and so we were using our family for our child support and all that stuff. And so I decided to go to the Medical Center of Delaware from Children's National Medical Center. So that, at that point, was a private practice, tertiary care hospital in Delaware, it was the only tertiary care hospital in Delaware. They were affiliated with Jefferson University, but they really didn't have a very strong affiliation at that point. They were sort of just their pediatrics program. And as I was leaving my program, my program director said, well, we wasted three years training you as a fellow in an academic program because you're going to go to this private practice program and never do anything else academic again because you'll just be consumed with clinical care, et cetera. And that sort of woke me up to sort of say, well, what is my plan? What do I want to do? Because at that point, I really did want to stay involved in academics. I wasn't quite sure how. And so as part of the negotiations, a part of the interview process, which was with the right people. Actually, Russ is in the room, but Bob Kettrick was there. And he had sort of gone out and started a program, which at that point was not academic at all, but had experience in that area and said, if you want to continue doing that, we can create. You can ask for some protected time. You can ask for when you're ready to start a lab. You probably won't be able to do that in the first few years of your career, but when you're ready, you can set aside some funds to start that up, et cetera. And I negotiated to have four weeks a year to have for Operation Smile at that time to do international work that was not vacation, but would be considered part of that. And because they were so desperate to have somebody at that time, they agreed to it. But it was a matter of discussing it in a manner that wasn't, I need this, I need that. But if I do these things that build your program, that help to build your program in that way, there's these things that I would like to try to build in. And I'm not even sure I'm going to need them. Maybe I won't. I'll decide not to go for four weeks a year on international missions. But I'll have that option. And so those are just some, for me, that was an example of sort of trying to set things up through the interview process for things that were important to me, but didn't conflict with sort of the program goals. So I'm just going to ask each of you to give maybe one or two elements of when you looked for your first job, was there something specific either in the people, or in the place, or the plan that you sort of focused on as you went through the interview process? And we only just take like one minute each. And then I think we probably want to open it up for questions from what you guys want to talk about. So Wendy, I'll start with you. So my first job was at the institution where I trained in my residency program. I went away and did my fellowship training. But I also did a little bit of private practice before I came back on for faculty. And then as a faculty member, they then paid to kind of subsidize some of my training to help kind of offset my fellowship funds versus what I was making in private practice. So that was kind of a nice way that, and then I came back as an assistant director of trauma and critical care at that time after I had done my training. So you came from the institution you stayed at, or you were interviewing and staying at the same institution potentially at that point. So did you get the full Monty? Did you get the regular interview process that all the other candidates were getting? Or did you get like an abbreviated, hey, we know her. She's. I got the abbreviated inside track. In the question and answer sort of discussion session, those of you that are thinking about staying at your own place, it might be good to discuss or think about how you deal with that and whether that's the right thing or the wrong thing. I'll tell you, at our institution now, for the applicants that are coming from within, they go through the exact same sort of interview process. They get into nice clothes, et cetera. They go around from office to office, et cetera. And they get exactly the same kind of interview as if they are coming from the outside. And many places don't do that, but we can talk about how to do that. I guess because there, I don't know if there was necessarily a search that was going on, but because I was linked in and was training the residents through my private practice, I was already faculty, but just coming into a different position within the organization. So it was a little different since I was already an adjunct faculty. Lauren, one of your jobs. Yeah, so I will, my very first job as a bedside nurse in the PICU, I picked the place that I wanted to work based on how I felt when I walked into the place. And I know that sounds crazy, but I'm still there 31 years later. Did you plan to be there? Was that your plan, or was it just it happened because it evolved? So my plan was to work there for a year. And I'm like, oh, well, with this experience under my belt, I'll be able to write my ticket to work anywhere I want. And what I didn't realize, being young and naive, was that the place that I worked at was the place in the geography where I lived, where I shouldn't have started, but should have finished. And so in order for me to find another freestanding children's hospital, I have to go from Chicago to Milwaukee. So my umbilical cord, admittedly, reaches four blocks. That's how far away I live from my mom and my dad. And so I never dreamed I would be at the same institution 31 years later. But for my nurse practitioner job, it was a transition into the role from my bedside nurse job. And it was a brand new position. We had not had nurse practitioners in the PICU managing the PICU patients. There were some in CV surgery, but their role was very different. And so there wasn't really an interview process. It was like, you're just going to do this now. Jeff, how about you? I did my training at the University of Arizona in Tucson. And when I was living there, I said to myself, you know what, I love living here. I'm never going to live anywhere where it's cold ever again. And then I took my first job in Detroit, Michigan. And if I had to summarize three reasons why I took that position, I would say, number one, it was a perfect fit for me career-wise and what I was looking for and what I was looking to do. I would say the balance of experienced practitioners. So you talk about that ratio of senior people to mid-level to junior folks. I knew I'd have incredible opportunities to work with senior individuals that can provide that mentorship and support. So I wasn't out there on my own. When you start out in practice, it's scary, right? Because you think you're all by yourself. And you're not. But it helps to have senior people there who can guide you. And then the third, I would say, is just the support for an academic model, support for research and scholarship, which now with the current thought for many administrators is that research isn't a necessity. It's a hobby. You do that on your own time. I think they're narrow-minded. But there really was support for research and scholarship. And it was a required part of my job. And I really enjoyed that. So yeah, I ended up in Detroit, even though I said I was never going to live anywhere cold. And the advice that I give to a lot of my students and residents and fellows, when I ask them, well, what are you looking for in a job? I'm like, well, I don't want to leave Phoenix. I live in Scottsdale now, Arizona, beautiful place to live. And I have a lot of people say, I'm not going to leave Phoenix. I want to stay here. And I say, well, why do you have to stay here? Because I understand there's life situations where I can't just uproot my family and move. And they say, no, I like living here. I have friends. My advice is, well, you can find friends in another city. Go and get the job that is right for you. Because even though I didn't want to move to Detroit, it was a perfect job for me. And it really laid that foundation for my career moving forward. And I think I wouldn't be the clinician or practitioner I am today without that experience. But I don't think you should ignore your support system either. And sometimes it's possible to take what might on the surface appear not to be the right job and to configure your contract or whatever so that it fits. And then you can mold it into what you want it to be. So I wouldn't just assume, right? You want to get in there and sort of see if you can either mold it to what you want it to be or go in there. Yeah, and I think you need to be open-minded because it's easy to stay where you're at. But if you're there for the wrong reasons, then that's not really the best thing either. Also have the moderators come up as the last person's doing. Because maybe you can pick up from here and see what other questions you have. And I think similar to Wendy, I had kind of an abbreviated interview for my job. I did my training at Ohio State. And they had a job opening up in their surgical ICU. I think what was unique at that time was although they had a part-time person shared between the college and the medical center at dual position, they hadn't had someone there for 18 months. And this was somewhat of a new full-time position. With the way that the position was set up, it was currently being done by some generalist pharmacists who worked out of a pharmacy satellite. And then with Joe Dasta, who ended up being one of my big mentors at the college, I probably did something unique. Because I worked there. It wasn't that I got interviewed. I was an interviewer. Because I wanted to make sure if I stayed there, I was going to get along with the people in the satellite and the people at the college, as well as everyone else, to make sure that what I wanted fit in there. And I think the other thing, like I said in my talk, that I think really helped out is when I went out there and I knew I had this job before I even went on any other interview, is one of my main preceptors, Carrie Pickworth, said, well, you need to go out and see what all these jobs are and see what fits best for you. I think that's really good advice, that even if you're planning to stay at your place, even if you don't really think that you're interested in going out, it's good to just make that a conscious decision by going out and interviewing other places and then coming back and saying, yes, this is actually what I want to do. And I will say the biggest reason that I stayed was that mentorship opportunity. Knowing that I trained in cardiology and critical care was a little bit different, there was a big learning curve I had. But that was by far the reason I stayed. So I think I'll turn it back over to you. And maybe you, Mike, guys, might have comments about your own search and your own thoughts on the process of the work. Thank you so much. And that was very valuable to hear the stories and how you made the decisions. But this will open it up to the audience. There are two standing mics. If any of you have questions, please head over to those microphones. And then our speakers, our faculty members, would be able to answer. Hi. Thanks for the session. It's really great. So I have a question regarding in the search for the new job. For a lot of circumstances, I'm starting off my fellowship, but also hunting for my first job. And so you have it in your mind now, after six months of fellowship, you kind of know your niche. But your CV might not actually reflect your niche quite as yet. How do I verbalize that in my first job interview, which is coming up next month? Great question. I would do some background work to see at those institutions what they're actually doing in line with what you're interested in. It shows preparation, and it shows insight that you are willing to go beyond just asking questions at the interview. You are more seeking clarification of what they have that you're trying to do, and what you would like to be involved in. So if you are interested in quality and safety, and you go on their website, and you find out who their quality and safety officer is, and you say, at my interview, I'd like to meet with the quality and safety officer, you have taken yourself to a whole other level. Like, wow, you're already trying to move your way in and ask important questions as to how you might get involved in that area, or if it's an area of research. Whatever it is, you can direct the interview process by saying and letting people know what you're interested in, and by doing your background research. Thank you. I also just want to say, there's nothing more disturbing when you're interviewing somebody to be the person to be asked. When I ask, what are your questions, and the person says, well, I don't really know much about your hospital. Tell me a little bit about it. Thank you. If you, particularly if you haven't published or you haven't presented on that topic that you say is your area, or you've done it in a different area, and now you're coming in and you really want to move into that area, have your mentor. I would not hesitate to have your mentor or the person who's helping you with you at your institution call ahead to their contact. From networking, they almost always will have or know somebody at the institution that you're interested in going. Don't be afraid to ask them if they could, on your behalf, call ahead. Talk to that person, and that oftentimes will transmit that even though you haven't published in that area yet, that they see you as a rising star in that area, and they're trying to create a venue for you to be successful. And that's really, I think, a very powerful way to transmit that before you get there. Great. Thank you so much. We have a question on the floor. So somebody said that there is no perfect job. And of course, the first job is going to be the least perfect ideally, and you're going to hopefully walk it up as you get more advanced. What is the balance between negotiating for a better job looking elsewhere and not appearing flaky at a job that you get by leaving too soon? In other words, how long do you want to have a position before you start looking for something better? I don't think there's any, I don't think anybody, does anybody have a perfect answer for that? I would say give it at least a couple of years, like two to three years before you sort of figure out that it's not the right fit, unless it's obviously like an abusive. If it's drowning, if the organization itself is drowning, they put up a good front and you didn't figure it out before you got in there, you've got a failed ship. And you won't have a problem with that. But besides that, giving yourself an opportunity to build connections and networks and the money they've invested in you to bring you on, they've been able to somehow recoup some of that so there's no ill will because you don't want to burn bridges. You're going to see these people for the rest of your life and you don't want anybody back talking about you, how you were flaky because you stayed for a short period of time and there wasn't any real good reason for you to leave. And I would say too, I think with my colleagues that have gone, most of the time that they have had to leave is broken promises. And I think if there's a must for you, there's something you must, you want to make sure that you get it in writing because that's one of the big things, I think, that you have to keep in track of. If I may ask, are there particular things you're referring to there? Like they put you on more weeks than you were supposed to be on. Or if you asked for lab-protected time and they didn't give it to you. If there are deal breakers for you, then those are the deal breakers that allow you to break the deal because they broke their promise to you. You know, one thing I ask every applicant that I interview is, what are your expectations with this position? Because often when these things happen, it's because you think the job is something that it's not. But I would say it takes a good year to even figure out a new position. So you have to give it some time. I would say, though, in your interview, if you come across as too protective, as sort of trying to delay, if you focus your entire interview on what's the maximum number of nights I'm going to be a call, what's the maximum weeks I'm going to be on service, although you can sort of generally address it, if you only focus on that, then the perception may be that you are not committed, not all in. And so I think you have to balance that with prefacing it by, I am all in. You have to demonstrate that you are all in, but there are some constraints you're going to set. And then in subsequent interviews, or as the process goes on, you may be able to establish what those limits are, and you probably, to yourself, have to sort of identify what would be crossing the line over what you would sort of leave for. Another big thing is finding up front, what are your metrics for evaluation that they're going to review you, as part of your review process. So there's nothing worse than not knowing what somebody's measuring you by, because you didn't ask, and they didn't tell. But you should at least ask, because everybody gets re-evaluated, you're a new employee, they've got to make sure that you're safe and effective, and you collaborate, and there's good communication skills. So there's going to be some evaluation, but it's better to find out, not at the end of the year, but at the beginning of the process, what are you evaluating me on, and get some feedback, so that you aren't blindsided by an evaluation that you weren't expecting. Doreen, Sasha, thank you all. Yeah, one more question. I was hoping you all could give us some advice on locating academic jobs, just because I find that they're not usually as visible as private practice jobs. Networking. A lot of it is going to be your current mentors, et cetera. So much of that is not going to be necessarily posted, and as Wendy was saying, a lot of times the academic centers are, when they're approached by somebody who is filling a niche they need, or is an exceptional person, are going to sort of create and make room for that person. So they might not be advertising for, we have a position, but almost all the medical centers, I think almost all the academic places are always on the lookout to sort of see, so you approach them. It's oftentimes your mentor, or somebody on the faculty that's sort of approaching them for you, and then figuring out if there's a fit. Are there other mechanisms? If you have other graduates from your program who are at programs, they oftentimes, a lot of the young faculty there are aware of other niches, and in particular, what you won't be aware of is people that they know that are leaving or planning to evolve to new positions within their system or outside of the unit, and those are things where you're not really allowed to post positions before the transition actually occurs, because they're still on the payroll, if you will. So it's oftentimes by networking with your buddies who are a couple years ahead of you, et cetera, you can find those positions more easily than just sort of looking on the websites, et cetera. If I may, can I add an extra level to that? If you're looking for an academic position, but also have additional requirements, such as waiver requirements, other than networking, what is your advice, or in terms of approach, for someone in a position like that? So most of that is based on past records. So as you say, it's usually networking. Oftentimes, if you're working with a lawyer on your waiver, et cetera, then they know the institutions that in the past have taken that on. And again, it's where sometimes people on the inside institutions that have not traditionally done that within a given department, like critical care, or pulmonary, or anesthesia, oftentimes there are other departments that have worked out a mechanism. And so if it's a place that you really wanna go, and it's either a location or an institution that you really wanna go to, then you can sometimes even look at other departments and look at their records and see if they have had waiver positions. And then you can bring that to the department so that when you contact them, et cetera, you say, I know within your institution in X, or Y, or Z, they have successfully had waivers. And then, because a lot of times it's a lot of work the first time you do it for the department, but once there's a system in place to get it done, then it's much, much easier. And so that would be one thing that I've found has helped. Others? And one suggestion that I really get to is with my trainees in the past couple of years with waiver positions, previously if people have gone there, people with J1 waivers who have been in your program have gone there, they are great allies who can advocate for you to get those positions. The other thing is sometimes it's not always fun to get recruiter emails, but there are recruiters exclusively for this, especially last year and this year, I've had my fellows who are on waivers be very successful with those recruiters because they look across the country and they see that there are 30 positions for each state, and they are able to track that and identify the specific academic jobs which would be able to get those positions and blast it out and blast your CV out so they give you a broader platform to make known your availability. So that has been very successful. At least the last two years, I've had fellows who've taken advantage of that. That might be more of an offline question. I will come find you if possible so we can chat some more if you're available. Look at that network happening. Yeah. Thank you all very much. My question is regarding the international work in terms of the first interview and maybe even negotiating your contract. If you have an idea of an experience that you want to participate in in the next year or two of your first job, how do you recommend different avenues for discussing that at the beginning, throughout negotiation, and whether or not you can discover ways that it could benefit the institution that you're at even though it doesn't clearly benefit from the outset? Mm-hmm. So I want to talk about the latter part of your comment about how to align it. I'm confident that you can find something in the information on the hospital, whether it's something on their website or something in communicating with the people who work there that can tell you about how what you're interested in doing would align with the mission and vision of the hospital. Many hospitals not only have mission and visions, which, as we all know, can be very broad, but they also have strategic plans. And on their websites, they will intermittently put up a patient's story that will exemplify one piece of their strategic plan. And you may find that that patient's story is what you want, the strategic plan exists, that you want to hone in on. And so it's sometimes a lot of homework, but you can find that information. And also in talking with people who work there about learning more about what the hospital is actually working on, as opposed to what's just the front of it. So I just wanted to make that particular comment. And I think it's a little different if you're saying, I want to build a program of international versus I want to go on a mission or I want to spend two or four weeks doing this. It's a little different. I think one of the things you can do is when you, either during or in setting up the interview, is you can ask to say, is there somebody in the department or division that is currently participating in international work? Could I meet with them, right? Like you were saying, right? And can you tell me how they've configured that? Just by asking that question to be set up for when you interview, they're going to have to scramble around. And again, it's about people and the place. So if it's a place, if that was your interest and you've done that before and you want to continue doing it, and they have nobody there that's done that and no interest, is it really a place you want to go to? Because the people that you're going to be with are going to be the most important thing about that young faculty position. So I think it tells you a lot if you ask them to say, look, we've got five people and which one do you want to meet with? Well, that's a very different message than nobody's ever asked us that question before. I don't think we have anybody here who's doing that right now. It doesn't sound like we can match you up with somebody. It tells you a lot just by asking that one question before you interview. And I think to go off Lauren's point too, for myself that works at Ohio State, it's a big university and stuff. There's so many Twitter handles and social media accounts and they have a big global and international presence. So you might have to do your homework not only looking at the hospital website, but maybe some social media platforms as well, looking over at this international or global presence if it's a big university. Thank you. My question is about being attending at an institution that you trained at. I'll be starting my attending at an institution where I trained as a resident and a fellow. I was wondering what are some of the challenges that I might be facing as a first-year attending at an institution like this? I'm gonna ask this question a little tongue-in-cheek, but I actually mean it. Do the nurses like you? Yeah, I think so. You'll be fine. No, that's a thing. Well, I do think coming from not being a physician myself is we have a lot of people that stay on. And I think one of the issues is what is your relationship with the other staff? And they're the ancillary staff, your pharmacist, your dieticians, your physical therapist. I think in some ways it's nice because you don't have to relearn the system. I think for each institution too, the hard thing as you grow and look is are your colleagues gonna treat you like a trainee? And one of the things as we've grown, at least my position is making sure in that negotiations and stuff, are you gonna have some role that you can own that's different than your colleagues? And that's something that I always suggest people really think about in the interview process. And then if you've accepted moving on, working, is there something, oh, I'm really interested in mobility in the ICU, or oh, you need help on this committee, can I get involved and get some mentorship there? And really ask for it up front. I would also say looking for partnerships outside your department is another way to make a new name for yourself. Because there may be saturation within your department doing the same things, everybody doing the same things. So another way, if it's not already saturated, is to look outside your department to make collaborations and inroads there. Because it's always nice when people are in the C-suite, the executive suite, and they're around a table, and somebody else, your chairman, hears them talk about you from another department because you're doing great work in that area. So you can make your name a name for yourself through different departments also, and look for collaborations there. And also make sure that as if you were coming in from the outside, that you get the benefit of the same kind of support that you would have gotten as if you were coming into a brand new system. So it's an opportunity for you to shed the things you don't want to be doing, and that you sort of fell into doing as a fellow, and to take on your new responsibilities as an attending. So are you keeping the same mentor? Are you switching mentors? You're keeping the same mentor. So having discussions with them about the transition, and almost like Russ is here, when a president sort of, when you evolve from a position to another position, oftentimes somebody who's sort of become really good at what they do needs to step back, and sort of be not absent, but be sort of supporting from behind and not visibly. So a lot of the things, the reason they kept you there is probably because, or they're offering you positions because you're probably really good at what you do, and they want, they like what you're doing, right? But your role is now switching. So shedding some of those things, if you're really good at admitting patience and getting all the things done yourself, then you may need to be able to, need to step back from being the person who does that all the time, and step into your new role, and sort of mentor softly somebody else to do what you used to do. But it's very easy to sort of continue on and be that super fellow, right? Yeah, that I think is a really key practical advice. We see this all the time with transition into practice is what we call it for nurse practitioners. Of course, it's the same for physicians. You're transitioning your practice to something else. And that transition needs to be acknowledged. And I think sometimes we think, okay, I've been training to do this for a long time. This is my next step. It should be fine. I know how to do this. And I will tell you that I transitioned to a new role as a full-time researcher in July after being a provider in the ICU for 31 years. I do not know how to sit at a desk for 10 hours a day. And I didn't appreciate that transition. And yours will be the same, because in terms of it's going to be very different from what you do. And acknowledging that my life is now changing, even though I've been working for it, even though it's really what I want to do, my life is changing. I'm not going to be a fellow anymore. These were the expectations of me as a fellow. These are the expectations of me as an attending. And cut yourself some slack, because it's not going to happen overnight. I do want to add one more thing, because I was exactly in those shoes about six years ago. I continued as an attending in the place that I trained as a resident and I did my fellow trip. And it's hard because everybody in your team use you as the trainee, even after you've become an attending. And it's because you get along really well with everybody and you're really good at your job. But then my first year as attending, at least in the first three months when I'm on call, they used to always page me to put in the orders, to put in the, and it's only comfort and familiarity, because if the resident is a brand new resident with me, they wouldn't ask the resident, they would ask me. But it's about gentle redirection, about how about you page the resident pager? I will get back to you if they're not getting back, but how about you try that one first? So kind of establishing that with your team is also helpful because they eventually get it, but it's hard in the first few months, just because they've always seen you as this person, as this go-to person to get these kind of things done. But that might be something that you have to pay attention to and have a plan around that redirection. One of my colleagues even changed the way that he dressed, because he looked so young, and when he came on, he stopped dressing like his fellow self. He started dressing, and he dresses really well. I was like, I'd love to see him dressed up. But it allowed him to start to differentiate himself from who he was before to who he was now. I even heard, I was at another meeting last week, and one of the female surgeons, she was saying how she used to go around without just regular clothes on, and nobody knew that she was really a doctor. And so she had to start wearing her white coat so that people would actually know that she was actually a physician, and she was in that role of providing healthcare. And that was one of the things she did. She had to change her appearance. She couldn't look like everybody else. She had to kind of stand out a little bit more so that people wouldn't think of her in that same role. And I think what I see from working with these physicians in particular is not so much the day-to-day people, because I actually think a lot of the bedside nurses, after you do your gentle redirection, actually do a good job. It's really the other consultants that come and see you in and come and look at that. I actually think having a plan and talking to your mentor, because there might be a couple that you're gonna have to get in fights with, especially early on, that you should just make sure that there's gonna be a plan and think ahead, because that's the worst thing to see in everything. And when you don't think about it, you're kind of lost. Why is this happening to me? Where you don't see it more with new practitioners coming from the other things is that people just might not see that. So just have a plan if that happens. Yeah, my advice would be to build strong relationships and empower and encourage. And even though you're starting out in your career, you're technically a mentee, but you're a mentor for others. So just keep that in mind. Thank you so much. One last question, because I think we're close to the end of our session. And I think this is a question that comes in almost all of our minds when we go for interviews. And I would like to hear what our panelists would do. It's about financial compensation. You go for an interview. We're talking, we're trying to see where our career goes, what are we gonna do? But eventually, we want to address that question as to, okay, so what is the financial compensation gonna be? And what would be a good time to address that question? Because it's kind of uncomfortable to talk about it, but it's essential that you talk about it. So what are your thoughts on that? I'm gonna tell you, and this is real life, don't do what I did and don't bring it up whatsoever, because I made so little money when I first started out, because I never negotiated that during the interview process. Luckily, I got a lot of, I was making so little money, I got like three raises in my first six months. So it was for cost of living, but I was the bad one. But it's something that you do need to, I mean, it can't be the first thing, but and you have to bring it up, I think, delicately too. Yeah, for me, that's something kind of on the backend of the process. And remember, there's other things that you can negotiate for. It's not just money, but there are other things that are just as important. Protected time, vacation, relocation packages. So I think one thing you want to ask is, maybe not so much, what will I make now, but what is the room for growth? Okay. So it is a difficult topic. But I sort of want to be a little bit of devil's advocate here. Are any of you planning to work for free? Does anybody in business work for free? It's just a matter of fact, right? So there needs to be a conversation about it. So transitioning from the concept that this is, oh, we're in medicine, we should really want to, we really just want to take care of the people. Yeah, we do. But we also need to be compensated for our work. So transitioning from, oh, I have to have this conversation too, I deserve to be compensated. And the compensation package, not just the money, all of your benefits, which include your protected time and everything, all the other things that come with it, your startup package, whatever it is, is a matter of fact. I wouldn't suggest talking about it like your first question, so what's my compensation package? But if you, in your mind, think it's too hard to talk about, it's going to be too hard to talk about. So it's about thinking about it from a business perspective. You have something to sell, and they have something to buy. If you, when you get your agenda for the day, you'll get it in advance, just put it on, have them put it on the agenda. That way it's not you having to bring it up, it's the agenda that everybody's following about things that you want to talk about during your interview process. And it takes the pressure off of everybody because everybody knows it's coming. You know it's coming, it's just on the agenda. Then, but before you get there, you have to do your research to find out for your specialty what are the 75th, 50% percentages for your particular specialty, what's the going rate, basically. So looking at the published numbers is important. Thank you so much. I would like to thank all our panelists here for taking the time and for this fantastic, invigorating talk and discussion. And thank you all for joining us today. Thank you.

professional networking

strategies

effective networking

career growth

opportunities

barriers

psychology

mentor

mentor-mentee relationships

learning

preparation

business card

dressing appropriately

icebreaker questions

follow-up