Welcome everyone to this Luminary Lounge session. I'm delighted you've elected to join us. I'm Ernest Alexander from Tampa General Hospital. It's truly my pleasure to moderate this conversation with Dr. Pamela Lipsett. I'll start with a brief introduction of Dr. Lipsett, and then we'll launch into what promises to be a great conversation. Her work will be well-known to most of you already. But let me provide a brief introduction. Dr. Lipsett is the Warfield M. Farrer Endowed Professor in Surgery and the first female professor of surgery at the Johns Hopkins University School of Medicine. Dr. Lipsett also holds an MHPE in medical education from the University of Illinois. She served as president of both the Society of Critical Care Medicine and the Surgical Infection Society. Based on the conversation I've already had with her, her passion for graduate medical education is clear. This theme of graduate medical education and staying in the learning zone is evident in her presidential address in 2011. She's received numerous awards and accolades, including the Distinguished Master of Critical Care Medicine from the ACCM. It's my pleasure to introduce you to the Luminary Lounge, and I look forward to a great conversation. We'll start with just a few questions that help us to get a sense of your start in the profession. Tell us a little bit about your professional pathway, the path you took, your back story. Well, first, Ernest, I want to thank you for that really generous introduction, and even being considered for the Luminary Lounge. I'm not sure that I really am luminary. Our pleasure. I think the back story is pretty much what I said in my presidential address that I knew that I wanted to be involved in medicine and science, and my pathway diverged before medical school to really consider a scientific degree in biochemistry. As I was undertaking that at the University of Kansas, I quickly realized that I like people more than the laboratory, but I still appreciated science and discovery. I accepted a position at University of Massachusetts Medical School where I did my medical school training and decided that surgery was a career for me, and came to Hopkins where I now am a lifer. I have always loved critical care because it combines really the best of being a physician and surgeon at the same time. It's both a living laboratory and perhaps the most exciting place for clinical discovery and research. In the end, I really got everything I wanted even though it was a different pathway. That's excellent. Thank you so much for that introduction and telling us a little bit of the back story related to that. How about your path to leadership within SCCM? What impact did that have on your larger career? I think it changed my life. First of all, I can't say enough about how important I think SCCM is to all of the practitioners involved in our team care of critically ill and injured patients. It is the only society that really espouses the importance of that teamwork. It is in our society that I found a home. I found a home there quite easily. I wasn't interested in really serving only the surgical section. I really believed in the mission and vision of the Society of Critical Care Medicine. It was easy to want to volunteer for things and to feel the passion. I feel every day for what the society does. That's awesome. How did you first get involved with the society? Well, as a surgeon, I started in the surgical section. I started, I think, probably by being involved in the surgical membership section and then did some activities, got involved, eventually became the section leadership. At the same time, I thought membership in the greater society was important and so I volunteered for the membership society of the greater society. You work hard, you do things, you get recognized, so you get asked to do other things. That's so true. Because I'm interested in education, I was interested in the courses and volunteer efforts related to education. The MCAP, the multidisciplinary course, the program committee, all of those things were involved at some point before council, and then, of course, from council to president, and now back to regular. That's a good place to be. Yes, it is. After having ascended to such heights, that's for sure. This is a good segue to talk a little bit about graduate education. Could you highlight the most important role you've played relative to graduate education in critical care? Well, I think there's two actually, and I'd like to just say a minute or two about each. First, my role as president of SCCM. I think I have always believed that as a provider training in critical care medicine, we should not be as siloed as we are and have been. And I reached out to emergency medicine and the hospitalist group, really everyone. I think we should all be in the same sandbox. And I frankly believe we should all have the same standards and tests. These are radical ideas, which have not essentially gone on to widespread belief because everybody wants to maintain their own section of the pie. And I don't think that's in the best interest of patients. Patients don't care what you train in, if they're acutely ill, they want to know that they're going to get the best care, the right care right now, agenda of SCCM. But I have another role that's been subsequent to SCCM. And that is, I am chair of the residency review committee in surgery at the ACGME. And under that comes surgical critical care. So that's a national platform to affect change in program requirements and structure. It doesn't cross into other specialties like SCCM does, but I think it's important. And so I did want to mention it. Thank you for that. And absolutely, that's the way to affect change on a broad level. Could you tell us a little bit about how you feel that critical care graduate education has changed during your time in practice over the years? Well, I hope it's been more inclusive, but I think in all ways, I hope it's been more inclusive. I think we've added more structure and with the more structure, it's really been mandatory because there's so much more to learn. And there's emphasis on ensuring that we don't lose the importance of interpersonal communication and teamwork at the same time recognizing technology is ever present, especially in our field. And so combining those things into what I'll call out of real patient experiences. I mentioned it in my presidential talk of the importance of simulation. So some of the learning we do is not actually in the ICU anymore. It's in a simulated environment where we can practice making mistakes. And I think that's a much better place to practice than in real life. That's so true. It's absolutely true. So what further changes do you foresee relative to critical care graduate education in the next decade? I hope this further blending between the specialties pretty much what I said a couple of minutes ago. What I hope and what I see may not be the same. We're an evidence-based specialty and I think continuing to build on our collaborative clinical trials worldwide is important. If anything, the pandemic has shown us is that we are one world and we really should be connected in how we're practicing and learning from each other. So I hope we come a little bit more together than we currently are in graduate medical education. Certainly a great deal of interdependence that we have on each other. And it's important to recognize that. I think the pandemic has definitely revealed that. Yes. For sure. What would you say is your favorite experience during your presidential year? Oh, there's so many. It was really, I think probably the greatest single year of my life to date. And what I really, really loved, I think around the world, maybe four or five times, but every experience, whether it was in the U.S., Africa, Asia, Europe, wherever it was, I always wanted to round in an ICU in that place. I wanted to meet the people who were our members and I wanted to see how critical care was practiced around the world. And I think that that was a joyous experience for me. It was an incredible learning event for me to see the commonalities, to see the challenges that some of our members faced. It was incredibly revealing, exciting at the same time, and yet challenging at the same time. So I don't think there was one of those experience. I think there were hundreds of those experience. And I just want to say hello to all the members that I met during those journeys, because it was as meaningful for me as I hope it was for them. I bet you they're probably watching right now, many of them are. And yeah, I'm definitely living vicariously through you as you relay that story. And I can feel the kind of goosebumps as it relates to spending time in the unit and just the excitement that comes along with being on rounds and being able to spend that in different places. It just adds to your connection to those clinicians within those settings. We've got more coming. A few times I got challenged by some cases that were presented to me. And I remember those cases and people very well. But I also got to meet some patients and talk to them really around the world. And I don't know how many of us can actually say that. And I'm very, very lucky to have had that opportunity. Yes, thank you for sharing that. Here's an interesting question that just kind of centers around many of us that look at a role like being president and also being a very busy surgeon and an intensivist. How did you manage your time balancing your professional and your SCCM leadership activities? Yeah, well, I would say for anyone who knows me, it's easy, I'm a lunatic. And so, no, I think you have to be incredibly organized and as efficient as possible. But right at the core of it, you have to keep in mind what is important to you. And if you lose focus of that, then things will get out of balance. I was very lucky in my institution and department supported the fact that I traveled a lot during my presidency. And so they said, it's okay for you to be away. Normally that would not have been the case, but I had a very generous chair who understood. And of course, I'm able to work off times when I was traveling and often in different time zones. So I think organization and keeping what's core at the heart, it's sort of like the patient care circle, except to your own personal life is what is important to you and keeping it centered. Thank you for that. That's definitely sage wisdom and advice. Have you ever experienced burnout and how do you support and treat it? I would say I've had ups and down days. I wouldn't say that I felt burnout in burnout sense. I think I've been lucky that way because I think I have the best job in the world. And I've been a very, very, very lucky person to have been able to do the things that I've been able to do. I don't think you could dream up the opportunities that a poor kid from Salem, Massachusetts would get to do. And I've gotten to do it. And again, when I think about how lucky I've been, I think it wards off all of the evils of disappointment and dissatisfaction. I think the last two years have been the most challenging because of more isolation, not being able to do many of the things that you've been able to do before, not seeing people. These have been challenging. So again, it's remembering what makes you happy and keeps you happy has been what has centered me. And knowing when you need to get out of whatever rut you're in, I think is important. Having a buddy, somebody you can rely on. I tell all of our residents, you need to have a buddy who is constantly watching out for you and can ask, are you okay? What can I do to help? And then you return that favor. And so I think these are the little things that help us get over the drudgery and difficulty. The burnout in our profession, even without the pandemic is a serious problem. It's now only been magnified four or five fold with the pandemic. Yes. Great tips and tricks and tools. Certainly gratitude, resilience. I mean, I got a lot from that. Thank you for sharing that. Do you, what do you think, having trained many within the profession, do you think the ability to be coached and mentored leads to being a good coach or mentor? No, I don't think so. But I do think they are trainable. There is nothing inherent in obtaining these skills. They're not natural. They can be taught. Part of it is opening yourself up to receiving feedback and then being able to give it. So I think really anybody can gain these skills. They are skills. They're not innate qualities, but you have to be open to them. If you're not open to them, then you're not gonna be a good coach or mentor. They are slightly different, but they are teachable and you can gain those skills. Awesome. Thank you for that. What advice would you, you mentioned the learning zone and I absolutely love just reflecting on that. And I use that quite a bit with my trainees as well. What advice would you like to share with others about stepping into the learning zone similar to an impacting SCCM and graduate education, getting outside the box in those areas with the society and also with relative to graduate education? Yeah, I think if you don't take chances, if you don't open yourself up for failure, it's hard to make progress forward. You can only really become more efficient if you're doing the same thing repetitively. You can become more efficient and that's satisfying, but you're not learning anything. And so to learn things, you have to step up, you have to step out of the box, whether your interest is in making a better team, making a discovery about a new therapy, a new process. There's so many different ways that one can step out and learn something. I'm very much in selecting applicants either to residency or fellowship programs. The last thing I want is people who are all the same because you're never gonna gain in knowledge if people are the same, they start thinking the same. Well, the end result is no progress forward. You're only going to make progress forward when someone challenges the status quo. And so when you start challenging what you're thinking and willing to go on the edge, now you don't want to get so crazy that you're anxious and can't learn. You don't want to make that kind of environment, but you want to make it a little bit uncomfortable. And so what I would say to the members is step up and out, learn something, do something new. Don't, when you go to the Congress, don't go to the things you already know about, go to something different, go to something you're actually gonna learn about. You know, I realized probably 10 or 20 years ago that I would always go to the topics that I already knew and I'm there like, why? Now I did occasionally have a reason to do so. It would be because I wanted to learn how someone else was explaining something so that I could be better in explaining it in the future. That's valid. But if it's just to affirm that you're so smart. Don't do that. Go learn something new. Step out and approach a new topic that you feel a little weak on. Yes. I love that. You really have to be uncomfortable in order to learn. Yes. And ultimately, you want to avoid that panic zone, but that learning zone is really, you know, that's the sweet spot. That's excellent. Could you list the three most, these are actually additional questions that have been offered up through the membership. We did some polling on the members and we've got some additional questions here for you. Could you list the three most important challenges currently facing critical care delivery? The workforce, I think, is number one. Perhaps an over-reliance on technology. Yes. And burnout, I think, are probably the three most important challenges. Yes. The workforce is the most complicated because I think it has several problems. One is certainly the nursing profession is disillusioned in many ways right now. And we cannot do what we do without nursing providers at the bedside being willing to take care of our patients with us. And so I think that's a real challenge. I think from a provider standpoint, there's still a lot of interest, a physician provider standpoint. Yes. I think there's a lot of interest in critical care and in surgery, specifically it's blossoming. So I'm not so nervous about that. But then you look in combination to probably an unacceptable burnout rate, high burnout rate. It's not unique to a provider group. And so the stress of the situation, pandemic or not, is something that we have to study more. We have to learn how we can do better at it. What are the things that create so much stress that in the long run, it becomes an unacceptable profession or less acceptable as you age? And I think that those are things that we can learn in the future. I am worried about technology overtaking the importance of interpersonal communication. And I would say my own experience during the pandemic, I really hated the lack of family around in order to see and communicate, to see their family members and to communicate with us in a face-to-face, in-person way. Maybe I'm just old and old fashioned, but really there's no replacement for that. And my own personal satisfaction was much less in the ICU. And I think if I had to do it all the time, like the nurses who were working in that environment, I think I probably would have been burned out from just that aspect alone. So we have to figure that out. And we have to make sure that we keep the things that really drive us to doing the best that we can do for our patients and families, and yet embrace technology when it helps us, but not when it makes care impersonal, because I don't think that that's going to be a good thing. It definitely doesn't replace the interpersonal interactions, whether it be that of the team or that with the patient and family. So it's revealed a lot of cracks in the foundation for us and things that we definitely need to continue to shore up. I think the words healing hand and healing touch have a therapeutic effect for a good reason. It's real. Absolutely. In terms of your time spent mentoring others, what would you say is your most important piece of advice you've given to mentees over the past decade or so? Be true to yourself. Learn to say no. Learn to say no to things that you think are not going to, either you don't have the time for, or you don't have the passion for. I think when you first start in your professional career, after your training, probably you don't have a focus or shouldn't have an overt focus on exactly what it is you want to do to be successful. So try out a bunch of different things, but not so many things that you can't participate. You know, that's one thing about any society that you commit yourself to. If you commit to doing something, do it. Don't commit to things you can't do. And I actually think that's how you can be successful is doing what you say you're going to do. Yeah, absolutely. Yes. Yes. It'll take you far in life for sure. What would you say is the biggest advance you've seen in surgical critical care in the course of your career? Biggest advance? I would say the biggest change is really in understanding the role of the ventilator in injuring the patient. Yes. And in the advances, we're still not perfect in understanding ventilator mechanics and how best to use the ventilator as an aid instead of as an assassin. And I'm quite sure in my own training that I only thought that the ventilator was a great thing. But now I have a different view about the ventilator. And I would say that's probably one of the more important areas. But there are so many, it's hard to, you know, the surviving sepsis campaign, I think probably if you looked at the number of individuals and the worldwide influence, probably that's the most important thing overall. Excellent. Thank you for that. Aid versus assassin. That'll stick with me for sure. Given the theme of this year's Congress, diversity, equity, and inclusion, what do you envision success for SCCM's DEI efforts look like in five years? Well, I know that the vision and passion to make changes are there. I think they've always been there, but now they will be visible and transparent. And anytime it is visible and transparent, I think there will be improvements in the area. You know, SCCM has always been diverse, but just in a different, in the professionality of its diversity. But I think now the other aspects of diversity have been embraced, articulated, and transparent. And in the recent communication from David Martin, clearly we have begun to make real steps forward, probably more than any other society, or at least transparently more than any society. So that's encouraging, but it's probably not enough because that's the critical care is the end product. We need to make sure that the pipeline, so we can't just say over here, we're going to do something. We have to invest in our community and our youngsters. We have to show them what a great career this is, how important we as a profession can be, as a field can be to taking care of their family. And so I think we're not done, and we can't just focus on the society, SCCM society. We have to actually focus on society. As a whole. That's an excellent point. You're absolutely right. You've got to lay the stage and the groundwork to make this an appealing setting for a diverse group of individuals to want to participate in that. And that's very, very, very forward thinking. I've got a separate question. It's shifting gears a bit. It's related to mentorship again, as well, fitting in the graduate education theme. Who's your most important mentor, and why? I don't think you usually have one mentor. I think you often have many mentors. And Tim Buckman certainly was one of my most important mentors. As you know, he's been a president of the society. But what you may not have right at hand is we were residents together. And he really embraced me as an intern. He walked me over to pathology. I can remember it as if it were the day it happened. And he said, this is an unbelievable resource that you can use to do research. And this is how to do it. And then he introduced me probably a couple years later to Margaret Parker in SCCM. And he said, you two have a lot in common, even though we don't really have anything in common except SCCM and critical care. I guess we're women, and that was in common. And I think our personalities are a little bit similar. So now I met this dynamic woman. I was still a trainee. And it was wonderful to have that relationship so early in my engagement with SCCM. So I would say Tim has been really important. But there were so many. And again, they were listed in my presidential address. And I don't want to ever exclude my colleagues, my residents, and especially my patients. Because there have been mentors in different ways. I've learned from them. There have been teachers in ways that are non-traditional. But every one of those people has made an impact on my life. And so I might not use a standard definition of mentorship and learning. But I think almost every experience you have, if you're open to it, contributes to your development. It's so true. It's so true. And that goes with the old adage of it takes a village to raise a child and a person and give you all the influences that you need. That's a really interesting perspective and take. Thank you for sharing that. I've got a couple of fun fact questions for you. And you mentioned your first surgery at the age of four. Tell us more about it. Well, it was a Christmas present. It was Chatty Cathy. Yes. And I believe I had a picture of this in my presidential address. I still have Chatty Cathy, by the way. Although the real Chatty Cathy was, that's a shorter story. I won't tell it at the time. But she was one, if not the first talking doll. Yes. And I wanted to see how she worked. Yes. So I operated on her. I took her apart right there on Christmas Day. I took her completely apart and I put her back together. Oh, wow. And she still talks today. Although I briefly had to lose Chatty Cathy because I got evicted from kindergarten and I had to donate Chatty Cathy to the to the school. So even back then, I guess I was not willing to always play by the rules. So it is possible to get remediated and it is possible that I do have Chatty Cathy back. Absolutely. And it served you well throughout these years. Here's another question just in your background. You mentioned, you know, your upbringing and your in and some of your early years in Massachusetts. How did your previous work at McDonald's prepare you for your future in critical care? Oh, it really in a lot of ways. First of all, I was a leader. I ultimately was a manager at McDonald's, but I went through all of the stations. So I learned all of the jobs. I got good at all of the jobs and then I became a manager. And so I had to manage a team of very different people. I had to recognize what their strengths were to put them in the proper positions to make the operations work. And I thought healthy competition was a good thing. I had to manage my own brother at times because an older brother. So I became the manager of my work there. So you learned I learned a lot of people skills and I think those were really useful. I also learned how to do a schedule. And I learned that no matter what schedule you have, you're not going to make everyone happy. So you have to do the best you can do to meet the needs of the institution. And I am very thankful to McDonald's for a lot of reasons, but especially for giving me leadership skills. Oh, that's excellent. Tell us more about your pets as we understand that you're a dog person. Oh, I am totally a dog person. I have four dogs. I have three King Charles Cavaliers aging from age three to nine. And I have one mini Australian Shepherd and they all go well three of the four go to agility. So I have a family plan to a training center. I go in fact, Wednesdays tonight is my time to go to the training center with my dogs to practice learning. And I just want to say that I've learned about learning from my dogs, at least from learning procedures. So and this is how dogs and residents are similar. Yes. First, break a complex procedure down into its component parts, and teach those component parts. That's one. Two, and this one probably is hard for me to learn, but incredibly important in both training. Use as much positive reinforcement as you can. Always acknowledging what is being done well, first and foremost. Certainly dogs do not do well with negative, a negative tone and punishment. Yes. Three, give treats, both residents and dogs. I bet you the residents love it. So it's very, very similar. And so I love my dogs. They're all three of them are quite good at agility training. They're all my favorites, all of them. And I actually have a dog party for the residents. Once a year where I rent out the training facility, bring my dogs, they can bring up to 20 dogs. And they don't have to have a dog to come, they can just come and play with the dogs. And so it's a time when, if you love a dog, you can come and play with dogs. If you want to bring your dogs, it's just a way to show people that you are something other than what they thought you are in the hospital. And that's your real person. I tell you, thank you for sharing that. That's excellent. Definitely some pearls that I'm going to take away there. The positive reinforcement is a big one. And I think it can be counterintuitive and also lost depending on the type of training and the environments in which some of us may have been trained. There may be more stick than carrot, but the carrot actually works really quite well. From that standpoint, is there anything, Pam, that you'd like to share with our audience relative to just any thoughts you'd like to share? Well, I really want people to understand how important their role as volunteers are to the SCCM society. It is an incredibly well-run society with important mission and vision. And get involved, I would say. I have immensely benefited from the personal relationships I've had with a whole variety of people at SCCM, of the other volunteers, of the SCCM staff and leadership. It's really been an incredibly meaningful experience for me. And I think all you have to do is step out. Awesome. Thank you so much for sharing that. And I can just speak to the fact that when we were having dialogue with the program committee and I was assigned to moderate this session with you, doctor, that there was very vocal acknowledgement of you being a pet person and a wonderful person to work with from the staff, from the SCCM staff. It just speaks to the impacts that you've made throughout the years working with the society. Thank you for saying that. I really appreciate it. Absolutely. It's the truth. Thank you so very much, Dr. Lipset, Pam, for sharing time and your story with us today during this Luminary Lounge session. Also want to thank you for your leadership, for your contributions to the society and critical care as a whole. Thank you very much. Thank you.

Luminary Lounge session

Dr. Pamela Lipsett

graduate medical education

critical care

diversity, equity, and inclusion

workforce issues

burnout