Leading the Rounds Caleb Sokolowski & Peter Dimitrion

Dr. Lindsey A. Criswell, is the director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Prior to joining NIAMS, Dr. Criswell was vice chancellor of research at the University of California, San Francisco. 
She has a bachelor’s degree in genetics and a master’s degree in public health from the University of California, Berkeley, and an M.D. from UCSF. 
As the NIAMS director, Dr. Criswell oversees the Institute’s annual budget of nearly $625 million, which supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases. 
Between 1994 and the time she became NIAMS director, Criswell was a principal investigator on multiple NIH grants and published more than 250 peer-reviewed journal papers. 
In this episode, we discuss her journey as a leader in medicine and science. Welcome to Leading the Rounds. 


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

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

Dan Dworkis, MD PhD FACEP is the Chief Medical Officer at the Mission Critical Team Institute, a board-certified emergency physician, and an assistant professor of emergency medicine at the Keck School of Medicine of USC where he works at LAC+USC. He performed his emergency medicine residency with Harvard Medical School at the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital / Brigham Health, and holds an MD and PhD in molecular medicine from the Boston University School of Medicine. Dr. Dworkis is the founder of The  Emergency Mind Podcast , and the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure. 
Questions We Asked: 
Why did you feel the need to create The Emergency Mind? Is poise under pressure a learned skill or innate? What are valuable skills you have learned creating The Emergency Mind? How does someone successfully improve through a performance loop? What are ways to decrease stress while performing procedures? How does the Emergency Mind address team dynamics? How do you build a well functioning solid team?How do you run a successful debrief?  Advice for medical leaders under pressure? Book Suggestions? 
Quotes & Ideas: 
Applying knowledge under pressure is a separate learned skill What happens when you are trying to intubate a patient and miss the first time? How do you recover and make the second attempt? Prepare-> Perform-> Recover-> Evolve “Create an environment that sets you up for success” Experiment and be a scientist of yourself: Build->measure->learn Exposing yourself to stressful scenarios outside of the hospital can help you build skills to help clinically Use self-talk to help yourself manage acute stress When debriefing, learn to separate outcome from performance. You can sometimes have a poor outcome with perfect performance and also a good outcome with poor performance. Debriefs can use outcome vs. performance on a 2x2 matrix. Never Waste Suffering. Both ours as providers and the patients. Harness the wisdom in the room around you Practice when you are outside of pressure and then slowly introduce it to stressful situations Book Suggestions: 
Thinking Fast and Slow by Daniel Sources of Power by Gary Klein “A Failure to Disagree” paper by both Ghosts of the Fireground by Peter Leschak 

Intro: 
Dr. Thomas Varghese Jr. is the Associate Chief Medical Quality Officer and Chief Value Officer at the Huntsman Cancer Institute, and Chief of General Thoracic Surgery at the University of Utah. 
Dr. Varghese is a national leader in minimally invasive applications for general thoracic surgery, recognized by Castle Connolly as one of America’s “Top Docs”, and is ranked in the top 10% of the nation by Press Ganey for patient satisfaction scores. 
His research interests bridge the world of Educational Research and Health Services Research, specifically in the arena of optimizing performance at the patient, surgeon and system levels. He created the Strong for Surgery program, which is now a formal Quality Improvement program of the American College of Surgeons, and active at 331 clinical sites across the nation and 3 state surgical collaboratives.
Dr. Varghese holds national leadership positions in the Society of Thoracic Surgeons, Thoracic Surgery Directors Association, American College of Surgeons, and the Society of University Surgeons. Dr. Varghese is active on social media and is the Deputy Editor of Digital Media and Digital Scholarship for the Annals of Thoracic Surgery.


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

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

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

COL (Dr.) Cristin Mount is an Army Critical Care Medicine physician currently stationed at Madigan Army Medical Center in Tacoma, WA. She graduated magna cum laude from the University of Scranton and completed medical school at the Uniformed Services University in Bethesda, Maryland in 2003. She did an Internal Medicine Internship and Residency at Madigan and moved to Walter Reed Army Medical Center in Washington, D.C., for Critical Care Medicine fellowship. 
After fellowship, she returned to Madigan as the Director, Critical Care Services and promptly deployed with the 28th Combat Support Hospital to Baghdad, Iraq where she served as the sole Intensivist and the theater consultant for Critical Care and Internal Medicine. She is the only woman to serve as Chief, Department of Medicine and the Deputy Commander of Medical Services.  Currently she serves as the Critical Care Medicine Consultant to the Army Surgeon General.
She is a Master of the American College of Physicians, and past Governor of the Army Chapter of the ACP. She is married to COL George Mount, an Army Rheumatologist, and they have three small boys under the age of 7.
Any views expressed during this interview reflect those of Dr. Mount and do not represent official views of the Army Medical Department, Department of the Army or Defense Health Agency. 
We hope you enjoy this episode where we discuss her journey through medicine and leadership as well as leadership in the ICU. Welcome to Leading the Rounds. 


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

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

Book Suggestions: 
Complications by Atul Gawande We Were Soldiers Once and Young by Lt. Gen. Harold G. Moore and Joseph L. GallowayThe Liberation Trilogy by Rick Atkinson 

Intro: In this episode we interview Dr. Karla Williams and Dr. KeAndrea Titer. They are assistant professors of Internal Medicine at The University of Alabama at Birmingham. They are passionate about diversity, equity, and inclusion and both work to design initiatives and curriculum focused on recruitment, education, and building community. This includes the AIRR initiative, which we discuss in the episode. In this episode, we discuss creating a welcoming culture in medicine and working to drive cultural change through seeking to understand others. Welcome to Leading the Rounds. 
Questions We Asked: 
What inspired you to develop the Clear the AIRR initiative? What’s the difference between a macro and microaggression? How should physicians deal with microaggressions? What does your program look like practically? How can leaders manage microaggressions?How do you create a culture of occupational wellness? What advice do you have for medical leaders? Book suggestions? Quotes & Ideas: 
Microaggression initiative (AIRR): Assessing, Identifying, Responding and Reporting As a leader, it is important to develop a culture where problems can be discussed openly and solutions can be made. As a trainee, it is important to seek out mentors who will feed into your career aspirations. Diversity and Inclusion programs should highlight mentorship, sponsorship and support “You have not been selected to this program because someone felt sorry for you. You have worked incredibly hard for this.”Occupational Wellness: Being in a career that you enjoy, providing value to those you are serving, and having a space to balance your own self care “You should work to see the best in everyone, but never be afraid to challenge them as well.” -Dr. Williams Enter to Learn, Depart to Serve Don’t be afraid to go against the grain and change the culture of medicine. Books: 
Dr. Williams & Titer suggested reading The Bible as a way to learn leadership 7 Habits of Highly Effective People by Steven Covey 

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

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

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