Amit Goyal, M.D. and Alexandra Sykes, M.D. | Cardio Nerds: Innovating Cardiology Education

Welcome to Inside the Studio, the official podcast of the Texas Heart Institute at Baylor College of Medicine. I'm Dr. Joseph Rogers, and together we'll explore the ever-evolving world of cardiovascular care. [music] In each episode, we bring you conversations with the people shaping the future of heart and vascular health, cardiologists on the front lines of patient care, surgeons performing groundbreaking procedures, and scientists leading discoveries that will change medicine for generations. We'll also highlight perspectives from [music] international leaders and community voices who share our commitment to preventing, diagnosing, and treating heart [music] disease. Whether you're a physician, a researcher, a patient, or simply curious about the latest in heart health, this podcast is your inside look at innovation, education, and care at the highest level. So, let's step inside the studio. Hi, I'm Dr. Joe Rogers, and I'm the director of the Texas Heart Institute at Baylor College of Medicine. And we're here in the studio today with two very special guests. First, Dr. Amit Goyal, um who's an assistant professor at UT Southwestern. Sort of a very storied training history uh from California to Hopkins to Cleveland Clinic, and a structural and interventional cardiologist in the UT Southwestern system and at the VA in Dallas, also directing one of the cardiac care units there. So, Amit, thanks very much. I'll get to the real reason that you're here in just a second. But, also joined in the studio uh by Dr. Alex Sykes, who originally is a Houstonian, so welcome home. >> Thank you. >> Uh chief fellow at UT Southwestern and staying on the faculty at the end of this academic year. So, welcome to both of you, and welcome to the Texas Heart Institute. It's It's such an honor to be here. Yes, completely. So, we started the discussion today in grand rounds, really focusing on cardio nerds. And I'm I'm just want to You start off with a very humble statement that struck me, where you said, "I really have to get something off my back, you know, I wanted to be an academic cardiologist, but I don't really want to do research. And then as I was watching you tell this story of how CardioNerds started and evolved and what it's evolved into, sorry, but you actually are doing research. >> [laughter] >> And maybe it wasn't the kind that you had intended on, but you know, like it it was it's it was really interesting and inspiring to watch what you've done with with in retrospect what was an amazingly good idea. But I'd love to get your both of your perspectives on on the way medical education is evolving. You know, and I think all of us that have been in the space for a while feel it, you know, it rounds are different. Uh all of medical knowledge is in in everybody's pocket. Um like talk a little bit about where we've come into this point and then maybe even look forward and what what does this look like even 5 or 10 years from now? Yeah, I think one you know, in these discussions, I think the boogeyman that people worry about is that we're all just going to have a generation of medical learners that's on our iPhones, siloed into something where we plug in a program and then the computer sees a patient. And I feel very optimistic that it's the opposite direction. And so I think things like CardioNerds have democratized medical education. Yes, you have information in your pocket, that's based different time learning. Today I saw a left main lesion. I can go listen to that podcast episode and enhance my learning. But we're also through CardioNerds creating a network where we get to deepen our understanding of medical education and something that came up in our survey as we you know, interviewed the different fellowship programs across the US is that people love didactics. People still love in-person didactics. And so the future state that I imagine is actually just an improved enhancement of all of us as learners that we have the ability to access information at the time that's convenient to us so we can be individualized and make space for a different types of trainees while also enhancing the you know, person-facing time. So you with your mentor, you on rounds actually gets better and makes us all more engaged is the way that I, you know, imagine it. Yeah, you know, I'm I'm reminded of um third year of medical school when I started my surgery rotation and the chief of surgery, he asked all of us. He's like, "What What makes a doctor different from a mechanic?" And like everyone is giving answers. Like, "No, no, that's not it." He's like a grumpy old man, you know, he's a incredible surgeon. He said "You know, the doctor doesn't leave when the shift is over. The doctor leaves when the patient's better, when the work is done." Right? Really emphasizing that that medicine is a calling. Like it is so much bigger than than than ourselves. And you know, it's it it's hard to translate that into today's world of duty hour restrictions and also, you know, people having families in earlier and earlier in training. But but there's an ethos there that I feel like we're chipping away at, you know, like the the calling aspect of medicine, the awe in the science, the awe in the humanity. And this like emphasis on duty hours, the focus on screen time it's just like depersonalizing that medicine as a whole that just takes it away from like the core of what makes it so special. So I, you know, I I'd love to see ways of really kind of bringing back that awe in medicine. And I think even more important now with AI. So one thing we we end all we end all podcast episodes on is what makes your heart flutter in X. You know, what makes your heart flutter in taking care of patients with, you know, cardio-obstetric disease and and and get to the humanism of of what drove somebody to pursue this calling. And then I also think with the advent of AI and having knowledge information so readily accessible as well as integrating it into our clinical workflows, helping it be the scribe that can have that work done. We can shift our attention away from the screen and back to our patients, you know, and free our minds to maybe focus both in education and in practice to not focus on memorizing things, but be more critical users of data and evidence. And then contextualize that for our patients. But but to do that, you have to know your patients. You have to understand their values, what drives them, what are the limitations they have, what are the socioeconomic barriers. And maybe there's a way in education we can start focusing more on bringing it back to the patient, letting AI hopefully in a positive direction free us to do that and maybe bring us back a little bit more of the sense of awe for why we do this. And it has to get back to the patient. It'll be really interesting because I think we're all almost going to have to de- cate and then re-educate. I think we become so acclimated to working in an electronic health record, which I agree is is very dehumanizing and and excessively we spend an excessive amount of time in that environment, right? In that electronic environment. And if you actually were allowed to work in a space where there was ambient listening and that would do much of the tedious, mundane work that were we have to do. It almost feels like in some ways we're going to have to go back and recapture some of why most of us went into medicine anyway, and that was to have those sorts of relationships with patients and be able to extract information and help guide people and counsel and listen in a meaningful way. Yeah, absolutely. And even with our colleagues, right? I mean like right now we we communicate with each other based on notes and try to interpret what the other person means, right? But but being able to go and actually say, what are you seeing in the CT and help me understand this and go down and talk to the colleagues. Um and bring the heart team together in the room to give a patient sort of a more of a you know, a consensus um recommendation. I think there's a lot of value in that. I think it's it's very interesting that you um were earl not not early at an early adopter of podcasting, but you've certainly been incredibly successful and I think capturing this movement toward a discussion about a condition. And and it's a very different way than sitting in a lecture hall with slides and you know, it which which is very unidirectional. I mean, is it is it the sort of the bidirectional interchange, do you think of a of a knowledge exchange that's so engaging in a podcast? Good. Yeah, I have a thought on this and and I think that when when a learner on the podcast, the host is asking questions of an expert what and somebody's listening to that conversation, they relate to the person asking questions. Right, there's like a role modeling there. So, you relate to oh, this is a question being asked, a question that I would ask, you know, and it triggers you to listen to it. Right, almost like prompts attention in a way that is very relatable. And it does I think translate into this the social cognitive learning theory in that there is not just information that's being exchanged, but it's also role modeling and that we we we kind of imprint on on our learners, right? And I think with a podcast, it simulates there's a conversation and it's not just it's not just okay, let me tell you the differential diagnosis for this. Let's have a exchange about it and share stories and maybe joke a little bit and show the humanity. So, it really becomes very relatable and memorable. Like we we are deeply social creatures, right? We don't remember data. Right? Like will know data, but you won't remember data. You won't internalize it. You won't It won't be visceral. But what becomes visceral are stories. The jokes. >> Right? And so when somebody answers a question in a conversation that relates back to an experience they had or a patient they remember, then you remember the story. It becomes visceral. It becomes organic. All right? And this is why I also tell my learners, when you see a patient, then that's the time to read about it because you will remember the patient and then you will remember the data. Right? And I think with podcast, that's what happens is it's a discussion. It's something you remember because it's a story form. And then you also relate because, you know, you would ask the same questions. I also think the to your point about the social, you know, dynamic of our learning, it's so amazing specific podcast like CardioNerds that you can hear from people, professionals who you've admired maybe at a national conference, but you didn't get to hear what makes their heart flutter. You don't get to hear them talk about a case through their unique lens and I think that that's something that is as a trainee very compelling. Yeah. And and I'll And this, you know, we're saying CardioNerds because we're here, but but this is also applicable to when you see webinars or see panel discussions at ACC. Like it is that interaction and interchange between between experts and learners and trainees. Like it's it's the dynamic discussions that I think we tend to remember. And that's why I think the curriculum have also sort of prioritized like panels and discussions in a lot of these forums. You know, I think the other thing that's really striking about this kind of a media approach is that as a trainee, you can learn from the the very best clinicians across the entire country. And every training program has, you know, some amazing educators with incredible expertise, but you can actually then begin to learn um from people who, you know, may have a different perspective that you would never have been able to access in your program. >> Completely. I totally agree. I also think the component of having that accessibility in a bite-size chunk. There've been several times I've been on our cardiac ICU rounds, saw a patient that I thought was interesting. I one of the case report series of suicide LV. I thought this is such a good case. Talked about it with our team that night, sent them a text saying, "Hey, just you know, for you while you're making dinner, while you're doing something, listen to this podcast episode to just sort of do that space learning." So, there's just a lot of ways that it can come up in your teaching. Yeah, it's really interesting. It was a great case. >> Yeah, it was great. >> [laughter] >> I still think of it like this. Great job. So, so I got very interested um in on the website and then in in your comments about the academy. And what an a brilliant idea. Um you know, it strikes me as I talk to trainees that there is a there are there are very consistent themes that people want to understand. They want to know more about how do I take a career path? How do I pick a mentor? How do I review a paper for a journal? Like I'm sure, you know, we could probably sit here for another next hour >> [laughter] >> and come up with, you know, those series of questions that we all hear. How do How do you take what you're doing now, for example, in the academy and then begin to expand that out and broaden it so that you're really touching more people and addressing these very common concerns? Yeah, that that's a great question, Dr. Rogers, and I don't have a great answer to that because we've thought about expanding the academy and it's really hard to do that and still maintain the value that it brings for people. Because there is the training part of it, there is the, you know, going through the curriculum part of it, but there's also like knowing each individual and developing them as individuals on a personal level and and that that that's not scalable, but what you hope is, you know, going back to like investments and and ROI, is that that every person that goes through some a program like this, whether it's the academy or mentorship programs through the ACC, is that there is a is a very By by investing so much in people, and all of us have had people invest in us, and we paid forward. Mhm. And so you invest in people and hope that they will pay it forward. And then, you know, it maybe it takes it takes some time and iterations, but that's that is a compounding effect, you know, that hopefully, you know, it's you can't prove that it will happen, but you hope that it'll happen. And that's what we try to teach people is is I am doing this for you because somebody did this for me. And so now you have you have this onus of responsibility. >> Right. Yeah, you can see the branching effect of that, right? And [clears throat] that is it 20 years from now there will be a huge cohort of cardiovascular specialists that can trace back to CardioNerds and and the experience No, no, that they their original experience for exactly the same reasons that you just described. I mean if you want to go back and look at an old example, think of Gene Braunwald's career. Right? I mean, the people that he trained, that his mentees, and and it just continues to branch out and branch out, and they're probably you know, it's a bit it's a bit like the you know, the Kevin Bacon the whatever degrees of separation so [laughter] many people have been touched by Dr. Braunwald in one way or another, and so So, you know, the other thing that strikes me is that you developed an incredible platform to potentially teach patients about their disease. Like, what are you guys thinking about doing something patient-facing? Yeah, that's a another great question. We've had a lot of people people come through to to do something patient-facing, and we just we haven't leaned into that as much. What we have done, you know, there's like physicians teaching patients, but then also patients teaching physicians. And so we've had several you know really meaningful discourses where we had patients and all their families talk about the trials and tribulations of being a patient. But you know what the advice we got from Dr. Sanjay Desai early on, he was my program director at in residency. And you know early on he also had an MBA so he had a you know business mindset. Is is the reason small you know like startups fail is that they have early success in something and then they think they're good at everything and they start doing everything and then they lose what made them special and they fail. So make sure that you have a mission that guides you and then you stick to it. You will have a lot of people trying to collaborate, you will have a lot of opportunities, but then at least your mission can be your North Star. So we said okay fine, let's let's really crystallize what our mission is and it's to democratize cardiovascular education. And really for the people taking care of patients. And so we said you know what, this is what we're going to focus on, this is what's going to be our North Star. And so how do we do that? So that's you know for better or worse that's been our guiding principle. You know what, I think that that's probably a very sound approach to this. Honestly, I think that we all probably have a lane. And you know the things that you're doing are remarkably impactful, successful. I was very impressed with the work that you described about the clinical trial network >> that you have developed and that the life changing experience that is for fellows in training to begin to understand what it's like to be a site investigator and and to and to provide that kind of experience. And so you know maybe we leave the patient facing stuff to the some other nerd community. >> one [laughter] of your branches. One of your downstream branches can >> Maybe one of the [laughter] branches will do that. Listen, I I just I know the time's drawing to a close and I just I wanted to thank again both of you for coming to join us here at in Houston and at at THI and Baylor and wish you all the best success in your new faculty role and I look forward to staying in touch with both of you as we continue to collaborate and and think about ways to educate people. Thank you, Dr. Reardon. Thank you so much for having us. Thanks. >> [music]