Amit Goyal, M.D. and Alexandra Sykes, M.D. | CardioNerds: From Passion to Purpose Through Community

Well, thank you so much for that very kind introduction. I have to say it is such a pleasure to be here in the storied institution. Um, particularly for us in interventional cardiology. I feel like there is just such a reverence for places like this that have a rich tradition of innovation, excellence, and just robust clinical training. Um, before I get started though, uh, I have a confession to make. And, you know, I had such a warm welcome with everyone last night. I I feel like I'm part of the family and I can get something off my chest. It's a safe space. Um, it's kind of hard, but I am an academic cardiologist and my heart is not in research. Good medical educator. Now 10 years ago if you said that I want to be a academic cardiologist not interested in research you know even uh more than now it would have been something odd to say to your mentors but I had the privilege of connecting with these three extraordinary women early in my training Dr. Katie Berlocker Dr. Carrie Schaefer Dr. Melanie Celestio who showed by example that not only is it a valuable pursuit to have medical educators in cardiology but it's something to be celebrated. How we teach the next generation of cardiologists um how we teach and train them is is is such an important calling. So um you know thanks to the three of them for giving me the the the privilege and and empowering me to really kind of lean into education and let go of some of my clinical research and fellowship. My disclosures are all related to various funding sources for cardianers. So my main thesis for you today is that a collaborative network empowered with purpose and resources can accomplish great things. But in and of itself, this is not very revolutionary and this is how we do good things like guidelines and trials and whatnot. But but I'm going to take it a step further and tell you that I very strongly believe that a collaborative network of trainees that are empowered with purpose and resources can accomplish great things. And I'm going to take you back to my undergrad years when I was a neuroscience major. Think about doing neurosurgery at the time. But one of my favorite classes was this introduction to um the theories of consciousness. And one theory in particular stuck with me, emergentism. It's a philosophical uh position that consciousness emerges from physical systems but cannot be reduced to them completely. In some the whole is greater than the sum of its parts. Okay. And so if you have a neuron, it's just you know a cell with biology, interesting biology, but it's just a cell. You put a bunch of neurons together, you get tissue, but it's still just biology. But in a brain, this complex network of neurons becomes the seat of consciousness. And it's something so incredible and beautiful. Uh this is me in my early years, you know, with my hopes and dreams and aspirations and my skill sets and my shortcomings operating in a bubble. And I think many of us throughout the world operate in a bubble. But imagine if you could break barriers, remove silos and interconnect people in ways that are productive. Then similar to neurons in a brain, you can develop a community that has a life of its own where the sum is greater than the the whole. So this living breathing community develops a mind of its own and properly nurtured it can accomplish great things and so what is in these connected networks. Um so how does cardiners kind of fit into this uh this background and my arc for us today is to talk about cardiner's origins and how it developed into an educational platform later how it developed into a community and then to give two case examples two case studies of how a collaborative network of trainees can accomplish great things. the cardio clinical trials network and the GMBB cardactic curriculum consortium. So we'll start off with the origins of the cards species and how it turned into an educational platform and this started in 2019 when I was a second year fellow with a good friend Dr. Daniel Ambiner who's also a structural interventional cardiologist practicing in Baltimore and we were prompted by mentors to try to find ways to pair our love for cardiology and education and think about creating a podcast following the template that has been done very successfully in internal medicine at the time. And so we talked to each other and we said, "Look, we like teaching in rounds and maybe you teach to a group of five to 10 people in a setting in noon conference. Maybe you get 20 to 40 people if the food is really good, but imagine if a podcast if you could reach 500 people and teach them about aotic stenosis 500. Imagine a room full of 500 people." I remember Dan said that to me. Imagine a room of 500 people. So we said, "Well, maybe maybe that would make this worthwhile." So we said, "Okay, maybe if we can reach 500 people, it would be worth it." But within the first month of trying this out, we had 5,000. And since launch, we've had seven over 70 million downloads across more than 200 countries. And this represented the you know more than 400 faculty and I see some in the group Dr. Deescu included. Thank you so much. Uh almost 500 trainees and counting more than 50 fellowship training programs and several organizations that have come together to create this educational platform. And the question is like why why has there been so much uptake? You know we started with a very modest goal in retrospect 500 people. And so let's kind of think about education and what we need to learn to be able to practice for our patients. And this may have been a very typical week for me um during my interventional cardiology training. Uh living the dream, right? I mean cases every single day Monday through Friday. Uh interspersed through all of this. Hopefully there's some time for family, some time for academics, some time for cardiners at the time, uh time for sleep and semi hall, right? But also over the course of the week, we have our dactics. We have our grand rounds, we have our lecture, path conference, a variety of new conferences. And so that's good for education. Over the course of that week, I may see a slew of different cases. maybe an emptier tric heavily calcific left main stenosis mital vavaloplasty in a pregnant woman and doing just a really good right left heart dynamics for our patients through the BSD okay that's what's on my mind right I walk into grand rounds and it's a grand rounds on coronary microvascular disease or maybe it's a grand rounds on cardio nerves and maybe that's not relevant to your goals right now as you walk into your next case the interventional cardiology lectures on venus interventions the cat conference is interesting but miscellaneous cases and so the learner in the room is distracted. They're thinking about the goals that are immediately relevant to them and Venus interventions may not be immediately relevant for that patient with calcific disease. Step into the virtual domain where you can have just in time access to asynchronous education. Well, now you can access podcasts, YouTube videos, the sky and tier ebook which is excellent. uh ACC, ASC, Echosap, um all sorts of media that is is is immediately relevant to your immediate goals. And so, you know, there in lies the difference between synchronous in-person education versus asynchronous virtual education, right? Synchronous in-person education is lecture lecturer centric where the teacher decides what they're going to teach, where they'll do it, when they do it independent of the learner goals. This is phenomenal for creating the foundation for education, early childhood education, undergraduate education. But as you know, everyone in this room is an adult learner. You know, you've gone beyond that. You have your own goals. Adults uh are busy and time constrained. They have they're very goal oriented, problem centric, and need to learn uh they're primed to learn things that are relevant to them um and their cases, you know, for physicians. And so they can access uh uh asynchronous media, you know, what the content they want, where they want it, when they want it. Um in a way that is much more reproducible. And so this is from the carder's email list. Um you know, at the time this was over,200 uh respondents comprised about 12% medical students, 25% residents, 20% faculty. Um I'm sorry, 20% fellows, 15% faculty, and then a smattering of allied health professionals. And among the self- selected group, 95% said that podcasts added to my knowledge base. 93% said it made them a better educator. 90% changed my clinical practice. Uh when asked what do you use most often? Only 11% said in person. Which modalities do you enjoy most? 15% in person. And what's had the greatest impact on your clinical management? 20% in person. Now obviously this is a very self- selected group of people that is biased, right? because they're listening to a podcast and signing up for that podcast email list. But nonetheless, this is a very large section of our learning population. And so there is, I think, value for this. Uh later on, and I'll get into this more, but we did a case report series with u partic fellowship programs. Um and we pulled these uh 44 programs and had a 77% response rate from fellows. That was 137 fellows, and a 69% response rate from program leadership, meaning program directors and EPDS. And so you know when asked um about these questions for the fellows on a lecturer scale it was four or above meaning agree or strongly agree to the statements listening to medical podcastes added to my knowledge base made me a better educator and changed my clinical practice and also consistently there was a less enthusiastic response by program directors and program leadership indicating that there may be a generational shift andor a difference in preferences in terms of how to acquire education. uh represented in a different way. Um looking at these statements uh between fellows and program directors um the vast majority reported agree or strongly agreed to these statements that this was an effective way to teach core cardiovascular concepts has changed my clinical practice made me a medical a better medical educator and added to my knowledge base u particularly for the question about changing my clinical practice again 46% of fellows strongly agreed compared to only 8% of program directors and APDs and so that probably does reflect that there is a generational shift and you know we'll continue to study this but that's all to say that you know I think the carers has had may have been a gap at the time but um but there is uh I think a a a reason why that may be in terms of how adults learn and there is at least some data to support why u you know there are changes in preferences among our younger learners so that's cardio education what about cardio community how did it go from a unidirectional podcast to becoming you know such a a rich community within the group and so I um don't just believe but I know that if Cardiners had continued to be the Amit and Dan show it probably sputtered along for a couple of years and then fallen off a cliff but um you know the reason that Cardi nerd sustains and has achieved so much is because of the community that collaborates and contributes to it uh through three big programs we call the Healey honoral the academy and the now the councils and the origins of how we develop into a community uh go back to the COVID pandemic when virtual fellowship recruitment went uh virtual fellowship recruitment went virtual for the first time. Um and you know every program will remember this but every program was scrambling to figure out what tools they had to to show prospective applicants the training opportunities in the program right the infrastructure just wasn't there and there was a lot of um the different ways of approaching this and by this time Cardier had already had a pretty strong following among mediology and so we got a message on Twitter this is Twitter not expect Dr. Noshin Rizo who is now advanced heart failure transplant attending at Penn and at the time was a chair for the ACC fit section sent us a message on X Twitter and then within three hours there was a Zoom link and it was centered around the idea of finding a way to collaborate to create a more standardized way of programs. And so what we devised was a an invitation that went out from the ACC PDGME section to all of the fellowship training programs on their email list to say, "Hey, why we invite you to come use cardio as a platform to one describe as well as uh you know the uh the pride they have in the city that they live in. So each episode had two to three fellows talk about the case and training opportunities, a fellow a faculty content expert to add an another expert opinion as well as perh personal message from the program director and all in all we had 44 programs participate that amounted to you know over like hundreds of fellows and and faculty and this was the um the group that we surveyed uh called the cardiner's case report or the CNCR um series and this survey looked at three different areas. The impact on education on recruitment and professional development but pertinent to this talk for the statement that the sense of community during the COVID pandemic 90% of program directors agreed or strongly agreed and 85% of fellows agreed or strongly agreed and this was at a time when there really was a darth of a sense of community during COVID when you know we were all in silos. This is one of our case episodes. um about intermediate risk PE and you know just to highlight that Dan and I saw that when we use cardio as a platform to have all of these people from different training institutions bring their unique perspectives their different backgrounds the areas that they're uniquely interested in and their zeal for education then the whole platform just got better right I mean the quality got better the breadth and the depth overshadowed anything that the two of us could have done alone and So we wanted that to um last longer than the COVID pandemic and become a durable community to be a bedrock for education and collaborations down the road. And so we founded um what we call the cardior Healey honor role. We invited all the fellowship programs that had participated in cardiers and invited their program directors to nominate fit ambassadors who were interested in education uh to be a part of this community with a goal of pairing content and education creation with professional development. So as an example, Dr. Hallelter nomad nominated Dr. Chel, Dr. Misro nominated Dr. Halute and Dr. Peterson nominated Dr. Sykes which is how we are here together today. And so the Healey honor role now has 48 programs again named after Dr. Bernardine Healey who's had a you know tremendous impact both at Hopkins and Cleveland Clinic and uh was the first woman to serve as director of the NIH in the early 90s. So that's the cards Healey honor role. Separate from that, we got really interested in how do we really kind of like cultivate the sense for education and skills and education um and and and created what we call the cardio academy which is through a competitive application for residents and fellows to join. It's split up into Harry Potter houses. The namesakes are legends in the fields to Vivian Thomas to Edith Irby Jones. Um and so the fellows within each house work together and each quarter they pick a topic and for that topic they divvy up the work and they focus on one written education. So how to become a better scientific writer and create a review article which will be published in US cardiology review to auditory education. How do you create a podcast and distill complex topics into an auditory form for a learner and then visual education essentially distilling all the education complex information into a graphic that'll be featured in the review article. And this is the first year we've done this curriculum has gone really well spans uh several different uh topics that they choose that feel are relevant. But again the the goal is to pair education creation with professional development. So uh this year for the first time we're also really being very deliberate about how do we uh develop our um our trainees. And so we created this framework um defining goals and milestones as two different elements to focus on. We define goals as things that we hope to achieve but may you know that may or may not happen and milestones as things that we know are coming our way and we decided to focus both of these in both domains professional domain and personal domain. The personal domain became very important to us because we don't just see people for the three years of residency or three years of fellowship. Now we have people who joined cardiners as medical students and now about to become early career faculty you know and so we see how the personal domain really has such an outsized impact on the trajectory of somebody's career and their values and things that they lean in on. So a professional goal may be something like hey I want to present at AHA I would I would love to have an abstract here whereas a personal milestone might be I'm having a baby this year how can we optimize that in the context of their training and career. So then we said okay why don't we operationalize this and identify steps to achieve goals and maximize milestones. And so within this framework each house has a house faculty leader who has graduated the program in the past. They'd meet with each of the individual fellows and interns periodically with with with the goals of one identifying personal professional goals and milestones for each individual. Just writing them on paper I think makes such a big difference you know to have something to write down. Two drop a plan with specific action items. and three to identify measurable indicators of success. So it is measurable and then the house faculty leaders themselves are residents and fellows or early careers. So you know they only have so much to offer but they they create a profile for each of their mentees and then report back to our leadership meetings. And so then we discuss each individual um you know on a personal level. And then when we discuss them we say okay one how do we help identify mentors both within and outside cards relevant to their specific goals and milestones. And two outline strategies personalized to what they want to achieve and three establish action items for the next meeting to have some accountability baked into this. And so you know again this is the first year we're doing this in a very deliberate way and and we will be studying this once the this current class graduates uh later this year. But you know all of this is really nothing if you don't have a sense of community. We are social animals and so Dr. Avanamir who is a ACD fellow at Mayo is a director of cardier community and just some examples of the life she's brought to the academy. On the top left is the the card's virtual paint night where we had Dr. Bontia who is an artist and a fellow um you know lead everyone into paintings. We've had several Jeopardy events. We've had virtual um cooking events, uh social events and gatherings at ACCA and other conferences. And on the bottom right was our first party cards 5K at ACC. And we're already in discussions with a run group to host one at Houston. So I hope to see you all there um next year. So that's the academy. And then you know like year after year we had the academy, year after year we had the heal honor role. We have such a cache of social and and and content capital right within this group. So how do we take it a step further? We designed the carder sub specialty councils and so these councils um each have these are the council chairs who are all either advanced fellows or peer faculty and many of them have very active ongoing projects like Dr. Opimus for interventional cardiology is uh you know we we'll be launching a brand new separate podcast called Cath masters which will be high level and technical for interventional cardiology and I'd like to again just give a sense of the depth of of how empowering these people with the right resources and purpose can help accomplish great things. This is our card's critical care cardiology council who who you know the critical care cardiology is a burgeoning new field but it is I think every program across the country is realizing that they really need to staff up the unit right the unit is a bottleneck for every other clinical section. When you have a unit that is capable, then every other clinical section can go full throttle ahead. We know more complex, high volume and know that you have the safety of bright people taking care of the of the of the unit. And so, but the problem is that there is uh despite it being a growing field with a talent pool that is going to be very training remains highly variable and illdefined, right? Um and so what the group decided to do is to design a qualitative research um study to to learn how trainees from one perspective and program leadership from another perspective for see the current training landscape and the current gaps in critical care cardiology training right I mean who's who's training these people are there pulmonologists who you know haven't had as much experience with the heart or they cardiologists who maybe don't understand pulary mechanics um as well and what what do the units uh look like right now in terms of their staffing at local training institutions and how do compare to where the jobs actually are. I mean, there's so many questions here. Um, and so how do we uh, you know, we we defined the programs that have successfully produced a practicing critical care cardiologists and we invited the mentors for this training pathway at these programs and the trainings that are going into these fields and we want to study them with semi-structured interviews. But the question is how do you engage them, right? I mean, it's really people are busy. it's hard to get time to do this. And so we decided to pair this with what we know works is invite the programs to to to um present a case on cardio units. And when you do a podcast, something beautiful happens like you completely occupy their time. You have engagement. It's intimate. And so we're going to use that not only to create education, but to really engage with them. And then as part of the educational public recording which will be the case report also do a private recording which will be reviewed as part of a mixed methods um research. And so uh this has been a very rigorous project that has been driven home by this extraordinary group within our cardio critical care council. Dr. Yu Carpenter is the chair for the council and Dr. Katie Ventur in the top right is a fellow at Penn who really led this um this project. But this is a approved IRB at 10. Um, and you know, they've gone through several iterations of semiructured interviews, done uh practice interviews, recorded them, got feedback, then reiterated um to uh uh to improve further. So the councils are doing great work, but between the Healey honoral, the academy, the council is like why do all of this extra work? Like everyone is busy and everyone has enough to do on their plates to begin with. And you know I would point to this very nice book by Daniel Pink Drive where he breaks down motivation as coming from three main areas is autonomy or the urge to direct our own lives. Mastery the desire to get better and better at something and purpose to drive the drive to do something that uh in is in service of something greater than ourselves which I think a lot of these programs bring together and I would add the sense of community which is such an important part of feeling the sense of belonging in in what the group is doing. So again, these are all the different programs that if you interconnect people in ways that are purposeful with resources, they can accomplish great things. And so this is something we wrote for Jack Advances comparing the pros and the strengths of traditional education versus the the digital domain. And we talked about both in terms of information educa acquisition and education on the left and the community development on the right. And just focused on community in the traditional domain. oftentimes it's vertical relationships right role models mentor junior mentees which is extremely important right I mean I have so many mentors to thank for being here right now but but also the digital domain allows for horizontal relationships so collaborations and birectional flow of ideas which is also important and empowering in the traditional domain relationships can be restrained by geography potentially the digital domain allows it for global communities to form to really kind of learn about having community of practice that spans outside the local geography and in the traditional domain uh the local community may be limited in content interest or background and I think that's probably not the case in Houston I had the privilege of joining the citywide forum last night and there's such a wealth of cardiology in this uh you know small span but a lot of people don't have that you know the digital domain helps each person gets access to a diversity of people and ideas so this is how card leaders turn into a community and I think is really the secret sauce of why it's worked and has become sustainable. So two case examples, one is a cardiner's clinical trials network. This is paraglide HF which was studying material valart versus valartan on changes in antior VP safety and tolerability in patients have patients with the recent decompensation event and during the covid pandemic which uh kind of struck during enrollment there were a lot of issues with recruitment delays requiring innovative solutions and Dr. Vandy Stling um who was one of my attendees at the time caught uh caught on to cards very early on and and thought that maybe there might be a connection for carders to play a role. Of course, sitebased research as many know here has uh is is wrought with many challenges. Bureaucracy, the workload, it's expensive, issues with enrollment, issues with retention, and how do you enroll the patient populations that is representative um for for the population you're studying. And then conversely on the trainee side, a trainee who aspires to go into uh clinical trials, you know, the path is oftentimes unclear and there are a lot of challenges along the way. And so the way we thought about this when Dr. Starling said, "Hey, is there something you can do?" He said, "Well, the scientific goal is to improve trial enrollment, right?" But the cardier's goal has always been how to pair education creation with professional development. And then if you put that together, then maybe like how do we devise a program with a the goal is to pair trial enrollment with professional development. And so we said let's create the clinical trials network as a uh as a test for paraglide hf and and identify card leaders fit trialists at participating sites with an emphasis on equitable enrollment and professional development. We had a tremendous support from this extraordinary steering committee including the late Dr. Brunwald as well as the PI Dr. Robert Mintz. And so uh together with the sponsor Novartis we looked at uh all the sites engaged with the trial and identified those with uh training programs and we invited the PIs the side of these training programs to nominate the trialists who would potentially aspire to become a clinical trialist down the road. And then we engaged the fifth trialists to not just be there for enrollment but also how do we invest in their success in the long run? How do we make sure they're actually incorporated in the research team as sub eyes create a lecture series uh mentorship from the site PI network uh within the group outside the individual institutions have funding support for their projects as well as engage them in opportunities that cart leaders has access to and so we got this great community uh 20 sites across the United States some phenomenal site PIs many of whom you'll recognize we use these PIs and the student committee to deliver a nice curriculum over the course of this program like the clinical trial PI women cardiovascular research career development uh trials and mentorship as well as community based leadership clinical trials you know just honoring the fact that a lot of trial recruitment happens in private practice and is opportunity that fellows also have an access to but what was the impact to recruitment so we had fellows at uh 17% of sites uh that during the the time period this was active they enrolled 45% of patients and when we looked at, you know, were these just reflect of the sites that they're there, but even within the sites, there was a sizable bump in recruitment when the fellows were active compared to before. And not only that, but these fellows, the patients that they recruited look different, right? They were the fit enrolled patients on the left were more likely to be women, 54% compared to 45% and more likely to be people of cover color, 71% compared to 23%. I think there are a few reasons why this may be get the data more but one I think is also reflective of that they were at like Atlanta Manhattan downtown Baltimore but also you know fellows there fellows in the room being your sen is patient care right you went into medicine to take care of patient so when you go to a patient and talk to them about trial participant it's about the patient whereas you know research coordinators god bless them they do the framing and the goal may be a little bit different from the patient, right? And I think that has a lot to do with how do we bring our patients into, you know, the the trust that they place for trial enrollment. So, not only that, there was this beautiful community within the um their fellow um trialists. There's also some interesting gamification and friendly competition between sites, but it was really a fun thing to see. Our top enrolling fellows, Dr. Jason Fineman from Sinai, General Bell from Johns Hopkins, and Christoel Nang from Morehouse wrote this for Jack um saying that the Cardinal Clinical trials network provided us with an incredible opportunity to gain firsthand insight into an academic medicine career and clinical trial participation. Um so um sorry I'm getting a call from the head of interventional cardiology at UT Southwestern. Hopefully it's okay. So you know this was I think a very valuable experience. We tried to extrapolate this to another trial. This is empower and empower was looking at the carolon device for uh secondary functional mital regurgitation and it didn't go so well. We realized that the trial really has to be matched for where general fellows can have an impact and oftentimes the general fellows are a little removed from where decisions are happening for structural heart procedures. Also the empower trials extraordinary heart trial to enroll for as a sham control procedure for a device that was only available. Um we also did a zeus trial which is zilakimab or anti 6 in for secondary prevention. Um and and here the data actually was actually uh quite um quite impressive, but we'll have more to share on this once uh Zeus is published hopefully either later this year or next year. Uh and with that, I'd like to get to our second case example, the Graduate Medical Education Cardiovasic Curriculum Consortium. Um and it is such a privilege to invite Dr. Alex Sykes uh to speak. And Colin, thank you for, you know, introducing her. I was going to do it, but you stole my thunder. Um, but I will say that one main takeaway I've had from cardio is that the key to success is to surround yourself by people who inspire you and push you to become better. And Alex has definitely been uh one of that those people for me. Um, and uh, you know, I in addition to her training, Dr. Sykes has distinguished herself as an emerging leader in cardiovascular medical education. Her clinical interests include women's cardiovascular health, cardioetics, and preventive cardiology. While our academic interest is focused on graduate medical education and curriculum development and while we are so thrilled to be able to keep Dr. Sykes at UP Southwestern with us, uh she is very much a native Houstononian and we'll take every opportunity to brag about the food scene in Houston and how Houston has been such a different childhood. So, Dr. Sykes, >> thank you. I uh thank you so much for the opportunity to be here. Like you said, I am a native Houstononian and so being back for the food, the people, I think the soul of Houston, it feels really nice to be home. So, thank you um for this opportunity and as mentioned, I have an interest in medical education. From my early early days in training back to medical school, I always knew I wanted to do something in med. Um that came from I had incredible faculty. I had amazing chief fellows, you know, even just the older medical students who impacted me. And so all throughout my training being chief resident, now being chief fellow, that's been something I've been excited for as well as looking forward to my continuing to, you know, pursue this as my passion. But at UT Southwestern in our third year, we have opportunities for more of projectbased learning, things like research projects or endeavors in that space. And so I started to think, how can I do this through a med lens? and really led me to the question, what do I want to know about medical education? So, of course, I took a look at our own internal didactics. This is an example schedule from what happens at UT Southwestern Monday through Friday. Things with stars show what we are required to go to as fellows. Um, there's food at some, not at others, variation in timing, and all of us fellows sort of have an idea of what are our high yield conferences. And so I actually met with Almond Oil to talk about what, you know, what makes it so great the conferences that we're all drawn to. We love Journal Club at Southwestern. What is it? And how does that align with adult learning theory? Are there is there sort of a scientific reason for why that's high yield? Why it's memorable? And so we started thinking, yeah, let's let's kind of look deeper into that. But as I started talking to others in the space and some of my colleagues across the street within Dallas itself, I realized I have no idea what happens not not just within Dallas but at any of the 200 cardiology programs apart from a little bit at my residency maybe what the programming was. And in light of that I realized there's not much that's known as I talked to other people. What do you do at your institution? What works there? What works here? What doesn't work? Can we learn from each other? So I you know looked to literature is there anything published about what are best practices in graduate medical education within cardiology or otherwise and there really was very limited information outside of some publications within subsp specialty content. So next I to the ACGME what does our regulating body say about didactic curriculum specifically and how it should be delivered at each of our institutions and it's very very vague. So it says it has to be present that fellows should be there and should talk to each other and faculty and that it needs to be sufficient to develop a you know understanding of that core content area for what this specialty is. So in light of the sort of posity of information that was available I again met with Dr. Goyle and he introduced me to Katie Dr. Katie Berlocker um to discuss this and together we came up with three aims for a project that we um I'm really excited to share with today. So the aims were number one to develop a collaborative network across institutions to define and iteratively refine cardiovascular graduate medical education curriculum to describe the current state of cardiovascular GME curriculum within the United States. And then the third point to identify gaps for future study and approach to optimal state based on again this learned theory principles and how we can apply that and um you know make all of our training more robust. So in light of those aims, our approach became sort of a three three layered approach. And the first was to make um the community of medical educators. And so you already heard a little bit about the Healey honor role, but we sent an email to all the program directors who are on the Healey honor role. And we had 23 program directors reply back that yes, they're interested in participating to joining this Medad consortium to move the work forward. And so the program director here and within those the program director nominated a fellow training sponsor. So at most programs that was the chief fellow but several of them they have a unique medical education pathway. And so sometimes it would be the med fellow or you know the one who is most interested and so we had 23 programs committed to this endeavor both represented by both the program director as well as the fellow in training. So the subsequent portion was to you know we started meeting as a group. We met with Dr. locker met with Dr. Goyle and we started you know sort of repeating what I had started doing. Let's look into the literature. What should what should journal pubs look like? What's the ideal state? And as we started talking amongst ourselves, we realized we have no record of what's happening at each of our institutions, what's been happening over the past, you know, several years, what happened during COVID, is it different, similar, etc. And so we realized we needed to create the information that we wanted to draw from. And because of that, we were introduced to Dr. Natalie Stoopes, who's featured here in the picture, who has um a master's in mixed method surveys, and that's her specialty within the medical education sphere, specifically in graduate medicine, her focuses. Um, and so together with her, we created a fellow survey as well as a faculty, not faculty, a program director survey that we would distribute to each of these 23 participating groups and collect the data together to just get a sense of what is current state at all of our cardiovascular programs. We met over several iterations to decide what should be included in the survey. Trying to balance a desire to know as much as we could with both quantitative as well as qualitative questions but also reduce survey fatigue and kind of we kept everything to sort of a goal seven to 10 minute target in terms of timing. Um these were some of the the domains of information that we collected. So of course demographics but also what is the structure at each of the institutions? What's the goal? is the goal to make you more likely to pass forward. It's balanced with being a good clinician, balanced with targeting your specific patient population, wherever the location is, things like what external resources are available to your fellows, feedback, and then an uh an area I'll touch on a little bit more later, but AI utilization, what's the current state across the cardiovasc programs that were included. And so we created the surveys, the fellows in training distributed to their fellows at the programs across the US and then I was very surprised and pleased to get our survey response rate. So overall 538 fellows received the survey and 252 fellows um submitted a completed survey back which gives us a response rate of 47%. which was um extremely strong and just shows the power of collaborating as well as having someone just you know on the ground with the fellows there who can you know talk to them and and remind them to help contribute to the data. I put a picture here. Justin Hollut was our Baylor representative. I know several people know him in the audience and he's been instrumental to this work. So a little bit about the demographics from our group. We are pretty matched uh male and female, 54% male and 46% female. There is an even distribution across PGY level for second and third year fellows as well as advanced uh sorry the additional year fellows. It's all general fellows. So anything subsp specialty was not included. And then we use number of first year fellows to represent the size of the program and so a pretty good split between sort of smaller middlesiz and larger programs. One thing about this information because we are pulling from the heel honor role and largely academic institutions we had a a strong representation from university based programs rather than community- based and it's an area that all of us the 23 programs participating are really excited to expand this and include more information as we take our next steps forward. Um, as it was a uh, you know, several different domains within the survey, there's not enough time to go into, you know, each of those to talk about results. But I wanted to use a representative question from the program director survey for why I'm excited about what's to come. And this was a question again to the program directors of large university academic institutions asking them, do you believe that you incorporate adult learning principles into your development of your um, didactic curriculum? And 8% said, "No, we don't do that. Just face value, that's not happening here." 46% said, "Yes, yeah, we are absolutely. We're taking this good scientific approach to how we train the next generation of cardiologists." 46% say, "Agree, neither agree nor disagree." Which to me says, "What are you talking about?" And that's the opportunity that I'm very excited about as I move forward in my career is how can we bridge this gap and help bring a scientific approach to how we educate our learners. And so that brings us to a separate part of the project. We completed the survey and are undergoing data analytics now. But then the final layer is this longitudinal workg groupoup sessions um usually monthly sometimes more frequent than that meetings with the fellow in trainings um joining subgroups that are defined on a on a slide I'll show in just a minute. But the stages were that we got the survey results. Each of those subgroups would then take a content topic, do a deeper literature search, literature review, come back and present that to our larger groups. So that both we can enhance our community, but also talk to each other about what we've learned, grow the field, and then together iterate on what are some ideas that we can use to prompt our next research question, our next thought in this space. Um, and then ultimately we'll culminate in a white paper output. This is our structure for the small groups. So we have adult learning theory which was led by Dr. FAF she's at Vanderbilt core didactics the what what are we teaching at each of these institutions Dr. Nusbomb at WashU St. Louis the how the where the when didactics occur um was Dr. Goodman at TUS dactic programming Dr. K at women's conference iteration Dr. Garber at Ohio State Medical Center and then external resource availability was Dr. Tulie at Alagany AI utilization future directions was Dr. con at Scripps Clinic. And so in December, we had together with Dr. Stokes, Dr. Burlocker, Dr. Goyle decided what would be a rough outline for how we should structure these small groups. What do we want to know as a med community? Then January through February, we broke into these smaller subgroup meetings. They would take the time amongst themselves to divvy the work, take the deeper dive. Again, often there's not much in the cardiovascular GME space, not much in the GME space, but maybe there's something in um education in the undergraduate level that could be pertinent, could be informative for what we do in cardiology. They would assimilate that and then bring it back to present to the bigger group and then use that and the feedback they get in the big group sessions to develop their section for a white paper which would then go back to their program directors giving input and then all together would um summarize in um what will end up in July as a published white paper. So I want to just bring you to one of those moments this subgroup led by Dr. Khan who is looking into utilization and she has been very inspiring. she has a unique and special interest in AI utilization specifically for medical education. Um, and she spearheaded that subgroup. So, this is the survey data for a portion. She saw that at the time that we did the survey just earlier this year, 57.5% of fellows said they use generative AI tools, which to me was surprisingly low based on my personal experience with my co-fellows. Um, but more surprising was that only 10% of program directors were using generative AI to develop their content. um which I think is just again highlights the interesting changing landscape that's here as we move forward in medical education. But the second part of the subgroup meetings is that they take this briefly talk about the survey but really do a deep dive into what can be our sort of optimal state our best practices as a cardiology medical education community. And so she came up with a proposed AI competency model. She talked about different things that can be incorporated into our learning both in dactics and beyond. And that has been something that of course will be part of our white paper as it's subsection that was intended but now she's launching into a whole other deeper dive manuscript of her own in the space and has the network that was developed through our consortium. So to conclude, I get asked what are some core takeaways as a project lead with someone with something like cardio nerves where you have this incredible group and number one of course is that collaborative meta the collaborative network is what accelerates the innovation and scholarship and so getting to meet together you have so many amazing like minds that propel your work and then specifically talking about the subgroups number two the engaged missiondriven leaders transform ideas into progress as a busy fellow it's often you know my productivity aligns with what the CICU schedule is, but if you have people across institutions that are similarly motivated and excited, things really can get taken across the goal line. And then number three, the sharing of resources and experiences strengthens our entire community. I think medical education in particular is something that if we band together, we can really raise all institutions and everywhere where our dactics are delivered. So with that, I'll conclude, but I want to say thank you first and foremost. There's, you know, we hear a lot as trainees about mentors, sponsors, and coaches, and it's rare that you can have one person who has uniquely been all three of those things in your life, and he is that to me and many others in the cardio nurse community. Dr. Stokes and Dr. Bird Walker, who dedicated their time and expertise to this project. um the consortium co-fellows. It's been so incredible to work with them and exciting also to make this connection now in training so that as we all take the next steps into our academic careers, we have this network that's being built and being incorporated with the next generation as well. Dr. Peterson, my program director, who's a mentor both academically as well as on a personal level and then my co-fellows as well as all of you for having us here and giving me this amazing opportunity. So, thank you so much.