We need to broaden the definition of what “counts” in careers [PODCAST]

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“Many colleagues in medicine already talk about medicine never going back to its state pre-COVID-19 – be it telehealth for patients, new flexibility to work/life scheduling, or a new acceptance of telecommuting outside of direct patient care. There has been too much suffering as a result of the COVID-19 pandemic and stressors of 2020 to progress through 2021 and beyond without lessons learned. New recognition of the need to broaden the definition of what ‘counts’ in careers, be it in health care or beyond, along with a means to articulate that, must be a lasting outcome of our nation’s response to the pandemic if we want to avoid losing more of our best and brightest in these fields.”

Avital O’Glasser is an internal medicine physician.

She shares her story and discusses her KevinMD article, “The COVID-19 pandemic brought many new challenges in medicine. A novel tool may help to overcome some of them.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Avital O’Glasser. She is an internal medicine physician, and she co-wrote the KevinMD article “The COVID-19 pandemic brought many new challenges in medicine. A novel tool may help to overcome some of them.” Avital, welcome to the show.

Avital O’Glasser: Thank you so much for having me. It’s a pleasure.

Kevin Pho: We’ll get into the article that you co-wrote in a little bit, but first off, can you share your story and your journey to where you are today?

Avital O’Glasser: Sure. I am an attending physician in Portland, Oregon. I’m a hospitalist who is in a very unique practice setting: I practice outpatient in our preoperative medicine clinic, which I have the privilege of being the medical director for. I like to say that I’ve had a healthy dose of serendipity and mentorship through my journey to this point. I did not enter college thinking that I was going to pursue a career in medicine, and then I was able to tap in and identify that passion. I finished residency on a career pathway that is not the career pathway that I’m on right now, again thanks to a set of circumstances as well as some failures. But I feel that through connections, and being in tune with mentors and opportunities, I’m just thrilled to be able to practice perioperative medicine within a multidisciplinary community.

Kevin Pho: So through your lens in perioperative medicine and what you do, in the past year, just describe what you’ve been seeing.

Avital O’Glasser: Oh, my goodness, we’ve had quite a year through perioperative medicine. I even recall, probably a year ago exactly, as the first couple of cases were being diagnosed in Oregon, we were just wondering what the next days to weeks had in store for us, wondering how COVID-19 and the pandemic would affect our workflows, beyond trying to strategize about sick leaves or employee exposures. But we’ve been very busy in the last year, ranging from shifting an entire clinic to telehealth in response to the pandemic to launching an entire screening program for pre-surgery, pre-procedure, and pre-anesthesia COVID testing, COVID swabs. We’ve done almost 25,000 COVID swabs in our pre-op clinic alone in the last year.

My current research and academic interest, as it pertains to COVID, is understanding when a survivor of COVID, symptomatic or asymptomatic infection, is medically stable to undergo surgery, given all that we know about the short-term and long-term harm of COVID.

Kevin Pho: So go into a little more detail on that. I’m sure we’ve learned a lot in the past year on that. We’re speaking in the beginning of March, so what are some of the factors that we need to consider when clearing a patient preoperatively for surgery?

Avital O’Glasser: Yeah. So if someone had a garden-variety upper respiratory infection, or even had something more serious like the flu, we would want to slow down and make sure that they were ready for an elective surgery at that time and place. How have they recovered? Are they back to feeling 100 percent? How is their lung function? What is their risk of being intubated or having a complication of the surgery from that acute illness?

One of the major things that we’ve learned about COVID in the last year is that it is far more than a garden-variety upper respiratory infection. Maybe not in every patient, but in a sizable number of patients, including patients who didn’t realize they had the infection, there’s a lot of long-term damage, both long-term fatigue or other symptoms, as long COVID syndrome. A large percentage of patients in some studies are being found to have silent cardiac damage, potential for kidney damage, and abnormal clotting.

My group and I started exploring the question of how we know if a COVID survivor is as safe as possible for a surgery probably around Memorial Day of last year, trying to draw from all of these analogies outside of the surgical setting to within the surgical setting, drawing analogies from recovering from a heart attack before surgery, recovering from a stroke, and recovering from a pneumonia. What we have found is that we have created and implemented a protocol to really slow down, ask a lot of questions, take a very good history and physical, and also use EKG, blood work, to try to help build a picture of a patient’s risk before surgery.

Kevin Pho: All right, so let’s transition now into the KevinMD article that you co-wrote with Vineet Arora and Shikha Jain. It’s titled “The COVID-19 pandemic brought many new challenges in medicine. A novel tool may help to overcome some of them.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you and your co-authors decided to write it?

Avital O’Glasser: Absolutely. I’ve been working with this wonderful team of other women in medicine, as well as some HeForShe men in medicine, and we’ve connected for over a year on the question of how we help women, underrepresented minorities, students, really anyone in medicine, articulate their impact and reach. I’m at an academic institution, and I’ve been part of discussions for several years that the long-standing currency of academic medicine, publications in peer-reviewed journals, followed by conference presentations and invited lectures, is an important part of driving our fields forward. But should it be the be-all and end-all of academic currency and weighting a CV, or the promotion and tenure process? So this was the foundation, this sort of shaking up the paradigm.

Then, when the pandemic hit, especially women, not only women but especially women, were bearing the brunt of shifting responsibilities, quarantining, child care, and family responsibilities, both in medicine and outside of medicine. There was already data quickly emerging that women were taking a very disproportionate brunt of the screeching halt that academia, both medicine and science and other fields, was experiencing. As a clinician leader, where service contribution and innovation are also the currency that drives health care forward, we rose to the challenge of trying to help our colleagues articulate the work that they were doing.

Both the disruptions due to COVID: Did your research lab get shut down? Did your conference presentations get canceled? Did your manuscript drafting stall because everyone got pulled into service, inpatient care, because of the surge? And then, what also were you doing? Did you rapidly step up and become a service director, or create a new workflow, or chair a response committee at your institution? So we were trying to articulate the breadth and depth of how we dramatically pivoted and impacted our professional communities during the pandemic. So that’s the piece.

Again, our group has been focusing on the CV itself, the curriculum vitae, or the resume, as a tool to articulate modern 21st-century impacts in medicine and academia. So we created a matrix to articulate categories of contributions to the fields during the COVID-19 pandemic. We were able to publish a couple of pieces about it, and then we wrote the KevinMD piece as well, laying out the background information as well as some of our recommended strategies and talking points.

Kevin Pho: So you talk about publications being the currency for advancing in academia. Can you paint me a picture of some of the disparities within that factor?

Avital O’Glasser: One of the disparities that we’ve highlighted is that if you are a clinician educator, so if you are almost full time taking care of patients in the clinic setting, or in the hospital setting, or some combination of both, much of your research time is really on your own time. It’s on your free time. It may not be funded through an NIH grant or other grant money, so it’s already work above and beyond the work you’re paid to do. When clinicians all over the world stepped up to the challenges of caring for COVID and mobilizing the response to the early surges, that time became even more constrained. So if you were an innovative clinician or innovative clinician educator but couldn’t articulate that through a publication, how could you articulate to your boss, to a future job application, or to a promotion committee that you were making dramatic contributions to the field? So that’s one example.

Kevin Pho: So tell me about some of the details in this new matrix that you created for the CV. What are some of these other factors that you’re talking about?

Avital O’Glasser: So one of the categories is research itself, or traditional scholarly output. Did you have scheduled presentations or visiting lectures that were interrupted? Were you actually able to pivot and capture the work you did, or the quality improvement research you did, into a rapid publication? So it’s sort of articulating, I don’t say the negative, but the losses and the gains due to COVID.

Were you engaged in volunteerism or service? A lot of the responses in medicine to the pandemic were volunteer positions, people stepping up to the plate in multiple ways. Were you engaged in advocacy? I’m very passionate about physician- or clinician-led advocacy, and that’s one thing that I’m passionate about helping individuals articulate on their CV: Research is not the only way that we can move a field and improve patient outcomes, but also political advocacy and public health advocacy. There was a lot of advocacy that was required during COVID, starting with even “Get me PPE” or “Wear a mask” or “Socially or physically distance” campaigns.

Were there other constraints? Were you both simultaneously leading your division and helping your kids with virtual schooling? We’ve created a matrix to articulate different categories of both, sort of, the losses and the additions.

Kevin Pho: So walk me through this tool itself. If I was a clinician who wanted to click on this tool and incorporate some of the things that you talked about, how would that work?

Avital O’Glasser: We’re advocating a sort of grid-like structure that could be added as an addendum to your CV, or saved as a living, breathing document. Again, we are a year into this pandemic, and the work is ongoing. It’s not just the work that people did in March, April, maybe May of last year. So we have published this through the Explore the Space and Women in Medicine Summit websites. It is also included in a recent Journal of Hospital Medicine publication, and those hyperlinks are in the KevinMD piece.

Kevin Pho: So one of the things that, you know, I have on my blog, and people have written about this, is that we want to get away from publications being the sole academic currency, as you put it. Some people have asked me, you know, do social media activities, do social media articles, can that count as well? How much do you see something like this moving the needle, knowing how notoriously slow medicine is to adapt?

Avital O’Glasser: I’m cautiously optimistic that we will move the needle in that regard, and that was actually the work I was doing before the pandemic. So this is some of my own background and passions in this area. I’m not a traditional researcher. I’ve done some quality improvement research, and I’ve done some publications, but I like to joke that my mom never thought I’d be a rebel with a cause, but I was working a lot and participating in a lot of these conversations to champion, air quotes, “novel” or “non-traditional” scholarship.

I think social media-based scholarship or scholarly teaching is here to stay in medicine. You can take a podcast and say thousands of people have downloaded this episode, which was a very robust clinical topic, maybe an hour-long subject, and a conference presentation may get weighted more heavily. But if a hundred people heard it at a conference, but thousands of people listen to the podcast, how do we reconcile that those are weighted differently? And how can we elevate the discussion about elevating and counting social media-based scholarship?

If you are doing novel, impactful scholarly teaching through your social media platform: I have friends who write tutorials that are fantastic versions of chalk talk, or five-minute, 10-minute teaching. Dr. Tony Breu has published about this in the New England Journal itself, that we are elevating a form of teaching adults in the 21st century. If you are using your social media platform via Twitter or podcasts or blogs to engage in meaningful advocacy: Shikha and Vinnie are very active in the IMPACT organization out of Illinois, which has done amazing work with advocacy and protection of patients and health professionals in the last year.

So I really hope that we will move the needle. I think we are, I think we’re at the five- or six-year mark of the Mayo Clinic announcing that their promotion and tenure process would include assessment of social media-based activities, and the documents they put out to the public talked about our duty as clinicians to teach, and social media-based activities are one way to teach our colleagues and the public. So I’m excited, and I actually wonder how much the last year of the pandemic will help us continue to move that needle, based on the impactful work that people have done outside of the traditional research setting.

Kevin Pho: We’re talking to Avital O’Glasser. She is an internal medicine physician, and she co-wrote the KevinMD article “The COVID-19 pandemic brought many new challenges in medicine. A novel tool may help to overcome some of them.” Avi, you mentioned the Mayo Clinic being one institution that includes non-traditional research as part of the advancement process. Just give me a sense: What proportion of medical institutions currently use these non-traditional avenues and weight them when they consider academic promotion?

Avital O’Glasser: You know, I don’t have a specific number or percentage, but my ears to the ground tell me that more institutions are at least engaging in those discussions about what should be included. I’m thrilled. I know that our institution has already taken this metric and has at least discussed it among the members of the P&T committee. You know, sometimes medicine changes slowly. We’ve changed so much in the last year alone, but I think if we continue to chip away at this, maybe we will reach a critical mass of institutions in the near future.

Kevin Pho: And so far, what’s been the response to your efforts in this article?

Avital O’Glasser: I would say it’s been positive. I feel very appreciative of the fact that I can give colleagues a voice amid a very challenging year. I think we have been inspired in a very SheForShe way to do this, but it does not restrict itself to women. I want to acknowledge that we have men and gender non-binary colleagues who also have had to pivot dramatically in their lives and their careers in the last year, and I think these lessons are also applicable to underrepresented minorities and disadvantaged colleagues within medicine.

There’s a line: Dr. Sasha Shillcutt and Dr. Julie Silver have a piece from a couple of years ago, in the New England Journal also, about the use of social media, specifically for its benefit for women. But I think you can draw a lot of parallels. The traditional hierarchical structure of medicine, for decades if not hundreds of years, has disproportionately given some people voices, and then that gets you a seat at the table at a conference. It gets you on a panel, it gets you into a committee role, and it gets you into a leadership position at your institution, or in a professional society at the national level. By giving people a non-traditional voice, I hope that we will have many more impactful voices at the conversations.

So the fact that I can help: Again, I talked about the power of advocacy, and articulating that advocacy is an important contribution to the field on your CV. I find this kind of work thrilling and invigorating, because it is a form of advocacy for my peers and colleagues.

Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?

Avital O’Glasser: I think my take-home message is that creativity and growth mindsets will get us far, as citizens of the world, and in medicine, and in science. Again, I like that we’re shaking up the conversation in a way that advances our colleagues and our peers, and it’s actually been really, really, after a very stressful year, creative in this regard. To challenge paradigms is one of the things that gets me out of bed in the morning.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Avital O’Glasser: Thank you so much.

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