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 

James (Jim) Wright obtained his MD from the University of Alberta in 1968, his FRCP(C) in Internal Medicine in 1975 and his Ph.D. in Pharmacology from McGill University in 1976. He is a practicing specialist in Internal Medicine and Clinical Pharmacology. He is also Co-Managing Director of the Therapeutics Initiative, Editor-in-Chief of the Therapeutics Letter and Coordinating Editor of the Cochrane Hypertension Review Group. He sits on the Editorial Boards of PLoS One and the Cochrane Library.Questions We Asked:•How did you become involved with pharmacology and drug prescription? •How would you define appropriate use? •Does financial implications to the patient play into appropriate use? •What do most physicians not know when they prescribe medications? •How does overprescribing play into medical waste?•Why is there a disconnect between systematic reviews and clinical guidelines? •How does bias play into drug testing? •How can we successfully collaborate with pharmaceutical companies without including bias into research? •How do everyday clinicians decide how to treat patients based on guidelines vs systematic reviews? •What makes a good systematic review? •What advice do you have for trainees who want to do good for their patients? •Book Suggestions? Quotes and Ideas:•Appropriate use of medications means that the benefits outweigh the harms of the medication •Every time a patient takes a medication, they are reminded of their medical condition that needs treatment. •Many psychiatric medications get onto market only due to short term medical trials, but many are prescribed for long term conditions. •Leaders should push for non-industry funded trials that evaluate the long term effectiveness of medications. •ALLHAT trial as an effectively run drug testing study  •We don’t want a situation where marketing is the driving force and not research •Choosing Wisely Campaign Book Suggestions: •Sickening by John Abramson •Our Daily Meds by Melody Petersen •Anatomy of an Epidemic by Robert Whitakers  

Dr. Paul Thomas is a board-certified family medicine physician practicing in Detroit, Michigan. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of three books: Direct Primary Care: The Cure for Our Broken Healthcare System, Startup DPC: How to Start and Grow Your Direct Primary Care Practice, and Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine. We hope you enjoy this episode with Dr. Paul Thomas about how to dress and present yourself as a leader. Questions We Asked: You just released a new book, Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine. What inspired you to write about this? How should you dress for a medical school or residency interview? How does virtual interviewing change things? How should you set up your background? Where do you draw the line between standing out and blending in with your dress and attire? How does appearance play into effectiveness leading teams and organizations? Is there a way to dress well when you have to wear scrubs? How do patient expectations change your dress? How much of dress is reading the room vs. holding yourself to a higher standard? You talk about house calls as a DPC physician, how does this change the interaction? How did you learn how to dress and carry yourself well? Book Suggestions? Quotes and Ideas: Medical School Interview: Blue or gray suit, white shirt with a colored tie. Leather shoes and a belt that matches. If you have a choice between a solid or swivel chair, choose the solid chair so you don’t fidget. Virtually: face a light, make sure the camera is eye level, set up and test your microphone. Make your tech setup pristine. Sprezzatura: When everything is perfect, you can introduce a splash of personality that highlights a creative part of yourself You should dress with the goal of looking professional so you can instill confidence and better care for your patients. Wear clothing that makes you look mature and confident. If you are a physician in a leadership role, you should take the time to dress well and change if needed. “If you want to be a leader… you should look the part and lean into dressing your best.” “If dressing well makes you stand up straighter, speak more clearly and develop trusting relationships with your patients, then do it.” Book Suggestions: Dressing for Medicine: what to wear for your medical school interviews and how to dress professionally throughout your career in medicine by Dr. Paul Thomas Atomic Habits by James Clear 

Dr. Peter Pronovost is a world-renowned patient safety champion, innovator, critical care physician, researcher, and entrepreneur. His scientific work leveraging checklists to reduce catheter-related bloodstream infections has saved thousands of lives and earned him high-profile accolades, including being named one of TIme’s 100 most influential people and receiving a coveted MacArthur Foundation “genius grant” in 2008.As Chief Quality & Clinical Transformation Officer at University Hospitals, Dr. Pronovost is charged with fostering ideation and implementation for new protocols to eliminate defects in value and thereby enhance quality of care. Previously, Dr. Pronovost served as the Senior Vice President for Patient Safety and Quality at Johns Hopkins Medicine as well as the founder and director of the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. Dr. Pronovost was elected to the National Academy of Medicine in 2011, elected as Fellow of the American Academy of Nursing and has received multiple honorary degrees. Dr. Pronovost is an advisor to the World Health Organizations’ World Alliance for Patient Safety and regularly addresses the U.S. Congress on patient safety issues. In response to a White House executive order, Dr. Pronovost co-chaired the Healthcare Quality Summit to modernize the Department of Health and Human Services quality measurement sQuestions We Asked: •How do you like the nickname Mr. Checklist? •How do you inspire those on your team to believe in themselves? •How do trainees fit into the safety paradigm? •How do we make quality something that everyone wants to be a part of? •What advice do you have for young leaders in healthcare? •Book Suggestions? Quotes & Ideas: •“Stories are the most potent force for change in the world.” •Steps that go before checklists: believing and belonging •Everyone is a part of the healthcare team and involved in patient care •“The secret of great care is love” •“If you have to drive change you have to believe in people and you have to love people.” •Stop believing that you’re just a _____ and start believing that you can make a difference •Teams that make good decisions are diverse and have independent input •Healthcare teams play “shorthanded” because we marginalize members of the care team •Experiential wisdom or time with the patient is often inversely correlated to medical wisdom •In 90% of sentinel events, someone knew something was wrong before the event happened•Three ways we change behavior: Regulate it, use economic incentives, and use the network effect •“Change progresses at the speed of trust, and trust grows when we do things with rather than to people.”•As an executive, your job is to illustrate why we are doing something, and then inspire others to figure out how to do it. •“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has. -Margaret Mead•Be scientifically sound and ruthfully practical •Change is almost always transdisciplinary so it pays to be curious and learn about other fields •Be humble, curious and compassionate •Large scale change is half evangelism and half science. It pays to communicate and write well. Book Suggestions: •Love 2.0 by Barbara Fredrickson•The Advantage by Patrick Lencioni •Multipliers by Greg McKeown and Liz Wiseman•Everybody Matters by Bob Chapman and Rajendra Sisodia 

We wanted to start by saying thank you to all our listeners for their feedback and the comments over the past two years and everyone who has played a role in helping us launch and produce this podcast. This marks our 50th episode of Leading the Rounds and we couldn’t have asked for a better guest!Today we have the Vice President of Performance Science at WHOOP, Kristen Holmes. Kristen drives thought leadership by engaging with industry leading researchers and partners to better understand performance data across high stakes verticals. Before joining WHOOP in 2016, Kristen was a 3x All American, 2 x Big 10 Athlete of the year at the University of Iowa competing in both Field Hockey and Basketball and recently inducted into the Hall of Fame Class of 2021 and was a 7-year member of the U.S. National Field Hockey Team.Kristen was then Head Field Hockey Coach at Princeton University where she was one of the most successful coaches in Ivy League history, having won 12 league titles in 13 seasons and a National Championship.Kristen blends her academic and applied background in athletics, coaching, performance technology, psychology, and exercise physiology to drive research, partnership, and product development initiatives to strengthen WHOOP as a leader in Human Performance.Please enjoy this wonderful discussion about health optimization, WHOOP’s work with front line healthcare workers and insights into maximizing human performance.Welcome to Leading the rRounds!Questions We Asked: How did you transition from a player to a coach and leader? Did you feel like creating team buy-in was something you could do naturally or have to learn? What did you learn as a player and coach that has helped you now as vice president of performance at WHOOP? What behavior have you found is most correlated with performance and health? What are the biggest barriers to performance in front line healthcare workers? Can you lead us through some breath work? Have you studied cold immersion for autonomic health? How can a resident physician optimize their sleep in a state of chronic sleep debt? What is your goal with bringing WHOOP to healthcare? Quotes and Ideas: If you want to perform at your best, you have to know your physiology and what your body needs to be at its best. For an athlete, it’s often not the 2 hours of training that determines next day training capacity, but what the athlete does within the other 22 hours of the day. We will be much better as a society if we can understand our physiology and how we modulate stress. Stability of sleep cycles may be the most important metric for health and recovery. Leaders who are underslept lead teams who report poor psychological safety. Managers rated with higher psychological safety bring in an average of 4.3 million dollars more of revenue each year. Breathing protocol for decreasing sympathetic drive “the physiologic sigh”: Two inhales followed by a longer exhale You can see the benefits of cold immersion with only 12 minutes of exposure per week. Tips for better sleep: Keep your sleep environment cold, dark, and quiet Avoid nigh time mealsAvoid alcoholKeep a regular sleep schedule and nighttime routine Avoid blue light before bed Book Suggestions: Awareness by Anthony De Mello Waking Up & Making Sense by Sam Harris Tools of Titans by Tim Ferris Thinking Fast and Slow by Daniel Kahneman 

Douglas Johnston, MD, is Vice Chairman, Program Director, and staff cardiac surgeon at the Cleveland Clinic. He attended Dartmouth College where he was a Presidential Scholar, earning his degree in Anthropology and Classical studies with Honor and Distinction. In the process he performed field research in tuberculosis among refugee communities in India. Dr. Johnston then went on to complete his medical education at Harvard Medical School, where he was a Harvard National Scholar.Dr. Johnston completed his clinical training in general surgery at the Massachusetts General Hospital in Boston. He was awarded the Edward D. Churchill Fellowship, the American College of Surgeons Resident Research Scholarship, and an NIH National Research Service Award for his research in the immunology of heart and lung transplantation.Dr. Johnston then completed his training in Thoracic and Cardiovascular Surgery at the Cleveland Clinic, including a focused fellowship in endovascular surgery and additional training in advanced 3-dimensional imaging techniques. He joined the cardiac surgery staff in 2008.Dr. Johnston is the author of numerous articles and abstracts published in leading scientific journals. His research interests include high risk aortic valve surgery and interventions, hybrid approaches to complex cardiac disease, and transcatheter interventions for valvular heart disease. He is a member of the American College of Surgeons, the International Society for Heart and Lung Transplantation, the International Society for Minimally Invasive Cardiac Surgery, and the Society of Cardiac Computed Tomography.An avid outdoorsman, Dr. Johnston enjoys hiking and sailing with his family during his time away from the hospital.Questions We Asked: Where in Cleveland do you hike and sail? Did you always know you wanted to be involved in leadership? What type of qualities do you look for in your team? Why doesn’t everyone define leadership? What makes a good leader in the operating room? How do you develop calm in stressful situations? Where do you draw the line with emotional behavior in the OR?How do you recover from a leadership mistake? What advice would you give to yourself at the beginning of training looking back now? Favorite book and hike? Quotes & Ideas: “No matter what specialty you are in, you have teams of people working towards a common goal.” “The best leaders are those who develop other members of the team to be leaders” “Traditional residency training doesn’t address this [leadership]” “A good leader will have the awareness to know the pulse of the room, but won’t try to control everyone.” “When you achieve a state of flow, it’s probably leadership that led to that.” “The best leaders I’ve seen are people whose energy level goes down in a crisis.” As a medical student, be the quiet professional Book Suggestions: Turn This Ship Around by L. David MarquetThe No Asshole Rule by Robert L Sutton 

John Abramson served as a family physician for 22 years. And was voted “best doctor” numerous times. He is a Harvard Medical School faculty member, where he currently teaches health care policy. He transitioned to litigation as a consultant to the FBI and Department of Justice  and served in many trials against big pharmaceutical companies. Dr. Abramson has appeared on more than 65 national television shows and podcasts, including the Today Show, the Joe Rogan Experience, Dr. Oz Show, Lex Friedman and now LTR. His writing has been published in places like the New York Times, LA Times and he is the author of the national best-selling book Overdo$ed America.Recently he published his second book Sickening and we are so grateful to have him here today to talk about how lack of transparency in pharmaceutical trials is impacting the healthcare system and what you as a future leader need to know about it.Questions We Asked: How did you transition from a family physician to litigation and writing work? What inspired you to write your second book, Sickening? What are a few examples of pharmaceutical case trials that have impacted patients? How can doctors learn about how drugs are marketed and what the data shows? Should there be a governmental body that vets clinical trial data? How should physicians decide which drugs to support and give their patients?How do we incentives caring for the patient? What advice would you give your younger self? Book Suggestions? Quotes & Ideas: Peer reviewers only get to see the submitted data instead of the raw data. This allows for cherry picking of data to prove effectiveness and maximize profits, not improve health. Most medical journals profit from sending reprints to pharmaceutical companies which creates an incentive to make the pharmaceutical drugs look good. Milton Freedman’s 3 roles of government, “It should provide for military defense of the nation. It should enforce contracts between individuals. It should protect citizens from crimes against themselves or their property.”US healthcare is alone in allowing commercialization permeate the healthcare system from drug advertisements to device sales and more The US healthy life expectancy has decreased from 38th in the world to now 68th in the world The system is designed to allow commercial interests to maximize drug companies profits instead of maximize the ability of physicians to deliver quality care Book Suggestions: Overdo$ed America and Sickening by Johnathon Abramson How Markets Fail by John CassadyPhishing for Phools by George AkerlofBetrayal of Trust by Laurie Garrett 

Dr. Cam Patterson is a renowned cardiologist and healthcare administrator who currently serves as chancellor of the University of Arkansas for Medical Sciences (UAMS).Patterson previously held numerous academic and clinical appointments at the University of North Carolina, including as physician-in-chief at the UNC Center for Heart and Vascular Care and executive director of the UNC McAllister Heart Institute.He was previously senior vice president and chief operating officer of New York-Presbyterian in New York.Over the course of his career, Patterson has received more than $60 million in grants from the National Institutes of Health, the American Heart Association and the Centers for Disease Control and Prevention and has published over 300 peer-reviewed articlesHis residency, including a year as chief resident, was conducted at Emory University Affiliated Hospitals. He was a research fellow at the Cardiovascular Biology Laboratory in the Harvard School of Public Health and a clinical fellow in cardiology at The University of Texas Medical Branch at Galveston, Texas, where he joined the institution’s faculty in 1998.His wife, Kristine Patterson, M.D., is an infectious disease specialist who is an expert in treating menopausal women with HIV. They have three children Celia, Anna and Graham.We hope you enjoy this episode where we discuss starting a new role as a leader, leading a medical system, and establishing an organizational vision. Welcome to Leading the Rounds! Questions We Asked: How did you come to be the chancellor of University of Arkansas Medical? Was there something that surprised you about becoming chief resident? How were you able to create a culture in your organizations? How do you go from planning to implementation as a leader? How are you able to see problems as opportunities? How do you keep a pulse on your entire organization and know when to step in? What do you use to guide decision making with limited information? As a leader, how do you decide what challenges to take on first? When do you work to create buy-in first vs making unwavering decisions? What advice would you give someone interested in leadership? Quotes & Ideas: “You can create an environment where everyone complains to you, or one where everyone is understanding and happy.”  “Culture eats strategy for breakfast” “Our goal is to help UAMS make Arkansas the healthiest state in the region.” “As a leader, there should be moments where you have nothing to do, otherwise you’re doing someone else's job.” “If you make a bad decision, move on fast and start making some good decisions.” “Sometimes you have to trust your gut, and your gut works best when you have a strong moral compass.” “Leadership is a job that should not have a reverse gear… The reason why you make a change is because there was a problem in the first place.” “If life and work isn’t fun then is it even worth it.” “You will be infinitely more happy finding and promoting the careers of people around you, than promoting your own career.” Book Suggestion: Music is History by Questlove 

Dr. Benjamin M. Scirica is a cardiovascular medicine specialist and associate professor of medicine at Harvard Medical School (HMS). He is the director of quality initiatives at Brigham and Women’s Hospital’s (BWH) Cardiovascular Division and a senior investigator at the Thrombolysis and Myocardial Infarction (TIMI) Study Group, where he is director of the Electrocardiography Core Laboratory.Dr. Scirica received his medical degree from HMS. He completed an internal medicine residency and a cardiovascular disease fellowship at BWH. He also completed a research fellowship in cardiovascular disease with the TIMI Study Group at BWH and received a master’s degree in public health from Harvard School of Public Health. Dr. Scirica is board certified in cardiovascular disease.His clinical and research interests include assessing novel therapeutic agents and developing electrocardiography and cardiac biomarkers. As director of quality initiatives at the Cardiovascular Division at BWH, he leads projects to improve delivery of care and inter-disciplinary communications. At the TIMI Study Group, Dr. Scirica’s research focuses on improving risk stratification and cardiovascular disease treatment. He has authored over 100 peer-reviewed publications.We hope you enjoy this episode where we discuss disruptive innovations, change implementation, and teambuilding. Welcome to leading the rounds. Questions We Asked: Tell us about your NEJM article “Disruptive and Sustaining Innovation in Telemedicine: A Strategic Roadmap”?How do we build sustainable systems to use innovative technology? Have we been able to effectively evaluate telemedicine as a healthcare media? What is your company CardioCompass? What have you learned about leading diverse interprofessional teams? What are your favorite books? Quotes & Ideas: Disruption theory by Clay ChristensenThe Innovator's Dilemma Cardiocompass In order to create an innovation, you need to release a minimum viable produce and then refine and improve it based on feedback and inefficiencies“What’s the job that needs to be done” As a leader, “think out loud and let people into your thought process.”“It’s almost impossible to over communicate, especially virtually.” Book Suggestions: Books about Abraham Lincoln 

Brian Ferguson has spent his career working in high-performance organizations, as well as learning from leaders and decision-makers in US national security, the military, and technology. He has used those experiences to build  Arena Labs , healthcares first performance platform.Brian is also a Partner + Co-Founder of the Liminal Collective, a unique company human performance focused company “enabling humanity’s boldest endeavors.” Liminal is currently working in civilian space travel, deep sea exploration, and the digital future of cyberspace. Before founding Arena Labs & Liminal Collective, Brian served in the military as a Navy SEAL Officer. Prior to joining the military, he was a Presidential Appointee in the Office of the Secretary of Defense, and worked in the White House managing Intergovernmental Relations Brian serves on the Boards of GenNext, Seatrec, and The Honor Foundation. He lives in Nashville, Tennessee and is most proud of being a great father to his daughter.We hope you enjoy this episode where we discuss leadership as a Navy Seal, wearable devices, and high performance medicine. Welcome to leading the rounds! Questions We Asked: Tell us about your time as a Navy Seal and how that has affected you and your outlook on life? How have you been able to build mental fortitude? How did you become involved in medicine and surgery? Tell us about the name of Arena Labs and how the idea started? What is high performance medicine? What does Arena Labs track and how does it use the data? How do you use wearables to improve performance? What are the programs Arena offers? What can performers do in the macro or micro scale to improve performance? What makes a good surgical time out? Book Suggestions? Quotes and Ideas: “[Military training] forces you to push up to your limit and then go a little further… and when you do that daily, you become a different person.” “Mindset is trainable” “From what I’ve seen, surgical residency and other residency are way more demanding [than the navy seals]”Tools to improve your performance : Be aware of your stressors and learn how to react Improve your energy management People in medicine are service archetypes: they do hard things, help people, and make an impact on the world "It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly." -Teddy Roosevelt There is a difference between endurance and performance. Endurance is repeated stress without recovery. Performance is repeated stressors with adequate recovery which leads to growth through hormesis. Non-Sleep Deep Rest Protocols “Don’t let your first time be your first time.” In an acute stress situation, use two inhales through the nose and then one exhale out of the mouth to try to slow your heart rate down “Is the surgical timeout an obligation, or an opportunity to improve team chemistry and performance.” Does it tap into the aspirational? Does it improve collegiality? Book Suggestions: Tribe by Sebastian Junger Atomic Habits by James Clear Nassim Taleb books