1 00:00:02,670 --> 00:00:03,519 Sara Dong: Hi, everyone. 2 00:00:03,770 --> 00:00:06,910 I just wanted to give a quick introduction for this episode. 3 00:00:07,270 --> 00:00:11,229 We were actually lucky enough to do another live recording. 4 00:00:11,649 --> 00:00:14,620 This time we were at the 23rd Annual St. 5 00:00:14,620 --> 00:00:20,565 Jude PIDS Pediatric Infectious Diseases Research Conference in Memphis, Tennessee. 6 00:00:20,625 --> 00:00:23,475 So if you aren't familiar, this is a really awesome conference. 7 00:00:23,825 --> 00:00:28,205 It features leaders in pediatric ID research, transplant and immunocompromised 8 00:00:28,234 --> 00:00:29,974 host ID, and global health. 9 00:00:30,365 --> 00:00:34,144 In addition to all these topics, there is an emphasis on career development. 10 00:00:34,805 --> 00:00:37,495 So we are fortunate to have Dr. 11 00:00:37,495 --> 00:00:42,019 Sumanth Cherukumilli, who is the top abstract winner and a pediatric ID 12 00:00:42,019 --> 00:00:46,080 fellow at the University of Maryland, as well as faculty members, Dr. 13 00:00:46,080 --> 00:00:49,334 Emma Mohr from the University of Wisconsin, and Dr. 14 00:00:49,334 --> 00:00:52,699 Paul Spearman from Cincinnati Children's joining. 15 00:00:53,009 --> 00:00:56,939 And just to provide a teeny bit of context for the podcast and a couple of 16 00:00:56,939 --> 00:00:58,829 the questions in the q and a at the end. 17 00:00:59,099 --> 00:01:04,170 This recording was completed after a presentation I provided on "How to develop 18 00:01:04,170 --> 00:01:06,840 and evolve as a digital medical educator". 19 00:01:07,550 --> 00:01:09,260 All right, so let's head to the conference. 20 00:01:10,580 --> 00:01:11,520 Hi, everyone. 21 00:01:11,630 --> 00:01:15,620 Welcome to Febrile, a cultured podcast about all things infectious disease. 22 00:01:15,740 --> 00:01:19,599 We use consult questions to dive into ID clinical reasoning, diagnostics, 23 00:01:19,600 --> 00:01:21,250 and antimicrobial management. 24 00:01:21,910 --> 00:01:23,280 You now, at this point, know me. 25 00:01:23,280 --> 00:01:24,190 I'm Sara Dong. 26 00:01:24,200 --> 00:01:26,239 I'm your host and a MedPeds ID doc. 27 00:01:26,270 --> 00:01:28,240 We have a live recording today. 28 00:01:28,290 --> 00:01:36,469 We are at the to the St.Jude/PIDS Pediatric ID research conference. 29 00:01:37,119 --> 00:01:40,489 Thanks to the audience for being here and we have three awesome guests so I'm 30 00:01:40,519 --> 00:01:44,470 going to move down the table and ask them to say hello and introduce themselves. 31 00:01:45,000 --> 00:01:45,720 Sumanth Cherukumilli: I'm Sumanth. 32 00:01:45,739 --> 00:01:49,550 I'm the second year Peds ID fellow from the University of Maryland. 33 00:01:50,420 --> 00:01:53,040 Sara Dong: And I would just like to introduce, we asked him to come on the 34 00:01:53,040 --> 00:01:56,960 show because his project was selected as the top abstract for this meeting. 35 00:01:56,980 --> 00:02:00,210 So, you'll get to see his presentation tomorrow. 36 00:02:00,650 --> 00:02:02,120 But, thank you for joining. 37 00:02:03,629 --> 00:02:04,970 Emma Mohr: All right, I'm next on the table. 38 00:02:04,970 --> 00:02:08,100 My name is Emma Mohr, and I'm a pediatric infectious diseases 39 00:02:08,100 --> 00:02:11,049 physician and scientist at the University of Wisconsin Madison. 40 00:02:11,120 --> 00:02:11,269 Paul Spearman: Hi, 41 00:02:14,850 --> 00:02:15,780 my name is Paul Spearman. 42 00:02:15,780 --> 00:02:19,330 I'm vice chair for clinical translational research at Cincinnati 43 00:02:19,340 --> 00:02:24,045 Children's, and I'm here also as a MedPeds ID doc, but practicing 44 00:02:24,065 --> 00:02:26,025 Peds ID and because Emma asked me. 45 00:02:26,045 --> 00:02:26,424 Thanks. 46 00:02:30,075 --> 00:02:33,555 Sara Dong: And as everyone's favorite cultured podcast, we always ask if 47 00:02:33,555 --> 00:02:36,394 our guests will share a little piece of culture, basically just something 48 00:02:36,394 --> 00:02:38,594 non medical that makes you happy. 49 00:02:38,674 --> 00:02:40,784 Please feel free to share something personal or you can also 50 00:02:40,784 --> 00:02:41,824 share something about Memphis. 51 00:02:42,565 --> 00:02:46,815 Sumanth Cherukumilli: This is not personal or about Memphis, but I am a 52 00:02:46,825 --> 00:02:54,095 big fan of trashy TV and Love is Blind has its wedding episode today, which 53 00:02:54,095 --> 00:02:57,384 I'm very excited to watch later today. 54 00:02:58,085 --> 00:03:02,015 Emma Mohr: I really enjoy running, um, and so I run usually a couple times 55 00:03:02,015 --> 00:03:05,275 a week and especially love running on trails, and it helps clear my head from 56 00:03:05,275 --> 00:03:07,015 everything work and family related. 57 00:03:07,865 --> 00:03:10,835 Paul Spearman: All right, I have recently taken up sculpture, 58 00:03:10,885 --> 00:03:12,914 and I love doing sculpture. 59 00:03:12,914 --> 00:03:17,014 It's kind of a total break from everything else, both kind of 60 00:03:17,015 --> 00:03:20,895 classical sculptures and weird sculptures, so it's a lot of fun. 61 00:03:21,795 --> 00:03:22,345 Sara Dong: Well, I'm excited. 62 00:03:22,345 --> 00:03:24,475 I wish we had a weird sculpture centerpiece. 63 00:03:25,305 --> 00:03:27,705 We're going to open up with something sort of clinically oriented. 64 00:03:27,705 --> 00:03:31,275 We wanted to share some clinical pearls, but then also shift a little bit at the 65 00:03:31,275 --> 00:03:33,035 end to talk about career development. 66 00:03:33,045 --> 00:03:35,344 And if we have time, we'll also open it up for questions. 67 00:03:35,474 --> 00:03:38,135 So I have a mini case I'm going to pitch to Emma and Paul. 68 00:03:38,475 --> 00:03:39,414 So you're getting called. 69 00:03:39,570 --> 00:03:44,120 We have a baby boy born at 38 weeks, 5 days gestation, it's been about 70 00:03:44,130 --> 00:03:49,310 24 hours ago, to a 32 year old G1, now P1, previously healthy mom. 71 00:03:49,359 --> 00:03:53,390 Mom has become unwell, she's developed a fever, but outside of that her 72 00:03:53,420 --> 00:03:57,539 antepartum course and labs have otherwise been negative and uneventful. 73 00:03:57,739 --> 00:04:01,880 The baby was initially doing well, but has since developed a fever and worsening 74 00:04:01,880 --> 00:04:06,129 respiratory distress, which led to transfer to the NICU for further workup. 75 00:04:06,359 --> 00:04:09,650 He now has worsening hypotension, requiring pressor support, and 76 00:04:09,650 --> 00:04:11,750 has been intubated and ventilated. 77 00:04:12,189 --> 00:04:14,960 And so I was going to ask if you could talk us through what's going on here. 78 00:04:14,960 --> 00:04:19,399 I know we have some earlier learners that maybe haven't been in the clinical setting 79 00:04:19,399 --> 00:04:21,349 before, and how you would approach this. 80 00:04:21,880 --> 00:04:25,359 Most importantly, we want to talk a little bit about empiric therapy. 81 00:04:25,765 --> 00:04:27,675 Emma Mohr: Sure, I'll take this early part. 82 00:04:27,745 --> 00:04:33,824 So, when I hear about a young baby, usually less than 3 days of age with 83 00:04:34,375 --> 00:04:37,964 signs of clinical distress, so sounds like the baby had some increased work 84 00:04:37,964 --> 00:04:42,455 of breathing, just not looking good, so other signs of not looking good 85 00:04:42,514 --> 00:04:49,725 could be things like lethargy or not feeding, not doing what a newborn baby 86 00:04:50,255 --> 00:04:54,435 is asked to do, which is not much, but you do have to wake up to feed yourself. 87 00:04:54,945 --> 00:04:57,815 When they're not doing that, we're worried about something like early onset 88 00:04:57,815 --> 00:05:02,474 sepsis or neonatal sepsis, especially less than three days of age or 72 89 00:05:02,474 --> 00:05:04,134 hours is what we usually think of that. 90 00:05:04,474 --> 00:05:07,404 And one of the things that we think about is, were they exposed 91 00:05:07,465 --> 00:05:12,724 to pathogens from the maternal GU or GI tract during the process of 92 00:05:12,724 --> 00:05:17,605 delivery, they can be transferred these bacteria and it can cause sepsis in 93 00:05:17,605 --> 00:05:19,885 them or pneumonia at times as well. 94 00:05:19,885 --> 00:05:23,034 So those are the things that I'm thinking about when I'm called 95 00:05:23,039 --> 00:05:24,864 to evaluate babies like this. 96 00:05:25,805 --> 00:05:28,474 Paul Spearman: Uh, and I agree completely with Emma on this. 97 00:05:28,474 --> 00:05:30,995 I think we have several concerning things. 98 00:05:30,995 --> 00:05:34,710 The maternal fever would already pique your interest that the baby 99 00:05:34,920 --> 00:05:36,730 could have a neonatal infection. 100 00:05:36,790 --> 00:05:40,320 It does sound like early onset neonatal sepsis. 101 00:05:40,790 --> 00:05:42,720 We don't know mom's GBS status. 102 00:05:42,720 --> 00:05:45,910 We'd want to know that, and that would also figure into the risk. 103 00:05:46,150 --> 00:05:49,390 But with the baby already having respiratory distress and hypotension, 104 00:05:49,670 --> 00:05:53,650 We don't really need a fancy neonatal risk calculator to say 105 00:05:53,650 --> 00:05:55,060 what we need to do next, right? 106 00:05:55,060 --> 00:05:59,300 Because this is so much in the category of neonatal sepsis that 107 00:05:59,300 --> 00:06:01,139 you'd want to start empiric therapy. 108 00:06:01,510 --> 00:06:05,009 And I guess that's our topic also for discussion is what would you, 109 00:06:05,019 --> 00:06:07,729 you know, what are the organisms that you would really be worried 110 00:06:07,729 --> 00:06:09,530 about and, and what would you start? 111 00:06:09,570 --> 00:06:13,840 So at the top, you'd still have group B strep, which is the number 112 00:06:13,840 --> 00:06:16,070 one for early onset neonatal sepsis. 113 00:06:16,439 --> 00:06:16,980 Then E. 114 00:06:16,980 --> 00:06:21,185 coli and other Enterobacteriaceae, I usually think of those 115 00:06:21,185 --> 00:06:22,085 together, although E. 116 00:06:22,085 --> 00:06:26,695 coli is by far the most likely you can have other gram negative sources of 117 00:06:26,695 --> 00:06:32,505 sepsis, and then a more distant third, Listeria, and we would maybe expect mom 118 00:06:32,594 --> 00:06:36,954 to have chorioamnionitis if there's a baby that we're thinking about Listeria. 119 00:06:37,445 --> 00:06:40,775 So we think about those kind of categories, and we'd be thinking 120 00:06:40,775 --> 00:06:44,115 largely of bacteria at this stage, but you'd want in the back of your 121 00:06:44,115 --> 00:06:46,444 mind to think of viral syndromes. 122 00:06:46,445 --> 00:06:52,800 This is a little early for presenting with disseminated HSV or enterovirus 123 00:06:52,800 --> 00:06:56,430 or parecho[virus] or something like that, but you'd want to not completely 124 00:06:56,430 --> 00:06:58,280 discount those and think about them. 125 00:06:58,280 --> 00:07:02,179 And if things are out of line, or if, let's say, the baby has really 126 00:07:02,179 --> 00:07:06,589 high LFTs, there's maybe a maternal history, you might think about 127 00:07:06,600 --> 00:07:08,445 herpes a little higher on the list. 128 00:07:08,445 --> 00:07:13,319 So fungal, probably not so much at this kind of early presentation and 129 00:07:13,319 --> 00:07:14,820 in a non premie [premature infant]. 130 00:07:14,820 --> 00:07:14,880 Thank you. 131 00:07:15,280 --> 00:07:17,719 Emma Mohr: So what do we do with this baby when we're called? 132 00:07:17,719 --> 00:07:19,340 What labs do we recommend getting? 133 00:07:19,340 --> 00:07:20,920 And then how do we treat the baby? 134 00:07:21,260 --> 00:07:24,310 One of the big things that you do for these baby is evaluate 135 00:07:24,349 --> 00:07:25,620 their blood with a blood culture. 136 00:07:25,680 --> 00:07:27,089 Are they growing organisms in there? 137 00:07:27,399 --> 00:07:29,940 And you really, really try and get that blood culture before you start 138 00:07:29,950 --> 00:07:35,200 antibiotics so we can make an educated decision about what infection they have 139 00:07:35,200 --> 00:07:36,430 and what they should be treated with. 140 00:07:36,849 --> 00:07:39,550 So you get that blood culture and then right away administer 141 00:07:39,580 --> 00:07:40,960 antibiotics for this baby. 142 00:07:41,505 --> 00:07:45,235 So the empiric antibiotics that we think about for these children are 143 00:07:45,265 --> 00:07:47,395 things like ampicillin and gentamicin. 144 00:07:47,415 --> 00:07:50,724 So we want to make sure that we cover the common organisms that we just 145 00:07:50,725 --> 00:07:52,445 talked about, especially GBS and E. 146 00:07:52,445 --> 00:07:54,044 coli, which are the most common. 147 00:07:54,564 --> 00:07:59,885 Usually we think about sepsis over things like meningitis right away 148 00:07:59,895 --> 00:08:02,145 in an infant that's 24 hours of age. 149 00:08:02,510 --> 00:08:05,240 But as they get a little bit older than that, a few days 150 00:08:05,240 --> 00:08:09,470 later, maybe meningitis can happen more likely than sepsis as well. 151 00:08:09,880 --> 00:08:13,720 So ampicillin and gentamicin in these early days, and then later on, if we're 152 00:08:13,740 --> 00:08:17,540 really thinking meningitis and we want better CNS coverage, cephalosporin, 153 00:08:18,540 --> 00:08:20,430 something like ceftazidime or others. 154 00:08:20,839 --> 00:08:21,384 That's it. 155 00:08:21,594 --> 00:08:25,675 Sort of leading into what we're talking about next is what empiric antibiotics 156 00:08:25,784 --> 00:08:27,905 to use in our practice here in the U. 157 00:08:27,905 --> 00:08:28,175 S. 158 00:08:28,175 --> 00:08:33,425 Ampicillin gentamicin is good based on our common organisms, but it's not 159 00:08:33,425 --> 00:08:34,784 like that everywhere in the world. 160 00:08:35,855 --> 00:08:38,444 Sara Dong: Yeah, and that's kind of what we wanted to transition about 161 00:08:38,444 --> 00:08:43,470 because often times we think about our differential and maybe don't always 162 00:08:43,569 --> 00:08:47,210 remember about how screening practices may be different somewhere else. 163 00:08:47,230 --> 00:08:52,069 I learned a lot about how GBS screening and prophylaxis varies 164 00:08:52,070 --> 00:08:55,389 in different countries and I hadn't really thought about that much until 165 00:08:55,389 --> 00:08:57,109 we had done a Febrile episode on it. 166 00:08:57,119 --> 00:09:00,989 And I think neonatal sepsis rates are quite variable. 167 00:09:01,459 --> 00:09:05,159 So Sumanth, I wanted to get your perspective because we wanted to 168 00:09:05,160 --> 00:09:07,245 also adjust this case a little bit. 169 00:09:07,245 --> 00:09:10,265 So we've said ampicillin/gentamicin for our sort of North American 170 00:09:10,265 --> 00:09:13,975 audience, but what if we thought about it from a different perspective? 171 00:09:13,975 --> 00:09:16,954 And I think that kind of plays into your research that you're presenting about. 172 00:09:17,395 --> 00:09:20,674 Sumanth Cherukumilli: Yeah, so I'm not sure if everyone is 173 00:09:20,685 --> 00:09:22,895 familiar with the CHAMPS study. 174 00:09:22,905 --> 00:09:27,744 It's a study that uses minimally invasive sampling techniques to look 175 00:09:27,754 --> 00:09:32,349 at children who have died under the age of five in multiple countries, 176 00:09:32,380 --> 00:09:34,390 mostly low and middle income countries. 177 00:09:35,030 --> 00:09:39,579 They actually published from their analysis a paper last year that 178 00:09:39,580 --> 00:09:44,390 looked at the causes of death in neonates between 2016 and 2021, 179 00:09:45,020 --> 00:09:48,700 and the majority of neonates had an infection in their causal chain, 180 00:09:48,710 --> 00:09:50,689 like in their causal chain of death. 181 00:09:50,770 --> 00:09:54,930 The most striking thing, there's actually a chart that demonstrates 182 00:09:54,980 --> 00:09:56,819 the burden of each infectious disease. 183 00:09:57,160 --> 00:10:01,999 The most striking thing is how, in comparison to gram negatives, 184 00:10:02,550 --> 00:10:07,149 GBS is not really as big a player in a lot of these different sites. 185 00:10:07,149 --> 00:10:11,060 Like gram negative Enterobacterales are really the biggest killers, specifically 186 00:10:11,080 --> 00:10:16,170 Klebsiella pneumoniae, and a lot of these isolates are multi drug resistant. 187 00:10:16,610 --> 00:10:21,710 The WHO definitely recommends intrapartum antibiotic prophylaxis for GBS positive 188 00:10:21,710 --> 00:10:26,160 moms, but what they write is that it's a conditional recommendation based on 189 00:10:26,170 --> 00:10:30,310 weak evidence, and they have a lot of caveats in there about how it really 190 00:10:30,310 --> 00:10:34,559 depends on your local epidemiology, and GBS screening is kind of a plus 191 00:10:34,559 --> 00:10:36,189 or minus depending on where you are. 192 00:10:36,189 --> 00:10:39,875 So, uh, If we just look at the mortality burden, gram negatives 193 00:10:39,875 --> 00:10:41,675 are really the biggest players. 194 00:10:41,755 --> 00:10:44,635 That's something definitely important to consider when we're talking 195 00:10:44,635 --> 00:10:47,985 about empiric regimens and settings outside the United States and Europe. 196 00:10:48,385 --> 00:10:50,785 Sara Dong: Is there anyone in the audience who would not use ampicillin 197 00:10:51,045 --> 00:10:55,410 gentamicin, you know, based on the most common organisms at their site. 198 00:10:55,710 --> 00:10:55,980 Yeah. 199 00:10:56,130 --> 00:10:57,200 I'm sorry, I don't have a mic for you. 200 00:10:57,690 --> 00:10:58,300 I can repeat. 201 00:10:58,300 --> 00:10:59,290 What is your empirical 202 00:10:59,290 --> 00:11:02,172 Audience Member: I think you said, it kind of follows up with what was just 203 00:11:02,172 --> 00:11:06,230 said about local rates, because our ampicillin susceptibility rates for E. 204 00:11:06,230 --> 00:11:08,530 coli are not satisfactory at all. 205 00:11:08,530 --> 00:11:10,370 They're probably about 50 percent. 206 00:11:10,490 --> 00:11:10,740 Sara Dong: Yeah. 207 00:11:12,890 --> 00:11:16,827 Audience Member: So we, very strongly encourage a third generation cephalosporin 208 00:11:17,337 --> 00:11:20,912 upfront plus or minus ampicillin if you're worried about Listeria and I think, and 209 00:11:20,912 --> 00:11:24,930 we have a very hard time getting our neonatologists to understand that because 210 00:11:24,930 --> 00:11:26,392 all the guidelines say amp and gent. 211 00:11:26,392 --> 00:11:30,515 But you really do need to use your local epidemiology to make that decision. 212 00:11:30,885 --> 00:11:34,500 Sara Dong: Hopefully, folks in the audience could hear most of that, but 213 00:11:34,500 --> 00:11:38,280 just talking about the importance of looking at your local epidemiology. 214 00:11:38,579 --> 00:11:42,050 And so if there is a high rate of ampicillin resistance, of course, 215 00:11:42,060 --> 00:11:43,810 amp would not be the ideal agent. 216 00:11:43,810 --> 00:11:44,460 Okay. 217 00:11:44,490 --> 00:11:48,480 And so Sumanth, you know, before we move on, I just wanted to follow 218 00:11:48,480 --> 00:11:52,320 up with you from your work because we talked about reframing this case 219 00:11:52,320 --> 00:11:56,660 from a different perspective using different empiric antibiotics. 220 00:11:57,070 --> 00:12:02,070 Are there any other considerations or challenges in management that you think 221 00:12:02,070 --> 00:12:05,660 of in this case or based on your project? 222 00:12:05,780 --> 00:12:09,470 Sumanth Cherukumilli: The project that I've been doing is mainly in Mali. 223 00:12:09,480 --> 00:12:12,750 It's a country in West Africa, which I'm sure many people are familiar 224 00:12:12,750 --> 00:12:15,780 with, that has some of the lowest indices of development in the world. 225 00:12:16,340 --> 00:12:19,570 And there we've actually been doing an invasive bacterial infection study since 226 00:12:19,570 --> 00:12:24,730 2002 to look at the causes of bacterial infections in kids under the age of 15. 227 00:12:25,130 --> 00:12:29,820 Initially, the burden was mainly just Hib and Strep pneumo, but the data that we got 228 00:12:29,820 --> 00:12:34,100 from the study allowed Milagritos Tapia and Karen Kotloff, my two primary mentors, 229 00:12:34,100 --> 00:12:38,370 to introduce vaccines in that setting that really reduced the burden of both. 230 00:12:38,450 --> 00:12:41,270 But our burden of gram negative infections, gram negative 231 00:12:41,270 --> 00:12:45,330 Enterobacterales specifically, has stayed pretty static and actually maybe 232 00:12:45,330 --> 00:12:47,300 has gone up over this time period. 233 00:12:47,640 --> 00:12:52,420 So I really looked at mortality rates between 2021 and 2024, really over a three 234 00:12:52,420 --> 00:12:56,035 year period, and I found that kids who had a positive culture had a mortality 235 00:12:56,035 --> 00:13:01,485 rate of 49 percent versus 28 percent in kids who had negative cultures, and 236 00:13:01,495 --> 00:13:03,575 both are really unacceptably high rates. 237 00:13:04,365 --> 00:13:07,255 The issue in Mali, and I'm sure this applies to other places 238 00:13:07,255 --> 00:13:10,705 in Sub Saharan Africa, falls into like four major buckets. 239 00:13:11,285 --> 00:13:15,335 Problems with diagnostics, problems with presentation, problems with antibiotics, 240 00:13:15,335 --> 00:13:16,725 and problems with supportive care. 241 00:13:17,165 --> 00:13:19,425 With diagnostics, there's issues. 242 00:13:19,565 --> 00:13:24,000 We are able to get blood cultures in Mali, but that's because, you know, it's 243 00:13:24,010 --> 00:13:28,020 supported by a major American institution, but there are lots of places in Mali and 244 00:13:28,020 --> 00:13:30,850 Sub Saharan Africa where you can't really get blood cultures, so you don't have 245 00:13:30,850 --> 00:13:32,590 anything to really guide your therapy. 246 00:13:32,990 --> 00:13:37,230 That's really a diagnostics issue, and other than microbiologic diagnoses, 247 00:13:37,230 --> 00:13:38,880 like, forget about molecular testing. 248 00:13:39,380 --> 00:13:40,510 When cultures are difficult. 249 00:13:40,980 --> 00:13:44,240 It's also difficult to get labs, things we take for granted like CRPs, 250 00:13:44,240 --> 00:13:48,750 lactates, procalcitonins, things like that, which can make it really hard 251 00:13:48,750 --> 00:13:52,410 to assess, especially in patient where infection can be subtle, like a neonate, 252 00:13:52,740 --> 00:13:54,540 where your patient really stands. 253 00:13:55,030 --> 00:13:56,620 And then there's issues with presentation. 254 00:13:56,620 --> 00:13:59,210 And again, I put this into like two different categories, right? 255 00:13:59,230 --> 00:14:03,310 So there's the issue with delay in presentation where kids maybe 256 00:14:03,310 --> 00:14:05,970 live really far away from the hospital, don't have transport to 257 00:14:05,970 --> 00:14:07,959 get to the hospital, and where. 258 00:14:08,035 --> 00:14:11,875 So, parents just aren't aware of what a sick kid looks like so they 259 00:14:11,875 --> 00:14:15,305 present in extremis and it can be really difficult to treat those kids. 260 00:14:15,305 --> 00:14:19,345 And that's kind of borne out by our data where greater than 50 percent 261 00:14:19,345 --> 00:14:23,055 of kids who die, really die within the first 48 hours of presentation. 262 00:14:23,595 --> 00:14:26,194 And then the other issue I think with presentation is um. 263 00:14:26,385 --> 00:14:28,595 And then there's seeking care in the community before they come to the 264 00:14:28,595 --> 00:14:32,445 hospital, and that can be with traditional healers, where they get medications, 265 00:14:32,455 --> 00:14:36,255 we don't know what sometimes is in those medications, those medications 266 00:14:36,275 --> 00:14:39,575 themselves can be toxic, and you can get sub therapeutic concentrations of 267 00:14:39,575 --> 00:14:41,454 antibiotics in those medications as well. 268 00:14:42,015 --> 00:14:45,895 And then some of these kids get treated out in the community, where they can 269 00:14:45,895 --> 00:14:49,905 get injectable antibiotics, but again, they're not getting cultures, so you can 270 00:14:49,915 --> 00:14:53,315 have kids that are partially treated, who limp along, limp along, limp along, 271 00:14:53,325 --> 00:14:59,075 until they present in overwhelming shock and then antibiotics, right? 272 00:14:59,115 --> 00:15:02,085 And I, again, I kind of grouped this into 2 separate categories. 273 00:15:02,095 --> 00:15:05,325 The 1st 1 is that, you know, 100 percent of our E. 274 00:15:05,325 --> 00:15:09,275 coli strains are resistant to ceftriaxone over the last 3 years. 275 00:15:09,275 --> 00:15:12,075 And that number is greater than 90 percent for Kleb pneumo. 276 00:15:12,075 --> 00:15:17,105 So, per Pranita Tamma's excellent talk on your podcast a few months ago, 277 00:15:17,125 --> 00:15:21,365 really, if you're thinking about an ESBL organism in a critically ill patient, 278 00:15:21,365 --> 00:15:22,935 the treatment of choice is a carbapenem. 279 00:15:23,285 --> 00:15:27,125 And it's really hard to get access to carbapenems in that setting 280 00:15:27,135 --> 00:15:29,995 because the onus is really on the parents to buy the antibiotics. 281 00:15:29,995 --> 00:15:32,255 And these antibiotics are very, very expensive. 282 00:15:32,615 --> 00:15:36,485 And so kids get treated with ineffective antibiotics like ceftriaxone and 283 00:15:36,725 --> 00:15:40,150 aminoglycosides, which again, have mortality, like, uh, resistance rates 284 00:15:40,160 --> 00:15:43,830 of greater than 50 percent to the most commonly isolated gram negative pathogens. 285 00:15:44,370 --> 00:15:47,080 And then the other issue that I think is a global problem is the issue of 286 00:15:47,080 --> 00:15:50,750 counterfeit and substandard antibiotics and antimalarials, which is really a 287 00:15:50,750 --> 00:15:52,470 huge problem in sub Saharan Africa. 288 00:15:52,480 --> 00:15:55,550 So even when you're getting the proper antibiotics, if you're not getting 289 00:15:55,550 --> 00:15:58,810 them from a good source, there's a high probability that what you're getting 290 00:15:59,110 --> 00:16:00,880 isn't good enough to treat your infection. 291 00:16:01,200 --> 00:16:04,740 And that I think drives mortality and further antimicrobial resistance. 292 00:16:05,350 --> 00:16:07,220 The last issue is supportive care. 293 00:16:07,250 --> 00:16:09,565 And again, I think that it falls into two categories. 294 00:16:09,585 --> 00:16:13,255 What we don't have, which in sub Saharan Africa, oftentimes, it's really hard 295 00:16:13,255 --> 00:16:16,735 to find mechanical ventilators as well as continuous vasopressor support. 296 00:16:17,275 --> 00:16:18,845 And then the problem is what we do have. 297 00:16:19,365 --> 00:16:22,265 There's a famous trial that came out in 2011 that looked at the 298 00:16:22,265 --> 00:16:26,555 impact of fluid boluses on patient mortality in East Africa in settings 299 00:16:26,574 --> 00:16:28,245 without mechanical ventilation. 300 00:16:28,245 --> 00:16:29,125 It's called the FEAST trial. 301 00:16:29,125 --> 00:16:30,135 It's an excellent paper. 302 00:16:30,465 --> 00:16:33,495 They divided them into several different cohorts, and they looked 303 00:16:33,505 --> 00:16:38,715 at the impact of fluid boluses on patient mortality in all these kids. 304 00:16:39,265 --> 00:16:43,315 They found that no matter what type of fluid they got, kids with 305 00:16:43,335 --> 00:16:47,265 boluses had a significantly higher 48 hour mortality rate than kids 306 00:16:47,265 --> 00:16:48,605 who did not get fluid boluses. 307 00:16:48,605 --> 00:16:52,625 And these are all kids with suspected bacterial infections, suspected sepsis. 308 00:16:53,160 --> 00:16:56,880 And this is a stunning result because for a long time, the standard of care in 309 00:16:56,880 --> 00:17:01,490 the United States and worldwide was if you think someone has shock or sepsis or 310 00:17:01,490 --> 00:17:05,080 something like that, you know, fluids are really fluids, fluids, fluids, 60 cc's per 311 00:17:05,080 --> 00:17:07,060 kg in the first like 20 minutes of care. 312 00:17:07,550 --> 00:17:12,010 And this pushed back against that idea that fluids were always beneficial. 313 00:17:12,850 --> 00:17:16,220 Authors did a secondary analysis a few years later where they found that 314 00:17:16,220 --> 00:17:21,350 the majority of kids who died from that initial trial died because they 315 00:17:21,350 --> 00:17:25,849 had a cardiovascular collapse, not respiratory failure, which suggests 316 00:17:25,849 --> 00:17:30,340 that some kids may have some degree of subacute myocardial dysfunction when 317 00:17:30,340 --> 00:17:35,100 they present with sepsis or septic shock that might make it dangerous 318 00:17:35,130 --> 00:17:37,310 to administer a lot of fluid therapy. 319 00:17:37,780 --> 00:17:42,910 When you don't have hemodynamic monitoring like we do here with CVP, SVO2, or 320 00:17:42,910 --> 00:17:46,850 renal NIRS, it's really hard to tell where we are in our resuscitation, 321 00:17:47,220 --> 00:17:52,170 which can make it so that we provide harmful amounts of fluid therapies 322 00:17:52,170 --> 00:17:53,760 that could potentially be beneficial. 323 00:17:54,280 --> 00:17:58,370 And I think all of these things really contribute to the mortality 324 00:17:58,370 --> 00:18:00,190 burden in a place like Mali. 325 00:18:00,210 --> 00:18:03,120 It's a lack of resources, but also a problem with the resources 326 00:18:03,120 --> 00:18:05,510 that we do have in that context. 327 00:18:06,010 --> 00:18:09,420 I wouldn't be able to do any of this work if it wasn't for the wonderful 328 00:18:09,429 --> 00:18:13,820 work that's been done by Millie Tapia and Karen Kotloff, my two primary 329 00:18:13,820 --> 00:18:19,609 mentors, Samba So, Adiba Mambiketa, who have been working on the ground 330 00:18:19,610 --> 00:18:22,810 to introduce a lot of these vaccines and therapeutics to Malian children 331 00:18:22,810 --> 00:18:24,540 and have saved countless Malian lives. 332 00:18:25,050 --> 00:18:27,580 Will Still is still one of the co authors on my abstract. 333 00:18:27,660 --> 00:18:30,489 He's a PhD student who's been working on the impact of supportive 334 00:18:30,490 --> 00:18:34,490 care on patient mortality and this population and a lot of the data that 335 00:18:34,490 --> 00:18:39,620 he actually came up with informed the hypotheses that led to my project. 336 00:18:40,080 --> 00:18:43,380 Finally, University of Maryland is a wonderful place to train. 337 00:18:43,810 --> 00:18:47,360 If you're considering a fellowship centered around global health and 338 00:18:47,480 --> 00:18:51,555 pediatric infectious diseases in a global setting, can't do much better than us. 339 00:18:51,555 --> 00:18:56,205 We have a really wonderful track record of obtaining funding for fellows and 340 00:18:56,205 --> 00:18:59,085 partnering people with faculty who are actually working on high impact 341 00:18:59,085 --> 00:19:00,945 projects in low resource settings. 342 00:19:01,605 --> 00:19:07,035 My mentors from residency, Tom Boyce, who's here right now actually, he's, he is 343 00:19:07,040 --> 00:19:11,925 a huge inspiration for me, so I have a lot of people to think and I definitely still 344 00:19:11,925 --> 00:19:15,465 have a lot to learn and hopefully can continue to contribute in any way I can. 345 00:19:15,715 --> 00:19:19,295 Sara Dong: Wow, that is just the perfect transition and giving a shout 346 00:19:19,295 --> 00:19:21,345 out to your mentors and collaborators. 347 00:19:22,665 --> 00:19:25,025 Just like this conference, we're getting a mix of clinicals. 348 00:19:25,025 --> 00:19:25,825 I'm actually going to pivot. 349 00:19:25,825 --> 00:19:27,105 I'm not going to give you the end of the case. 350 00:19:27,105 --> 00:19:30,085 So it's just a sneak peek because we actually wanted to talk a little 351 00:19:30,085 --> 00:19:32,245 bit about careers in pediatric ID. 352 00:19:32,295 --> 00:19:35,585 So I actually was hoping that Emma and Paul could just tell us a little bit 353 00:19:35,595 --> 00:19:40,790 about your career path and maybe one thing that you've, a piece of guidance that 354 00:19:40,790 --> 00:19:44,270 you would give to a fellow who's trying to figure out what do I want to do, what 355 00:19:44,270 --> 00:19:46,180 kind of pediatric ID doctor I want to be? 356 00:19:47,220 --> 00:19:49,450 Emma Mohr: Oh, what a great question because there's so many 357 00:19:49,469 --> 00:19:53,570 options as we've learned during our career paths session today. 358 00:19:54,070 --> 00:19:58,750 I've been set from pretty early on that I wanted to do research and 359 00:19:58,759 --> 00:20:02,955 medicine, so I think I've wanted to be a physician scientist for a long 360 00:20:02,955 --> 00:20:07,475 time, but I was always scared by the scientist piece because that seemed big 361 00:20:07,475 --> 00:20:09,594 and scary and the big world unknown. 362 00:20:09,975 --> 00:20:14,985 I didn't start believing that I could actually do that until later in 363 00:20:14,985 --> 00:20:20,275 fellowship, that I could fund my way to doing that and have my own research lab. 364 00:20:20,940 --> 00:20:25,540 So I encourage people who are in fellowship to really explore your options. 365 00:20:25,890 --> 00:20:28,870 You never know when you're going to be, I don't want to say in the right 366 00:20:28,870 --> 00:20:33,910 place at the right time, but when you are going to be called upon because 367 00:20:33,920 --> 00:20:39,480 you are the best option for some need that your institution or your lab has. 368 00:20:40,089 --> 00:20:44,975 My opportunity to really establish my research niche fell when 369 00:20:44,975 --> 00:20:50,015 I was in fellowship and my PI mentor, he's a straight PhD 370 00:20:50,025 --> 00:20:51,915 scientist, wonderful person, Dr. 371 00:20:51,955 --> 00:20:55,615 David O'Connor at the University of Wisconsin Madison, his area was 372 00:20:55,615 --> 00:20:58,875 in developing non human primate models of infectious diseases. 373 00:20:59,475 --> 00:21:02,695 And my fellowship happened to fall right during the time of the Zika 374 00:21:02,705 --> 00:21:04,275 pandemic throughout the Americas. 375 00:21:04,875 --> 00:21:08,105 And so we, uh, developed the first model of Zika virus 376 00:21:08,105 --> 00:21:09,595 infection in non human primates. 377 00:21:10,115 --> 00:21:14,435 As a pediatrician and peds ID fellow, I was really, really interested 378 00:21:14,735 --> 00:21:17,405 in understanding what happens to the infants after they're born. 379 00:21:17,695 --> 00:21:20,225 And these virologists that I was working with are like, what? 380 00:21:20,255 --> 00:21:21,165 What's developments? 381 00:21:21,455 --> 00:21:22,245 What does that mean? 382 00:21:22,455 --> 00:21:24,685 What does it mean like to have neurodevelopmental 383 00:21:24,685 --> 00:21:26,255 deficits or microcephaly? 384 00:21:26,305 --> 00:21:29,804 So I was really able to add the pediatrician piece to 385 00:21:29,805 --> 00:21:31,285 that and establish myself. 386 00:21:31,285 --> 00:21:36,795 That was really a wonderful experience and I thank you for that opportunity to 387 00:21:37,025 --> 00:21:41,225 add these other things to the project that would not have been there initially. 388 00:21:41,555 --> 00:21:46,415 But that was sort of my experience of using the skills that I had to 389 00:21:46,435 --> 00:21:48,125 answer a clinical need that came up. 390 00:21:48,380 --> 00:21:49,840 I was there when it was needed. 391 00:21:50,160 --> 00:21:54,060 And so now I run my own research job and it's wonderful, great experience, 392 00:21:54,120 --> 00:21:57,300 and I've been fortunate to be involved in these career development sessions 393 00:21:57,300 --> 00:22:00,770 and invite wonderful people from all over the country in different clinical 394 00:22:00,770 --> 00:22:05,679 niches to help talk with current ID fellows and younger trainees about all 395 00:22:05,679 --> 00:22:07,449 the different options within our field. 396 00:22:07,680 --> 00:22:12,130 Paul Spearman: Maybe we are a somewhat skewed kind of population here because 397 00:22:12,130 --> 00:22:17,820 I also am a lab based scientist and went into that during the HIV pandemic, 398 00:22:17,820 --> 00:22:23,360 the early days of the HIV pandemic, when it was really the mystery illness 399 00:22:23,360 --> 00:22:25,020 at the time and so much to learn. 400 00:22:25,020 --> 00:22:26,900 And I wanted to help with that. 401 00:22:26,900 --> 00:22:31,705 And so I sought out actually a fellowship where I I could join a retrovirology 402 00:22:31,705 --> 00:22:33,625 lab and become a retrovirologist. 403 00:22:33,635 --> 00:22:35,965 So that was sort of the early years. 404 00:22:36,035 --> 00:22:37,435 And it's been a great career. 405 00:22:37,495 --> 00:22:43,055 So let me just more generalize, because as division chief at two institutions, 406 00:22:43,264 --> 00:22:48,350 I have come to appreciate the value of all of the things that we do in Peds ID. 407 00:22:48,630 --> 00:22:52,350 We used to maybe have a field bias toward basic research, 408 00:22:52,380 --> 00:22:54,640 maybe, but we never should have. 409 00:22:54,670 --> 00:23:01,770 I mean, clinical research, epidemiology, service oriented work, antimicrobial 410 00:23:01,770 --> 00:23:05,470 stewardship, infection prevention, government work, industry work, it's all 411 00:23:05,890 --> 00:23:10,660 incredibly valuable, and I appreciate that in the faculty that I've had a 412 00:23:10,660 --> 00:23:15,150 chance to work with over the years, and in trying to help them just find 413 00:23:15,150 --> 00:23:17,560 what is the passion that they have. 414 00:23:17,560 --> 00:23:21,300 What part of the field, first of all, are they, are they really good at? 415 00:23:21,300 --> 00:23:24,360 And that often marries up with what they're really passionate about. 416 00:23:24,360 --> 00:23:28,190 And how can you develop that into a lifelong career 417 00:23:28,190 --> 00:23:29,670 that's very, very satisfying? 418 00:23:30,020 --> 00:23:35,380 So that has been enlightening and opens up to all of these different areas of 419 00:23:35,380 --> 00:23:37,440 Pete's ID that are great opportunities. 420 00:23:38,110 --> 00:23:41,780 Another thing I'll just comment on is that we have a lot of leadership 421 00:23:41,780 --> 00:23:43,390 opportunities as you go on. 422 00:23:43,390 --> 00:23:45,090 You all will have chances. 423 00:23:45,090 --> 00:23:45,520 You may. 424 00:23:45,715 --> 00:23:49,255 may or may not be inclined that way, but being a division 425 00:23:49,255 --> 00:23:51,555 chief is a terrific way to go. 426 00:23:51,555 --> 00:23:52,575 It's a great job. 427 00:23:52,915 --> 00:23:57,625 Uh, or being a leader within a division, a clinical director, all fellowship 428 00:23:57,625 --> 00:23:58,855 director, all of those things. 429 00:23:59,235 --> 00:24:03,465 And then some of us also take on institutional leadership responsibilities 430 00:24:03,495 --> 00:24:07,645 that maybe it's a shift, but it's still, you get to benefit a lot 431 00:24:07,645 --> 00:24:09,805 of people and do a lot of good. 432 00:24:10,235 --> 00:24:14,395 You want to find what you're passionate about, and as you go along in your 433 00:24:14,395 --> 00:24:19,975 career, you want to know yourself and what makes you tick and when you need 434 00:24:19,985 --> 00:24:24,315 to take the kind of break that Sara was talking about earlier, when you need 435 00:24:24,715 --> 00:24:27,455 a reboot, and be sensitive to that. 436 00:24:27,845 --> 00:24:33,335 One thing I have found helpful, just in my personal journey, is to occasionally 437 00:24:33,335 --> 00:24:38,575 do some journaling, where I'm talking to myself, basically, and then I look back. 438 00:24:38,795 --> 00:24:42,005 Sometimes months, sometimes years later, and I can kind of see where 439 00:24:42,005 --> 00:24:45,585 I've been and what I was thinking, and it's a tool that some people use. 440 00:24:45,615 --> 00:24:48,355 There are many other ways to do it, but I've found that really useful. 441 00:24:48,515 --> 00:24:52,825 Sara Dong: Okay, so we have a little bit of time, and I wanted to open it 442 00:24:52,825 --> 00:24:56,625 up so that if anyone wanted to ask some questions, and you're welcome to 443 00:24:56,635 --> 00:25:00,625 ask questions about career development or comments on the case from earlier. 444 00:25:01,050 --> 00:25:04,140 Emma Mohr: Could they also ask questions about your presentation 445 00:25:04,150 --> 00:25:04,990 that you just finished? 446 00:25:05,290 --> 00:25:05,530 Sara Dong: Mine? 447 00:25:06,340 --> 00:25:06,590 Yeah. 448 00:25:06,590 --> 00:25:07,950 I mean, if, sure. 449 00:25:09,480 --> 00:25:10,120 Go for it. 450 00:25:11,340 --> 00:25:11,870 Shreya? 451 00:25:12,910 --> 00:25:14,260 Looks like there's a mic coming for you. 452 00:25:14,350 --> 00:25:17,950 Shreya Doshi: Sara, that was a great presentation, very 453 00:25:17,970 --> 00:25:20,250 inspiring career trajectory. 454 00:25:20,830 --> 00:25:25,610 When you were looking for jobs, and I know mostly people are looking for 455 00:25:25,910 --> 00:25:29,010 clinic, clinicians to do clinical work. 456 00:25:29,210 --> 00:25:34,090 How did you pitch that I also want to, you know, continue pursuing 457 00:25:34,100 --> 00:25:37,660 this other interest I have, which I'm very passionate about? 458 00:25:38,080 --> 00:25:38,470 Thank you. 459 00:25:39,260 --> 00:25:42,310 Sara Dong: So I was looking at heavy clinically oriented jobs. 460 00:25:43,000 --> 00:25:45,750 I was usually just pretty honest. 461 00:25:45,750 --> 00:25:51,620 I think that a lot of the projects that I had done before expressed for me that 462 00:25:51,730 --> 00:25:58,270 those were important and I tried to just share my story of, you know, these are my 463 00:25:58,270 --> 00:26:02,710 interests and how I've sort of weaved them together and trying to brainstorm about 464 00:26:02,710 --> 00:26:05,610 how that could be incorporated into a job. 465 00:26:06,230 --> 00:26:07,790 I will not say that I have it figured out. 466 00:26:07,790 --> 00:26:12,320 I don't think that any medical education job right off the bat is 467 00:26:12,320 --> 00:26:16,630 going to be easy, because some of that right place, right time is true. 468 00:26:16,640 --> 00:26:20,469 There is only a certain number of educational leadership roles, and they're 469 00:26:20,469 --> 00:26:22,470 not going to always be open when you go. 470 00:26:22,480 --> 00:26:27,430 But if you have a division that is passionate about incorporating medical 471 00:26:27,440 --> 00:26:32,690 educators, as it's part of their mission that they'll find creative ways to build 472 00:26:32,690 --> 00:26:36,520 that in when you start until you have time to get your feet under you and look 473 00:26:36,520 --> 00:26:40,940 for those roles that might have true sort of support and FTE behind them. 474 00:26:41,360 --> 00:26:46,620 So I am kind of lucky in my position now I'm getting supported through my 475 00:26:46,620 --> 00:26:50,630 division to spend time on my medical education activities to hopefully 476 00:26:50,880 --> 00:26:54,500 build them out to where they are into roles that either in educational 477 00:26:54,500 --> 00:26:55,880 leadership or something similar. 478 00:26:56,300 --> 00:26:59,645 Being upfront and honest because that all those divisions that are 479 00:26:59,645 --> 00:27:02,855 going to be excited to talk to you are going to tell you what they're 480 00:27:02,865 --> 00:27:06,775 able to do and what they don't think that they can and be honest with you. 481 00:27:06,815 --> 00:27:10,775 So I think the best thing you can do is say, this is what I'm really motivated by. 482 00:27:11,075 --> 00:27:15,455 And then just try to think creatively about are there these are all things 483 00:27:15,465 --> 00:27:18,705 that can overlap with your interests and you can marry them together. 484 00:27:19,025 --> 00:27:22,665 Other thoughts from not the brand new attending? 485 00:27:24,315 --> 00:27:25,905 Paul Spearman: No, your perspective is great. 486 00:27:25,935 --> 00:27:30,785 I mean, you're closer than we are to like, when you start, you want to go into that. 487 00:27:30,850 --> 00:27:32,352 And so, you know, I think that's a really important thing to remember. 488 00:27:32,352 --> 00:27:34,300 I think that when you're looking for a position with an idea of what you want 489 00:27:34,300 --> 00:27:38,430 to do and just express it well, and you don't want to go in and be kind of 490 00:27:38,430 --> 00:27:41,010 flat and not say what your passion is. 491 00:27:41,290 --> 00:27:44,280 To me, that's really important when you're trying to hire someone. 492 00:27:44,280 --> 00:27:48,340 And it could be clinical work, it can be a mix of clinical and education, 493 00:27:48,340 --> 00:27:49,710 it can be any of these other things. 494 00:27:50,050 --> 00:27:51,490 But just knowing that. 495 00:27:51,595 --> 00:27:55,615 And then maybe showing something you've done that expresses that 496 00:27:55,625 --> 00:27:58,525 during your fellowship, that expresses that special interest. 497 00:27:58,845 --> 00:28:01,005 It's very helpful to the people that are doing the hiring. 498 00:28:01,545 --> 00:28:04,365 Emma Mohr: I was going to say also being able to express your passion 499 00:28:04,365 --> 00:28:07,955 gives you something to talk about during the multiple interviews 500 00:28:07,995 --> 00:28:09,485 that you're going to have that day. 501 00:28:09,595 --> 00:28:12,765 So you're going to have to talk about it over and over again. 502 00:28:12,795 --> 00:28:15,745 So you want to make sure you really love it and you're really excited about it. 503 00:28:16,230 --> 00:28:19,340 Natasha Halasa: As someone who's been, gosh now, over 20 years in the field, 504 00:28:19,540 --> 00:28:22,140 and that's the first time I'm hearing about Febrile, and everyone who raised 505 00:28:22,140 --> 00:28:25,870 their hand are probably within five years of fellowship, which is great. 506 00:28:25,900 --> 00:28:31,880 But you hit on a point for promotion, and I think we as leaders, or people talking 507 00:28:31,880 --> 00:28:36,740 to the leaders and talking to the chairs, for promotion, we need to be the ones that 508 00:28:36,740 --> 00:28:42,010 need to be educated on this is how the new learners are learning, and how important 509 00:28:42,010 --> 00:28:45,070 it is, and that we need to start changing. 510 00:28:45,130 --> 00:28:48,919 So that's why I'm excited to be part of the promotion committee to 511 00:28:48,919 --> 00:28:50,668 say, is there a digital platform? 512 00:28:50,668 --> 00:28:53,875 How are people being innovative as someone who sits on the 513 00:28:53,875 --> 00:28:55,430 promotion committee for VMC? 514 00:28:55,450 --> 00:28:59,360 Like if I would see your CV, I think there's, uh, enough of us that would 515 00:28:59,370 --> 00:29:03,700 advocate to say like this is where she's excelling in education and so I just 516 00:29:03,700 --> 00:29:06,930 want to commend you on that and it was inspiring and I already sent it to all 517 00:29:06,930 --> 00:29:11,120 the faculty and fellows that are not here to say this is something that we 518 00:29:11,120 --> 00:29:17,170 need to incorporate in our teaching for learners because you helped you did a 519 00:29:17,170 --> 00:29:21,370 lot of the legwork and we should be able to take advantage of it And so thank you 520 00:29:22,630 --> 00:29:23,180 Sara Dong: Thank you. 521 00:29:23,680 --> 00:29:28,190 Most places you can look up if your institution just online has those metrics 522 00:29:28,190 --> 00:29:29,880 like that impact grid I showed you. 523 00:29:30,410 --> 00:29:33,240 Hopefully you are friends with people who are in places that can 524 00:29:33,250 --> 00:29:36,850 advocate for changes to that if you are an institution that does not 525 00:29:37,160 --> 00:29:41,250 lean towards having opportunities for digital scholarship to show impact. 526 00:29:41,280 --> 00:29:42,340 So it's nice. 527 00:29:42,350 --> 00:29:47,110 The one I showed everyone has for example like granular metrics and that's for 528 00:29:47,110 --> 00:29:51,535 example what I put in the publication to say there's no way to actually tell you 529 00:29:51,535 --> 00:29:56,445 the impact of Febrile, but based on this one grid, this is sort of where they would 530 00:29:56,445 --> 00:30:01,055 decide, and I think everyone has to judge for themselves, but ultimately that's the 531 00:30:01,055 --> 00:30:06,505 goal, to make it part of, of all the other types of great work that people are doing. 532 00:30:06,735 --> 00:30:10,325 Emma Mohr: Can we take just a second and say all of us here on the panel 533 00:30:10,325 --> 00:30:15,325 in the room think Pediatric ID is the greatest specialty and we hope, 534 00:30:19,435 --> 00:30:24,765 we hope all the listeners are considering a career in Pediatric ID. 535 00:30:25,845 --> 00:30:26,895 Sara Dong: Nick's asking a question. 536 00:30:28,705 --> 00:30:29,655 My co fellow. 537 00:30:30,655 --> 00:30:34,325 Nick Venturelli: So how do you advocate, a lot of medical schools are now doing it. 538 00:30:34,470 --> 00:30:38,530 I think we've done an okay job at integrating some of these new teaching 539 00:30:38,690 --> 00:30:41,710 technologies and methods, especially for adult learners, but there's 540 00:30:41,720 --> 00:30:42,304 still a lot of work to be done. 541 00:30:42,625 --> 00:30:46,295 A long way to go, and especially in, as you kind of move along in your training 542 00:30:46,295 --> 00:30:50,565 and get a lot of hour to hour and a half sessions of slides being read to you. 543 00:30:50,605 --> 00:30:54,495 How do you, how do you advocate for like integrating more of 544 00:30:54,495 --> 00:30:59,175 these interactive technologies and interactive teaching sessions into 545 00:30:59,175 --> 00:31:01,505 our medical education landscape? 546 00:31:01,615 --> 00:31:04,495 Sara Dong: That is one of the next frontiers for digital education 547 00:31:04,495 --> 00:31:08,405 is how to either make things that are standalone curricula or build 548 00:31:08,405 --> 00:31:13,255 them into either rotations or local curriculums and rotations. 549 00:31:13,605 --> 00:31:16,775 I don't have a great answer because I do think it's a little institution dependent, 550 00:31:17,105 --> 00:31:20,195 but pitch these to educational leaders. 551 00:31:20,425 --> 00:31:24,375 Oftentimes there are spare blocks in residency lecture spots where 552 00:31:24,375 --> 00:31:27,565 they would love to do something creative and out of the box. 553 00:31:28,160 --> 00:31:30,680 The other example I'll give is the escape room. 554 00:31:30,680 --> 00:31:33,920 I don't know how many people were able to participate in the ID Week escape room. 555 00:31:34,400 --> 00:31:38,410 That was just a, you know, that was a pitch to the ID Week sessions proposal. 556 00:31:38,430 --> 00:31:42,430 So I think a lot of times you just have to throw out those ideas and maybe they don't 557 00:31:42,450 --> 00:31:48,700 stick the first time, but eventually it'll open up and a lot of the medical students 558 00:31:48,700 --> 00:31:53,580 are advocating for these as resources, so hopefully that will eventually help. 559 00:31:53,810 --> 00:31:58,135 So I don't have an easy answer, but I think it's suggesting ideas and, 560 00:31:58,355 --> 00:32:00,155 and try them out and pilot things. 561 00:32:00,155 --> 00:32:02,945 And if they go well, then you build off of it and refine it. 562 00:32:02,965 --> 00:32:07,115 And the other plug I'll give is if you do something like that and it's successful, 563 00:32:07,515 --> 00:32:11,145 tell other people and try it out at other centers and like submit it to something 564 00:32:11,145 --> 00:32:14,405 like MedEdPortal so that people can replicate it at their own institutions. 565 00:32:14,775 --> 00:32:17,065 And then you've made your work count multiple times. 566 00:32:18,835 --> 00:32:19,445 Okay. 567 00:32:19,505 --> 00:32:22,135 Well, I think that wraps it up for our episode. 568 00:32:22,145 --> 00:32:22,895 Thanks everyone. 569 00:32:28,825 --> 00:32:30,515 Thanks so much to you, Sumanth. 570 00:32:30,645 --> 00:32:35,475 Paul and Emma for joining Febrile, to the audience for their participation, 571 00:32:35,955 --> 00:32:38,685 and to the organizers of the St. 572 00:32:38,685 --> 00:32:39,765 Jude PIDS conference. 573 00:32:40,175 --> 00:32:41,645 This was really fun. 574 00:32:42,745 --> 00:32:46,135 As always, don't forget to check out the website, febrilepodcast. 575 00:32:46,405 --> 00:32:50,925 com, where you will find the Consult Notes, which are written complements to 576 00:32:50,985 --> 00:32:55,075 episodes, our library of ID infographics, and a link to our merch store. 577 00:32:55,965 --> 00:32:59,935 Febrile is produced with support from the Infectious Diseases Society of America. 578 00:33:00,615 --> 00:33:03,105 Editing and mixing is provided by Bentley Brown. 579 00:33:03,545 --> 00:33:06,385 Please reach out if you have any suggestions for future shows or want 580 00:33:06,385 --> 00:33:07,625 to be more involved with febrile. 581 00:33:07,995 --> 00:33:10,465 Thanks for listening, stay safe, and we'll see you next time.