 Move on to the research presentations for today's symposium. And I'd like to introduce our first speaker, who will be Dr. Neil Hyman. Dr. Hyman is professor of surgery and chief of the section of colon and rectal surgery. He's co-director for the Center for Digestive Diseases. Dr. Hyman specializes in the surgical treatment of gastrointestinal malignancies and inflammatory bowel disease. He's currently working on a Bucksbaum Institute funded pilot grant to promote compassionate patient care during invasive outpatient procedures and colon and rectal surgery. And he's gonna talk to us today about a problem which of course doesn't occur here, right? But is a very important problem in all of our fields. It'll be about the surgeon burnout. Dr. Hyman. Thanks for, thanks very much, much mad burnout in seven minutes. Okay, so I wanna just start by saying I'm not an expert at burnout. I just wanna tell you the story a little bit. I don't mean to offend anybody. I'm not a psychiatrist, but the fact of the matter is I was a little embarrassed by my ignorance and I wanna share and expose my ignorance here. So, I was one of the, to my credit or discredit, the early advocates for residency work hour restrictions in surgery. And not so much the 80 hours and a lot of how it was implemented, but the concept that residents of human beings that, so I practiced in New England for 25 years. So needless to say, it was very hard to find a surgeon in New England that spoke about work hour restrictions and was in favor of them. So they assigned me to talk at a symposium. And this was basically my talk saying, oh yes, that it's a different time than when we train back in the day in this frantic pace of healthcare, that career needs and some of the things that we just heard about. And Julie Freischlag, who is the editor of, then it was called Archives of Surgery. Now JAMA surgery, she said, can you write an editorial and I'll publish it. So I did it. And they publish your email address and I got probably several hundred emails like this that I liked it, that we're human, thank you for saying that we're human beings. But this is the part that killed me is that a number of them certainly not all finished with this. It says, by the way, do you know how many surgeons suffer from clinical depression? And you can read this. And then it says you're not safe because you're depressed and now medicated. And then like the dagger in my heart was I hate this job. And I said, oh my God, can you imagine being a patient of this man? You know what I mean? Can you imagine what the burden that we suffer in surgery, trying to go to work every day, feeling like this. And it was like an aha moment for me because I've always liked being a surgeon. I'm a pretty happy guy. And so that got me interested in burnout because I didn't know anything about it, made me wanna learn about it and look into it a bit. So as we know, burnout's a clinical syndrome. And I wanna move things along. Emotional exhaustion, depersonalization and the cynicism. This is the one that to me is the most difficult to conceptualize is that you see a patient and you view patients as your enemy. Can you imagine being a doctor who feels that way about their patients? And we have ways to measure it. This Maslak burnout inventory that looks at three subscales, emotional exhaustion, depersonalization, personal accomplishment and it's not just surgeons. Of course it's across the board that the US population has been felt to have a 28% incidence of burnout and we're much higher. And it's not surprising in light of the environment we practice that it's 38% of surgeons meet qualifications for burnout. And the issue in surgery is there have been quite a number of studies I'm just very briefly gonna flip through them that the burnout rate among trainees who trained at the University of Michigan was 30 to 38%. That's the very consistent number for general surgery. High levels of emotional exhaustion, 32%. These are really alarming numbers. The symptoms of burnout and I'll say for me as a surgeon as someone who from this experience became sensitized probably the most helpful thing in recognizing it in my colleagues is this third thing. Here are the symptoms of burnout but I've been a section chief for a long time and that's always how I know it's happening to somebody is that Dean Polanski, not that this has happened, says we're all getting a raise and the person says, oh, you mean I'm gonna have to go to the bank and deposit the check? You know, it doesn't matter. There's nothing you can say that they think is okay. You know, they'll complain about anything and everything and at least in surgeons that is clearly how surgeons typically I think most obvious to the non-trained observer. So when everybody's complaining about everything, you know, one of my colleagues, that's always what I think about first and there are a number of consequences of burnout that it destroys your relationship, substance abuse and in surgeons we have a very big problem with every early retirement which is really creating some major man person power issues and we know there are consequences to the person who's burnt out in terms of a variety of health related problems but from the standpoint of the patient, doctors who, physicians who are burnt out make more mistakes, their patients are less satisfied with the care that they deliver and they get sued more often. So you can actually quantitate this. There's almost a dose-response curve between if you will, the extent of burnout in terms of a measurable way and how this affects our patients that this is very, I think this is, would be very recognizable to most surgeons. This is kind of our typical work week in most places. 73 hours, only 44% of surgeons at WashU had one completely free day per week, 95% paged overnight at least once, 73% returned to the hospital at least once. Part of this, some of this was done again in the context of the work hour restrictions and how it affected faculty. It's not certainly not general surgeons. He is the rate 56% of neurosurgeons met criteria for burnout. It's all, I'm just gonna show a few, transplant surgeons, astronomical levels. It's a global problem. It's certainly not specific to the United States. I just picked a few random recent studies that look at this. Korea, and this one is pretty amazing to me, is that this is suicidal ideation among surgeons. 18% in Italy, 12% in Sweden. These are pretty startling and shocking numbers. With respect to orthopedists, I won't make any comments, but 50 to 60% burnout rate and again, 30 to 40%. And I think this is an important factor here is when you ask the surgeons why this happens. Yes, it's the caseload, but this constant relentless proliferation of more forms and more things that are not doctorly, if you will, and don't help make patients better is really having a very taxing effect on surgeons. So this is the part where I hope I don't get shot, but I'm really not sure that every physician, although we're all physicians, I think we have different stressors, different work patterns. And I don't think that the stressors of being a surgeon are necessarily or any subspecialty, it's uniform. I think it can be different because I think our jobs are a little bit different and I can respond to that in a minute or two if people are interested. And that is it really true. I think that people seek out their own people when they choose their specialties, that there are certain things about the subculture of each specialty that draws different students to them. So I don't think all physicians, residents and students have the exact same personality and that this idea of joy and mindfulness really is a one-size-fits-all notion. So if it's not a one-size-fits-all notion, clearly there can't be one solution. So I don't mean to demean a lot of surgeons do yoga, but it's really that do you have a course on yoga and that this is the answer. Now we've taught your yoga so no one's gonna be burnt out. Is there really a guru who can prescribe the one-size-fits-all antidote for all physicians and in terms of what I'm interested in looking into further because there's a lot of interesting data about this, it also seems clear that the burnt, where in the process from being a medical student to a resident to a physician or practicing, where does it happen? Where does it get entrenched? Where does it dig its roots in? And it seems that on the little data that's available, it's very different based on specialty that it doesn't occur at the exact same time in that process. So I'll end with my last two slides on a very positive thing that when I think about, frankly, why I didn't get burnt out, why I've always liked working and being a surgeon, I think in large part for me it's been this, I love the residents and students, even you Christie, because the issue is that's, they ask the great questions, they make it interesting, they make the difference between a career and a job always cause me to think about what I'm doing. And I think we've lost a lot of our connections with our trainees in the frantic world that we practice in now, and that's unfortunate. I noticed that I think a lot of young physicians don't have the same relationships with the trainees that we had in years gone by, and I think that's hurt, not just hurt our mentees, but hurt us too, made us more prone to burnout. And I will say, this is the ultimate antidote for me, these are my sons with a dear family friend. They got to go to London for school while I was working, in any case, but that to me is the ultimate antidote to burnout. So I thank you for your attention, and of course I'm happy to answer any questions. Right, so that doesn't surprise me. What that refers to is the trial looking at flexible work hours versus the rigid 80 hour work week that it didn't impair patient care. The patient care wasn't improved, if you will, by the rigidity of the 80 hour work week. And I'll tell you that I think for our residents, the 80 hour work week's been a nightmare because their care, they care very much about their patients and forcing them to leave in the middle of operations or before their patients cared for, and to have it clock all the time, running tick, tick, tick, tick, tick, how many hours, how many hours? It's another source of stress, and I think it's actually in surgery, a major contributor to burnout, not a minor one. Yes, sir. Thank you for your comment. Yes, Dr. Kohn. I wanted to add to that, as you may know, that the ACGME is now taking a very hard look at this issue as a consequence of some recent spate of suicides among residents that has drawn this issue even to higher relief. And there is a very serious effort being mounted currently to try to find ways to improve the working conditions and address the issue of early identification, access to appropriate counseling and services when there are issues of depression or burnout. So I think there is hopefully some help on the way and some recognition that this is a very serious problem. It's not just suicide, which is, as Arthur mentioned, obviously a horrific tragedy. But the burnout and the kinds of things that you point out of being consequences of that are intolerable for the profession. And I think we need to take concerted efforts to try to find out how we can fix it. Thank you, you know, my last come be that. I think one of the big things for me is we're very fortunate here. We have a terrific leadership. But I think in many increasing institutions that surgeons are asked to manage and not lead. And therefore, it shouldn't surprise us that the burden that's placed on our residents, that as the number of administrators doubles and triples every few years, you know, these are all people who send our trainees forms, emails and use them for iterative, you know, work. And I think that it, I think probably the best thing we can do is get back to leading instead of managing. Our next speaker is Dr. Nier Uriel. He's the Director of Heart Failure, Transplant and Mechanical Circulatory Support here at the University of Chicago. Dr. Uriel specializes in caring for patients who require mechanical circulatory support, including ventricular assist devices. His research has helped to redefine current eligibility criteria for advanced heart failure therapy in these high-risk patients. One of the areas that we've been thinking about and grappling with in the Buxbaum Institute is how do we best mentor our students and our residents? And Dr. Uriel will present today a model of mentoring that he's working on in advanced heart failure, which we hope we will expand to throughout the institution, Nier. So, good afternoon, everybody. And thank you very much. I want to thank K. Buxbaum, first of all, for this wonderful opportunity to be part of this amazing institution and to mark that actually, since we became encountered due to this, we decided to make something that was very important for me throughout the heart failure program and to put it as part of the Buxbaum Institution. So is this mentoring? How actually we build our career? We just spoke out to not to burn out our career, but in order not to burn out, we need to enjoy it and we need to have a successful career that gets to the next step. What we also know that the profession of medicine is profession of apparatus. We learn and we learn every day from everyone. And no matter what stage in our career, we see someone that is a role model for us and can take us to the next phase and regardless what phase in our career we are. So in order to have a successful group, a successful people in our group, we need to provide for them tools that maybe help us get to where we are. So how is the Buxbaum Institute actually will work with the heart failure program? This is something that again, Mark and I spend quite a meeting about that and to see how we can bring the Buxbaum Institute together with specifically in this specific mode of the heart failure. But as Matt mentioned, maybe to expand it a little bit above that and I will share with you what we already done is first of all, part of the appointment heart failure doctors to a master clinic or associate scholars to be part of the same institution, to share the same philosophy, to be part of those meeting and to the discussion that we're just seeing here. The second phase, we know that research and career development is not coming without any kind of financial support. And to see that by supporting the heart failure scholars with pilot grants in order to launch their career, to have some starting, to create some preliminary data in order to achieve the next step. By encouraging the mentoring by senior physician or junior college and to encounter more and more interaction with more people that can guide them to the right place. And by providing a forum at the Buxbaum seminars at lab meetings to present research and finding, we all know that as much as we will participate more in meetings, there is an opportunity for us to be more ready for the next step that we need to achieve. So what is mentoring and what do we need to do? And I'm still learning and I still have my own mentors that I'm calling every time and see how to next to my next phase is achieving actually, a physician need to be a lot of thing. Today, if you want to be a academic doctor, you need to be a better clinician every time you need to achieve. This is actually the core of our existence. We cannot do anything if we're not good doctors. We don't have a good bedside manner. We don't know how to react to our patient and we don't know how to actually react to the clinical scenario that we are involved in. So before we even going to how to become an academic doctors, we need to be good doctors and good doctors is experience and experience come. We've seen someone else teaching you what is the next phase. We all know that in academic medicine, we need to do research and we need to learn from the patient that we meet and every patient is an opportunity. Every patient actually can teach us about the next patient and so we need to become how to be a better researcher. We all know that in academic medicine, we need to teach other people. We need to teach them what we know and actually all the times there is other people that we can teach. We also learn all the time from the people that we teach, by the way, it's going both way from actually from medical student you learn every day because they just so updated on the literature and say, oh my God, I didn't know this is existing but you learn all the time. So how to become a better educator, more humble about what you know and what you don't know and always mention how much you don't know and how to become a better administrator. Administrator, first of all, of your own time, we need to manage time. We need to manage the time of being a clinician, a researcher and an educator. However, we need to start managing time of other people and as much as you go up, you need to manage all of this. So in order to do that, what we develop is a cascade like a waterfall. There is a program director that is the main mentor to the majority of the people and there is a junior faculty, the attendings. The majority of the mentoring that the program director is investing is in the junior faculty. However, he is also directly mentoring the fellows, of course. However, the junior attending have to already be incorporated into the mentoring programs themselves. We've having fellow a direct mentor relationship with the fellow and we do it in a parent system and I will share with you in a little bit what are we doing. And there is the residents. Immediately, there is residents that involve in the project. So we take the fellows and we pair them with the residents. So in a way, the junior attending that he still need a lot of mentoring find himself, mentoring to level in order to assess that. And lately we add the medical student. We are up to now actually, we did not have medical student as part of our mentoring program. We were less involved in the medical school. We just build this heart for the program two years ago in University of Chicago and it took us time. So we were focused in first and for all in the attending others and the fellow. We went to the residents and now when we have more establishment and I have to say that working with the residents was so successful. So we decide to add another level to medical student. However, everybody is involved in mentoring everybody. This is a group that actually is a cascade of thing. As I said, water for the teacher. What does it include? It's include actually a lot of time that is invested in the program. There is a weekly one-on-one meeting. There is each one of the attending have one hour every week a sign to report as a progress. But before that in the first meeting, what we done did is actually something that in the beginning I have to say a lot of my junior attending raise eyebrow and said, seriously, that's what you want us to write. So I ask each one of them to write three things. What is your long-term goal and what is your short-term goal? And in your short-term goal, it has to be something that is, I want to finish this paper by this date and to see the progress. What is their long-term goal? I want to become an associate professor within three years. I want to achieve X amount of international meeting that I will be speaking at in that way. And after they gave it to me, I have to say I asked them to put it in their office and they can see it because if we are meeting once a week and we invest in this time, we need to see that there is a progress and there is something I don't want to come to the meeting. Oh, we didn't do anything. So if we didn't do anything, nothing is progress. So we need to make sure. So the attending have one-on-one meeting that is actually on a weekly base in order to make sure that the program, the attendings themselves of meeting with the fellow that they are paired to in order to make the project that assigned to the fellow is also progress and the fellow have a meeting with the residents. We develop it in our own space. So actually there is a lot of people coming to a lot of other people meeting and everybody is very involved in the research that someone else is doing. Every Friday, today not because it started 2 p.m., so we canceled the Friday meeting today due to the books about my event. Every Friday at 2 p.m., we have a research meeting that's actually free people at the junior attending fellow and a resident supposed to present the progress of the project. So not only that there is a meeting that you need to come and be ready a little bit, the group need to see what you've done. So there is a little bit of a pressure here, but in the other hand, this is create a motion, a movement of the project. And there is an annual research day that we just actually review and we just added actually a few months and a half ago. And I have to say that we sat down in a setting that we have five attending in the Outfeller Group. We have a lot of fellow now that is assigned to work with the Outfeller Group, seven fellows. And we have that are not advanced outfeller fellow, but the cardiology fellow with this interest. And we have almost 12 residents working with us. And just sitting in the audience, I felt the time in an international meeting and I was so proud of the project that they achieved. But there was a day that we assigned to do that. So how do we sit down with each one of them and we discuss what is a clinical research? What does it mean to be a clinical researcher? It's something else than to be a basic science researcher. From clinical question to study design and this is going directly to the main core of who we are, we are physician. So we encounter a patient and we don't know what to do. So just to remember every time today we have the iPhone, just to put the question, I don't know what to do with this patient. From this phase that you have the clinical question that you didn't know the answer, to have a study designed to study and to execute it, to know that you have to execute this project, to do a data analysis, to come from conclusions from this data analysis, how to present your study, manuscript preparation, grant support and mentoring someone else already. This is part of the concept of all of it. I have to say in the beginning, we give everybody a support that is biostatistics. We learned that this was the majority of the people, they don't know how to collect the data, they don't know how to analyze the data. So just the basic stuff that is available to everybody actually make it much more easier. So what I choose to do and to get over with Mark to give some example of junior faculty and as you can see there is specific names and to see how they move. All the junior faculty were in the beginning of their career. Gabriel Sayer was the first person that we recruit here after my arrival today out for the group. He was my residence at Columbia University in 2008 and our road diverse and he continued to Mass General and other institution. However, from academic perspective, he was not build himself yet. So when he heard that I'm coming here, he said, here I want to join. And I said, so let's have some short-term and long-term goals and to see where we are. I just put a bunch. We already one and a half year into this mentoring program that is maybe the one that is the most time invested in him. But this is just a bunch. The guy published more than 12 paper in the last year and a half. He have two main papers, first author already that is leading. It already were published. However, you have three major project now that is leading as part of it. Side by side with that as you can see because he's mentor other people and he involved in other people research, he build his career also as a co-author on a lot of other people progress. And beside that, he receive his first grant. So a small industrial grant in order to support the clinical question that we ask. The second person that I will share with you is Taza Datius, both of them junior faculty. He was my fellow at Columbia. So as you know, we moved New York into Chicago. He was my fellow at Columbia. And again, our road diverse a little bit after that because he went to Minnesota University. And again, he came after that here to join me here. So we had some mentoring experience while we were in Columbia. However, immediately upon arrival here, we rejoined it so it will be, it was a little bit easier. And that's the reason it was a little bit more prolific. And I have to say yesterday night we succeeded in submitting another paper that I'm sure that will be successful. But again, a grant that he's already received, a grant that we submit just this week to the Quality Control of the University of Chicago about one of his projects. And as you can see here, within a two and a half year old together, however, the guy is already published almost 20 papers in this project. However, as I said, we take it also to the fellow level. Jonathan Greenstein joined us to as a general cardiology fellow. And immediately we assign him a project and we assign Gabriel Sayre to be the attending that supervise him. So we have another level. Jonathan already published two paper with us and now he's running an industry grant that we receive with him. And yesterday we are going to die a such a team in the end of the week, the biggest heart of the meeting. It was just a rise. What is the best eight abstract that must be seen? And why, and suddenly I see Greenstein at all. So they choose one of his abstract to be in this meeting. So this is how the fellow is assigned. Similar to him, it's Sarah. Both of them started with us when they were in the first year of the fellowship. And Sarah was already immediately assigned to have an attending assigned to her in this specific, it was Staz, was assigned to follow with her project. We successfully received a big grant that actually we thought that may be a good opportunity to her to build her career to the direction of regular heart failure, not advanced heart failure. And she's running the project amazingly. And beside that, she just came out with the ACC with an oral presentation and she's going to do two oral presentation in the Common Eye at such a team. However, the main is to come because she's running a big grant that I believe is going to address. However, John, for example, is now the mentor of a Mecca that is a residence. So he's mentoring a Mecca how to do a project and already again, a project that was assigned and already became a first author and the paper was published and actually have two more paper coming up and he's going to, just submitted to the HFSA an abstract. In the HFSA, for example, the Heart Failure Society of America, the deadline was this Monday, all the abstract that the heart failure group submitted, the first author, a residence. We decided we're going to do a residence and we submitted seven abstracts. We didn't submit a lot to the HFSA, it's less our main meeting, but all the seven abstracts were by residence. So we believe that by building a cascade of mentoring program, we will be able to provide support to people that want to grow into it and feel a group that gives them some support and doesn't judge each one personally and there is a lot of level that we can help. So that's what we do and thank you very much for your time and I'll be happy to answer your question. No question, it's easy, it's simple. Thank you very much.