Fellows/residents: training

Episode Transcript

Good afternoon, everybody. Welcome. I’ll start by introducing myself. My name is Dr. Kirema Garcia-Reyes, and I’m here with two of my colleagues, interventional radiologist extraordinaire, Dr. Jessie Stewartwho’s here all the way from UCLA, and also Dr. Rocky Ahuja, who is from UT Houston. So we are here live at SIR to kickstart four incredible days of a podcast series located at the Cook Booth. So come by, visit uscheck it out, and–So today we are going to start talking about our different perspectives during our fellowship, our residency, our trainingin hopes of helping you guys–if you’re interested in going into IR, if you’re in IR already–kind of figure out how to get there, and just tell you a little bit of our stories. So, what I’ll do first is–we’re going to go around the table, kind of–pleaseJessie and Rocky, introduce yourselves and kind of tell us how, why, when did you fall in love with IR and kind of tell me a little bit about how you got here. So, Jessie, I’ll start with you.

Well, first of all, it’s great to be with you guys today. Great to be at SIR againut back and better than ever. It feels like we were just here like nine months ago, because we were. But yeah, soreally excited about these podcasts. I don’t know if you guys noticed the banner coming into the Sheraton today actually features the podcast series. That was pretty exciting to see getting out of the Uber today. So why IR for me? I found IR as a medical student. I was kind of looking for a specialty thatyou know, kind of embraced the spirit of innovation. I was interested in device design, had a background in engineering from undergrad, so I was kind of looking for a specialty that kind of combined innovation and working with my handsand problem solving on the fly–problem solving was very appealing to me–and also had some research opportunities as well. And so luckily I had an advisor who–at Stanford–put me onto–Dan Z as my first IR mentor. Andyou know, how could you not go into IR after working with him? So that’s–that was the end of that.

Awesome thanks Jessie. And what about you, Rocky?

So, thank you for having me here. Andit’s actually a very tricky question for me because I actually don’t belong in IR. To begin with, I was a surgeon before. I trained in India and completed my general surgery residency and came to the US in the hopes to become a vascular surgeon, as an integrated IR–integrated vascular surgery resident. I tried really hard because being in IMG and some other issues and all that, I couldn’t get into vascular surgery. Did a couple years of more general surgery, and eventually I think I saw the light in the dark room, and there was an open spot in Radiology. I took it in the hopes that maybe I’ll do IR–I don’t know, we’ll see, we’ll explore–ended up in my first year as R-1. I met with a couple of the attendings in IR, and the first case I saw was stroke.

And in 14 minutes, the first thing that comes out of the patient’s mouth is, “What the hell are you guys doing with me?” That’s when we knew we are done. So that was like, fascinating. I was like, “Oh my God, this is like a magic wand,” and this is it. That’s it. I don’t want anything else in life, this is what I want. So I ended up pursuing that and we got approved for an IRDR spot. So I became an integrated IR resident. I graduated as the first IR resident, and I went one step further because I was always fascinated to work with kids. So I went to Boston Children’s to do a Ped’s IR fellowship, and now I’ve joined the practice at UT Houston and my practice is from adult to peds, anywhere in between, from zero days to a hundred years old.

Amazing.

So I really enjoy that.

Well, thank you for sharing that. It’s pretty fascinating actually. This was not done on purpose, but it worked out well because I think–you know, Jessie, you knew from medical school, you knew early, you kind of went straight through. And Rocky, it seems like you had kind of another whole career and then decided to switch paths. It’s never too late. So I’ll tell you a little bit about mine. So I actually did a little bit of work, NGOs, kind of housing code enforcementbefore going to medical school. And then when I went to medical school, I had–I’m the first physician in my family, so I had no idea what you–I thought radiology was X-rays and CTs. So at Duke, fortunately, they made us rotate through Radiology and you spent two days rotating. And then when I got to my IR day, I was like, wow.

And then there was this woman–I still thank her. She was–I’m from Puerto Rico, very proud of where I’m from–she was Puerto Rican, this incredible Puerto Rican female force at Duke IR, Dr. Wally Ramos. And I met her and I–you know, that’s when I decided to–that IR was for me. Soyeah, here we are. And then, so what do you think–if I can just kind of turn the conversation a little bit–what do you think was the most impactful experience that you had in your training?

SoI mean, it’s very hard to pick one because my whole training was amazing. It was like every day there’s fun something going on. And as I told you, first impactful was that stroke case that I witnessed. I wasn’t even part of this, I was just standing outside. But there have been so many instances where we not just saved a person who is actually sick, but when you go and talk to the family and you feel like you saved a family. That was so impactful, especially when they have been given the diagnosis where–“We cannot do anything for you.” And then eventually we end up doing something for them that changes their whole life. And for one example, was a patient–[unintelligible] angio carcinoma metastasis to the glenoid, and she had no range of motion in her left shoulder. I did a cryoablation and I did a suprascapular nerve ablation for her. Immediately post-procedure she’s moving her hands up and down and she’s like, “Oh my God, I cannot believe–Can I eat food? Can I use my hand?” And I’m like, you know what? This is my end end point. That was very impactful. I mean, I–I get emotional with patients sometimes and I actually have a tear in my eye when they do so good. Because I connect with them. This is a thing that I love about IR–you can connect at like, organic level.

Yeah. And I–thank you for sharing that–and I’ll echo that. I think–and Jessie, you can tell me your experience–but I think that was one of the things originally, you know, that attracted me to the field was the fact that, you know, at least–you know, I did my fellowship at Sinai, I left for a little bit, came back and I’m there as faculty and something–testament to my predecessors–but something that I love about where I work and where I trained was the fact that, you know, if there’s any problem in the hospital with a patient, you know, people will come down to IR and they’ll be like, “Can you help us?” You know, and we get creative, and when I saw that early as a medical student rotating during–you know, you would rotate in medicine or surgery–and they were always involving IR. I think that–I thought that was just something I loved about it and, and that attracted me to the field a lot.

Oh yeah. I mean, there’s nothing better than feeling like you are the one who can help them. Everybody else has said no. And this happens all the time with IR, you know. Everybody else has declined to take them to the OR or anywhere. And, you know, we say, “Okay, well we’ll try something.” Andyou know, it’s so satisfying to, kind of, help out a patient in a tough situation. But I think also during, you know, my training, I would say–just circling back to the idea of mentorship, it was so important for me just to see how–you know, and with a close mentor, I think this is just so valuable–just seeing how they approach patients, how they approach the referring clinicians and kind of help and work together with them. You know, just things about career building and what kind of a career you’re looking for and how to get there. So I think that’s just so important and something that I was lucky to find at at Duke IR, like you did.

Aw, that’s cute. That’s awesome. It’s been–I mean, we’ve been here for what, like five minutes, and we’ve–mentorship has been recurring a–we’ve mentioned people that brought us here, opportunities that were created for our mentors. So yeah, big shout out to mentors. And anybody can be a mentor, right? When I think–when you think about mentorship, you think about kind of top-down mentorship, right? But you can be–you can mentor your peers, you can mentor students, students can mentor you. You know, it, it really depends. So that’s one thing I’m passionate about and I’m–we all are–and that I’m very grateful for all the mentors I’ve had out there. So what was something–so, you know, we’re thinking–we’re talking about training pathways, we’re talking about the training experience here. So what was something you wished you knew when you were a trainee?

Well, I wish I knew IR existed.

.

Fair enough.

I mean, I trained for surgery in India and IR pretty much had no existence and it was all radiology, something they did. We had no idea. And then I came here thinking that, because endovascular was still developing there. And then I came here thinking that I want to do high-end endovascular stuff, which is not there. But then I started seeing IR, and it’s like, not just endovascular, you are like–have a magic wand, like you can do shoulders, you can do bones, you can do brain, you can do necks, you can do this, you can do that. And I was like, man, isn’t that the reason I came to medicine for, so I can help people in whatever way possible? So that was absolutely fascinating. And coming back to your question about the training program, that’s something I–I think I got lucky to be at Einstein. There was one open spot and they were very kind to give it to me even though there was a tough competition. But I can tell you, it took me time to find a mentor, but once I found that mentor–my prior program director–he walked me through this whole fire holding my hand. So that was very impactful for me.

And you said that was the program director at Einstein?

Einstein, yeah.

Oh, amazing.

Yeah. His name’s Bala, by the way.

Okay. Shout out. Big shout out.

Absolutely. Dr. Bala Natarajan.

We’ve mentioned literally like five people so far, so, yeah. And then just going back to–so you said that when you were there, when you were doing your surgery training in India–a little unrelated, but I think it’s ah–I’m fascinated by it. So and you said there was no IR there. Has there been any change since then?

Yes, significant, actually. It’s interesting you ask that question because India now has an Indian Society of Vascular Interventional Radiology. It’s over 50,000 members, but that’s mostly radiologists who are like now seeing–and they have like active members–I think 2,500, 3000, something. They have annual meetings, they are invited at the annual meetings, and international meetings. They are the–so laws there are much more lax compared to approval, so they do things and innovate things from nothing. Like you will just have a catheter and a wire and they’ll find something out. They’ll figure it out.

Yeah.

Because in India the way it works is that you have to pay yourself. You may have insurance, but it only covers part.

Got it.

So you have to be very cognizant about the–what you’re doing and what you’re using.

Yeah. Yeah. It seems like, I mean, it’s very variable across the world. But yeah, one beautiful thing about the field, you know, you do need that technology, but I think with very little, you can do a lot if you have that creative IR mind. So thanks for sharing that. So tell me a little bit about your residency programs, where you are. Jessie, how’s it at UCLA? Your trainees?

Oh, I mean, we have a fantastic group there. I think, you know, with the current paradigm, you can really, you know, tell the difference, you know, that they’re getting a lot more clinical exposure really early. You know, these additional rotations and additional months of IR I think are really making a difference for them. And I think they’re coming out, you know, better prepared and better clinicians, maybe than out of the old pathway. So that’s really exciting to see them kind of be able to hit the ground running immediately.

And I’m pretty sure everybody’s aware of this, but we’re talking when she–when Jessie’s saying–when you’re saying “the new paradigm,” you mean this whole–

Integrated–

Integrated residency.

Yes, absolutely.

And then, have you–how many integrated residents–are you guys trying to–so I guess the question is, you know, I think the–you were talking about how you can notice the difference, right, in those IRDR integrated residents because they’re–that’s the word–they’re literally integrated earlier to the program. So I wonder, when this was started–I wonder what will happen eventually. I am guessing we’ll start–you know, there will be more and more integrated residents. We’ll still probably have some independence, but it’ll mostly be–

Ttransitional.

It’ll mostly transition out of that. And what about UT Houston?

So, UT Houston is a very unique kind of a situation because our residents, no matter what level of training you are, you rotate at MD Anderson, UT Houston’s main hospital, which is Memorial Herman. You go to St. Luke’s, which is sort of a private practice. You go to Texas Children’s for your children’s. And then you come to us for Children’s Herman, which is where I am in–I also work. So they get exposure and they work with probably over like 60, 70 attendings throughout their training. So they see so many different things and they’re like fascinated with the stuff. But one thing I would certainly say, it’s still a work in progress, is this integrated residency that we are talking about, in integrating stuff. Radiology is too long, and some people get jaded in like three years, and they came with a different mindset, but now radiology has changed their mindset, which is a fundamentally different arena.

You know, like diagnostic radiology is very cool. It’s–although not for people like me, I do not identify as a radiologist, I identify as more like a surgeon. Because that’s where I am from, right? So I think that’s where IR integrated residency is headed. And some way, one way or the other, this three months of IR rotation during their first three years probably is not enough. We need to get clinics, we need to get consultation, we need to get our own admining privileges. We need to do–get them to the clinic as soon as possible–clinical medicine as soon as possible, and not have this delayed extended times where they lose interest. That’s where probably we are having like 10% attrition rate right now.

Yeah. Yeah, I see where you’re coming from. I think, you know–I think the training, the new training paradigm, how we’re trying to shift how everything’s evolving is the correct–but figuring that out is going to be tricky, right?

Absolutely.

Because you know, you do need–that’s established by–so you do need to get those radiology numbers, but I wonder how it’ll evolve, and I’m sure like you’re saying, it’ll definitely evolve.

Yeah.

I–our IRDR trainees at Sinai are just–I mean, I don’t think I–when I see them, when I see their work, when I see their involvement, their passion for IR, it’s like they drank that IR Kool-Aid, you know. It’s just–it’s just so amazing to work with them. And I think–I wonder now I’m–you know, so Jessie, you were–and you were talking, you were an IRDR resident–

Jessie and I are from the old school, you know, we did radiology residencies and then we had to do a fellowship. So just seeing them–they’re pretty involved. They’re involved early even when–it’s pretty small, everything’s pretty close by, so even when they’re not in IR and they have time, they might stop by IR and say hi. So it’s–I do think it is moving in the right direction. I do agree, Rocky, with a lot of what you’re saying, so I wonder what solutions will come up for in terms of that attrition and things like that.

I think IR residents themselves will find solutions because that’s the–that’s where we are headed. And this is–this is going to be the workforce that’s going to come into play soon. They’re going to graduate–I was the second class to graduate and there’s more and more classes getting–and they’re going into the leadership spots. And that’s–they are going to bring change.

Amazing. So we talked about a little bit about what we wish we knew as trainees, and I think one thing for me was the amount of resources, you know, that are available outside of just your training institution. So can you–can either or both of you share kind of some resources you can think about that trainees can use? Medical students, residents, fellows? Us?

I mean, I think an easy one, especially for, you know the younger generation, is social media. I mean, there’s so much out there now to learn, ways to become connected. You know, if you’re looking for a mentor, for instance, which again, we keep circling back to, you can find one on social media a lot of the time. You can find someone who’s doing the kind of work that inspires you and the kind of work that you want to be doing. You know, it’s just a good way to make connections, learn about things. Of course, it’s social media, so you have to take it all with a grain of salt.

Yep.

But it can be a great jumping off point for building real life relationships and, you know, learning a little something.

You speak of social media. I know some people who have secured residencies because of social media

Oh me too.

For sure.

.

So it’s a–it’s a reality. Yeah.

Yeah. I mean, look, you can tame this beast the way you want it, and it will actually listen to you. And you can say Dracarys and it will actually throw a fire on it. Sorry, that’s a Game of Thrones reference.

We know

. So, speaking of resources–so that’s one thing that I have always done throughout my residency. Remember I came to radiology and I just happened to fall in radiology because there was an open spot and then I moved to IR. I used everything that was available. I–mentors, RFS–I started with reserves. I started–then I became–into the committees, then I went to the annual committee, then I became an annual committee chair, then two years down the line I became a governing council chair. And then I became an ex-governing council, like, past, so advising them. My next step was I finished my fellowship, which was very busy, so I didn’t involve much. But now, first year attending, I just got elected into the early career section governing council. Resources are unlimited, you just need to identify them. And not just this–like coming to the meetings, you talk to people, you develop the relationships. Believe me, I’ve called people sometimes at 2:00 am and I’m like, “Hey, what am I supposed to do? I’m stuck.” And I have never had anybody say no to helping me. This is the beauty about IR as a community. Approach people, they will help you. If you can put in hours, you can put in effort, they will help you.

It seems like you’re talking about a kind of pay it forward. Not only pay it back, but pay it forward. And I think that’s what mentorship is. And that’s the–you know, these meetings can be pretty exhausting, right? Because you’re talking to people, you are making new connections, like keeping up your old ones. So you kind of have to get out and about. You have talks, you have podcasts so–but it’s so worth it, right? That’s why we keep on doing them, I think. You know, unfortunately with the pandemic there were–we didn’t have SIR in person. So I think people are back at it.

With a vengance.

What did you say earlier? Better

Back and better than ever.

There you go. . Yeah.

One thing I forgot to mention about resources, you said–I mean, I just did one yesterday at a Cook Vista course. I’m sure there is many, many companies who have like these courses. And during those three years of radiology residency, as a resident, these are all free for you. Go to these courses, it’s amazing. You know, believe it or not, I just learned a complex tibial pedal access reconstructions and recanalizations on a cadaver model, which–I’m a new attending, I’ve just started doing PID like a year ago, and I’m now doing more complex tibial pedal loop constructions and all that. But I needed to learn more, so I reached out to them and they said, “Hey, at SIR we have a course.” All I have to do is show up.

Yeah.

And it’s so amazing. A lot of time I think I can do it. I have a confidence in myself.

I guess that’s another thing you’re pointing out is partner–being partners with industry. And I think early career and even, you know, as a trainee, there’s so many opportunities like the Vista courses you were talking about. So thanks.

Especially if trainees are on a limited budget, I mean, this is–these are such great opportunities to take advantage of, to just supplement your learning. If there’s something that you’re feeling like you might have a knowledge gap on.

They don’t even ask you to pay. They cover everything.

Yeah. It’s–I took advantage of that as well and it was a huge opportunity, especially when the budget’s tight.

Yeah. Yeah. Awesome. And then

tell me, what do you enjoy the most about your job? Do you want me to start? Training. I think–I have a passion for education and I think, you know, when I think about future career, like, would I ever leave academics? I think it’s the residents, it’s the training that I think is my favorite part of the job. You know, like from here, we’re going to–I have to go–you know, I give my talk, but then I have to kind of run because, you know, one of my mentees has a presentation and you’re–they’re just so excited and they work so hard, and it’s so amazing to see them. So I think I–other than patient care, I think that’s one of my favorite parts of being at Sinai.

Totally, totally echo with you. I’m sure she’s going to give a better answer than I’ll give, but what I’m going to say is I–as I told you, it took me a long time to find a good mentor. And once I found it, my world changed. Literally I told him, I promised him, whenever I have an opportunity, I’m going to pay it forward. Fortunately, I’ve had several opportunities because of my involvement with RFS. And right now I have over like 40 med students that I’m working with through SI mentor program. And people who reach out and just want to talk to you like, “Hey, how did you do it?” There is social media, there is mentorship, there is networking, and there is education. These are the four aspects of my IR life besides, of course, taking care of patients. And that’s how you complete my fist . That is fascinating for me.

Say those again. What are the five?

So of course, patient care, social media, networking, mentoring, and education.

Nice. You thought about that before.

That is a fist, right there.

I know, I know. . Jessie, what’s your favorite part about your job?

Oh, gosh. What not my favorite part about my job?

Good answer.

I mean, it’s–you know, I love everything about being an academic IR. Personally, you know, I get to pursue research interests and try to move the field forward through those avenues, which I just find really intellectually stimulating. Getting to work with trainees who have such passion and such talent, and watching them and helping them build their careers. I mean, the patients are just, you know, the light of like every day, getting to work with them and help them out. And yeah, I mean, just kind of being a part of, you know, moving this specialty forward and helping more and more patients across the world with moving innovations forward and just caring for patients every single day. So what’s not to love?

What is not to love?

Exactly. One thing I would mention for both of you, we talk about mentors and reaching out, but there are people who you can be like, you know, watch them and consider them your mentor. You don’t have to go and speak to them because they’re too high up the level. For example, you are a program director, Kirema, I follow what you guys do at Mount Sinai. I follow you, talk to your residents. I’m very good friends with some of your prior fellows and who are with me–bunch of friends–and you still have some of your residents who are really good friends, and we are in the same WhatsApp groups and all. So I talk to them and I hear like, what are these people doing? What are those people doing? And I love it. For you Jessie, you’re Fallopian Tube Recanalization program. I literally just spoke to my chief and I said, “Hey, they are doing this. Is this something that we can do? And if you give me a green light, I can actually reach out to that person and see how they developed their practice, and so I can help take it to next level.” So for me, you guys are my mentors too, in a way. But it’s just that I haven’t reached out to you, but I just follow you from far off because you’re like–

It’s funny because we follow you back. So , so I knew who you were when you were in training because of social media. So you know, it all goes all the directions.

Yeah. And I think that’s a really good point. It’s the fact that never underestimate the influence you can have on somebody because people are–with social media, people are always watching. So. Beautifully said Rocky. Beautifully said.

Thank you.

Okay, so what is something–you know, we’ve been super positive and I definitely don’t want to be negative or anything, but what do you think we could do better in our training programs?

I think we–you know, as Rocky was alluding to earlier, we need to kind of encourage the focus on kind of being a clinician overall. And I think, you know, back when I was in training, one thing that I could have done more of, I think, is focus on the overall clinical management, seeing them in clinic. What do you do before when you decide to treat? What do you do if it doesn’t work? All these kind of things. And not so much the focus on the technical accomplishment of the procedures.

A hundred percent.

So yeah, I think that’s already shifting, but I think a further shift in that direction is certainly in order.

Absolutely. I cannot agree with you more. And I mean, look at that, in 1964 when this all started with Laura Shaw getting her first angioplasty from Dr. Dotter. What was it said, at that time? If you as a radiologist or as a physician, you’re not going to know your disease and know your patients, somebody else will learn these techniques and will become better than–better at this than you. This is literally what we strive to do, right? My–one of the other biggest mentor–which we keep bringing up–again, Dr. B–I think everybody knows him. He keeps saying, “We need to have all the three Cs in our practice: clinic, consults, catheter time.” Period. He literally–whenever you speak to him, that’s the three things that come out of his mouth, and it so resonates. We–sure we give them catheter time, residents do get that, but–clinic, consults. Clinic, consults.

That’s so important.

Very, very, very important. And then–no, so clinic, consults–and then you build on that, and then you actually go talk to the family, go talk to the patient. Your perspective is going to change. You’re going to become a very different person. I told you, I get emotional sometimes with my–especially pediatric patients when they’re like, I see them–oh my God, he’s like walking.

Yeah.

He’s walking out of the hospital.

Yeah, I think that’s–you brought up probably the most important thing and something we’d like to really emphasize in our practices. You have to be an incredible clinician, right? And that can be challenging during fellowship because you’re assigned to a room or–so that whole, you know–you see the patient in office hours, right? So you see the patient, then you schedule the procedure, do the procedure, see them the next day if they’re admitted or if it’s an inpatient, and then kind of follow them. I don’t think you kind of–you do, you–the same patient can be hard, but it’s emphasizing that it’s as important for me that you know the patient well, that you know the workup, that you did the workup, and to follow this patient while they’re admitted or while they’re in the hospital, as it is for you to be good technically, right?

Longitudinal folloup, yeah.

A hundred percent. And I think interventional radiology is evolving in that direction, you know. I do a lot of interventional oncology, so I follow these patients, and I find that very satisfying and gratifying, and I do think that’s something that we should really, really emphasize on our–

We keep talking about this turf wars and somebody wants to take over your procedure and this and that. That’s some negativity you can see on the social media all the time on social forums. But think about this, if you are that good, you own the disease, you talk the language, you talk the same language as the the clinicians speak, nobody’s going to take a patient away from you. They’re going to actually be very happy to send a patient to you. You need to do work, you need to put in hours, you need to own the disease in medical management, the physical management, the procedural management, as well as their personal management. Believe me, when I talk to the patients and they say, “You know, it doesn’t bother me with this much of claudication. I can still do my daily activities.” But then I say, you know what? I’m not going to treat you. It doesn’t–what’s the end goal? If you’re so happy already, what am I trying to change? You need to know when not do, right?

Mm-hmm. .

So that happens when you speak to the patient. So knowing that, that part is what I was trying to allude in the beginning, that three years of non-clinical exposure to the patients, I think that’s something that we need to work on. At least make it intermittent.

Yeah, I agree.

Yeah. I mean, as far as the, you know, following patients longitudinally, I think it’s important that trainees really treat their residency like it’s a job.

Mm-hmm.

And really take it seriously. And so if your residency is not set up for you to have longitudinal followup necessarily, like do it yourself, you know. Like get after it, you know. Look into what happened with the patient before, like you said. Make sure you know them before you walk in the room, but also chart check them, keep a record, and follow them up and see what happened and see what different people did along the line for them after you saw them that one day in the angio suite. So I think if you just take the initiative yourself, you know, you’ll help yourself down the road, like a million percent.

A hundred percent.

A shameless plug on that: If you actually as a resident do that, and you go out of your way to set up a clinical practice, I promise you I will recommend your name for the clinical VI recognition series, which we do this every year. You are going to be the champion for that year.

Rocky rmaking promises.

Yes.

I like it.

Just do the clinical learning.

Yes. That’s, it’s–I mean, and it’s going to benefit the resident, right?

A hundred percent.

Obviously the patient–when we talk about all these things, the patient’s actually at the center. But yeah, it’ll benefit your education and then you’ll just be a better clinician for it. So we are kind of closing in on time, so I do want to ask you both one final question, if that’s okay. So, dedicated to our trainees, right? So if you had one piece of advice, and Rocky, you have five fingers and you like to count things so you can–you can do more than one.

Oh my God.

But what is a good solid piece of advice you would give physicians in training?

Okay, no pressure, right? . So one piece of advice–I mean, it’s a very loaded question, to be honest. There’s not–it’s faceted, right? Like that even one piece is faceted. Be humble, be hungry, and be available, affable, and able. Literally, this all combined together in one piece, that makes you a clinician.

Five fingers.

Correct. But it’s one piece.

Say them again. Humble. Hungry.

Hungry. Available, affable, and able.

Love it. Jessie?

You guys got a lot of fingers assigned.

I’m a numbers person.

. No, I mean, for trainees, I think just keep your eyes open, you know, keep your eyes open for opportunities to help out patients, opportunities to learn, opportunities to build relationships. You know, you never know where those are going to lead you. So really just embrace it and enjoy the ride.

Sorry, if you don’t mind me adding one more thing.

Of course.

During residency, one thing that we basically overlook or we never taught is the financial and business aspect of radiology and IR, as a whole. I you know how much the device cost and how much you’re reimbursed, believe me, you would actually, it has–So I did a radiology leadership institute course for nine months and I learned everything about work R-views, this R-view, that R-view, and I didn’t even know what those even mean. But I went to these courses and I learned. It has become so much different when I do the cases and I’m like, what am I doing? Is it worth it? Is it not worth it? Am I helping the patient? Am I using the right device? Am I using the right tool? And how does this translate into the financial aspect of it? It’s very important. Nobody teaches us the business aspect of radiology. That’s one thing I would say is another thing that during residency we can improve on.

I think that, and that makes me think of, you know, insurance, insurance denials, and going through the whole peer-to-peer process. And I think that’s something I did as a like–early in my attending career, right? I never–and there are resources, there are resources on the SI website and there–but I have to go to my colleagues and be like, what does this even mean? Right? So definitely areas we can improve.

Yeah. And these apply across any kind of practice scenario regardless of what kind of practice you’re going into, so yes, good to seek out that knowledge while you’re still in training.

Yeah, it’s more easier that way.

Yeah, definitely is. Yeah.

Right. So I want to thank you both for being here today with me. Thank Cook for including us and inviting us.

Oh yeah. Thank you guys. Thanks Kirema for moderating. You did an amazing job. We did want to put in a little plug for the synergy dinner with Cook tomorrow night, the sixth, Monday. So there is a hands-on reception from six to seven that everybody is welcome to come to. The program slash dinner is to follow, but that’s actually full at this point, but you can get on the waitlist if you’re interested.

Well, for me, ending thoughts–I am just ecstatic that I got to do this with you both. It was amazing to talk to you and thank you Cook for letting me do this and giving me an opportunity.

So stay tuned. More episodes coming the rest of the week. So thank you everybody. Enjoy the rest of the meeting.

Thanks guys.

Thank you.

Happy meeting all.