A few words about this Blog

     This Blog was created to integrate the information on different aspects of Head and Neck Diseases. Its target audience includes medical students, residents, Otolaryngologists/Head and Neck Surgeons, Medical and Radiation Oncologists, Pathologists, Cancer researchers and all other specialists interested in head and neck. 

Two men and the Ocean, Ralph Steiner (1921)

       Τhe main topics of interest are clinical and translational head and neck cancer research, and academic surgery. Through interviews with leaders in the Head and Neck field, the blog aspires to increase awareness among medical students and help as a platform to inform, educate and inspire. This effort wouldn't materialize without the generous contribution of all participating faculty, sharing their expertise and knowledge. 

       Please keep in mind that the purpose of this Blog is informative and the Blog does NOT intend to replace your doctor. You should ALWAYS comply with your doctors' advice.

PS: The Blog's conception was inspired by a discussion with the unique in so many ways KD.

      Please do not forget to cite the Blog when you reproduce the material published here.

Dr Kennedy - Thomas Jefferson University

 

                David W Kennedy, MD

Professor, Department of Otolaryngology- Head and Neck Surgery,

Sidney Kimmel Medical College at Thomas Jefferson University

Emeritus Professor of Otorhinolaryngology- Head and Neck Surgery

University of Pennsylvania

Dr Kennedy earned his MD from at the Royal College of Surgeons in Ireland and completed a residency in Otolaryngology-Head and Neck Surgery at Johns Hopkins. He pioneered endoscopic sinus and skull base surgery, and the medical and surgical management of chronic rhinosinusitis. Dr Kennedy developed the first rhinology fellowship thereby introducing the subspecialty of rhinology-anterior skull base surgery. He was recognized by the American College of Surgeons as one of the most influential surgeons of the 20th Century.

 

 

Jason Tasoulas: Dr Kennedy, I was going to start with my with my first question about the early years of your career. I mean, obviously, this career ended up becoming one of the most important in the field. I'm really curious to hear more about the early years. what made you choose Otolaryngology and what made you choose Otolaryngology in the United States in particular.

David Kennedy:  I'm originally from the British Isles, as you probably know, and I did my medical school and my internship in Dublin.  For internship, we do six months surger and six months medicine. When I was halfway through my  surgical block, the Professor of Surgery came  came up to me and said, David, you've been offered a job at Hopkins. You've got two weeks to make up your mind. I had actually never applied or really thought about leaving Ireland. It did seem like a good opportunity .so, I said yes. What I didn't know was that there was actually a secret agreement for me to go into the Cardiac surgery program at Hopkins afterwards and go back to Dublin and be the cardiac surgeon. And cardiac surgery was not what I really liked by any means. I had an uncle who was an otolaryngologist and., very successful in Dublin and I liked otolaryngology as a potential area. So, subsequently I had the pleasure of telling my chief of surgery at Hopkins, that I was not going to go into the cardiac surgery program and I had decided to do otolaryngology. It was certainly not popular with him.  In fact I don’t think that he talked with me again after that!

 

Jason Tasoulas: I can imagine..

David Kennedy: So then I ended up doing my residency in otolaryngology at Hopkins. Someone dropped out of the program, so they offered me to go in a year earlier than originally planned.  I decided to do it as long as they gave me time off to go back and do my surgery and otolaryngology fellowship exams in the in Ireland.. I wanted to get made sure that I was able to go back there if I wanted to do that At that point in time that was my plan post residency.

 

Jason Tasoulas: Υou said that you were offered the a job without you applying. You went to Hopkins, and this was for a general surgery internship. And then you would decide what subspecialty within the surgery. Correct?

David Kennedy: So in those days, you had to do General Surgery before you could do Otolaryngology. Most programs only required one year of General Surgery. Hopkins actually required two years of General Surgery before you went into the Otolaryngology program. So I went over to Hopkins, actually as a PGY2 in General Surgery. And for someone who is coming from overseas only having done six months of surgery, and basically having done almost nothing surgically, it was a trial by fire because suddenly I was told by my chief resident “this is your list for tomorrow - I won't be able to be in the OR with, you'll have an intern with you. We will meet at the bedside and discuss the cases”. This is what we did. We met at the bedside at 2:30 a.m., and we went through the cases for the next day. Pretty much every day. He was a chief resident who slept in the hospital, as was not that uncommon in those days. I didn't get much sleep either, needless to say. But it gave me a great surgery experience. I mean, my first day of surgery at Hopkins was a below the knee amputation, a trans-metatarsal amputation, and an incisional hernia. I remember it well.

 

Jason Tasoulas: That sounds quite like quite an experience. Did you also have to stay at the hospital?

David Kennedy: So I actually was staying in a dormitory just across the street. In those days, you were on call or at work enormous numbers of hours. On the ICU rotation, you didn't leave between Sunday and on the following Saturday. So you were there on Sunday morning, and you stayed through until you went for your resident lectures on Saturday morning. And then you got off Saturday afternoon and that was it. It was it was pretty much a trial by fire.

 

Jason Tasoulas: So it's quite different.

David Kennedy: It was not that good in some ways. But the advantage that you got to really learn to take care of the patients 24/7 and to be totally responsible for them. That was the advantage that you got out of it along with a lot of surgical experience. On the other hand, the fatigue was pretty terrible. I can remember falling to sleep talking to a patient in the ER and then he woke me up.

 

Jason Tasoulas: So you decided to go into Otolaryngology. You finished your PGY2 in General Surgery, and then you went to Otolaryngology. And that was for 3 or 5 years?

David Kennedy: In those days, it was four years, but the last year was actually an instructorship. So the total training was six years, two years of general surgery and then four years of otolaryngology. At Hopkins, the last year you were an instructor. So you're sort of a junior faculty member, which was actually a great experience and a lot of responsibility.

 

Jason Tasoulas: A few weeks back, maybe a couple of months ago, you gave a wonderful Grand Rounds talk in our Department, at Jefferson. I know a little bit about how and why you got into Rhinology and Skull Base, but for our readership, I will just mention that you said at the time, that you were thinking to actually become an otologist. So I was wondering if you can share that story.

David Kennedy: So I actually was an otologist! I said we had that last instructorship where we had some flexibility in that year. I actually ended up spending the majority of the year doing otology-neurotology, and then became one of the otologist-neurologists on the faculty at Hopkins for several years. In that role that I had a joint appointment in Neurosurgery. So they would also call me to do the trans-sphenoidal approaches because I was available and I was on their faculty as well. And so I wrote up our Hopkins transphenoidal experience going back to Cushing in 1912. And it had some really great drawings in it, because we had some old drawings that were done at the time of Cushing. And so the publication got some publicity, and I was asked to present it at a meeting in Europe. It was a sinus meeting, and I really did not want to go. I had nothing to offer and wasn't interested in the sinus field. So my boss actually bribed me with the ability to spend some time with my parents on the way there, in the UK, if I went. I went and there I met Dr. Messerklinger, and that really changed things. He had done a lot of research on mucociliary clearance, and I was able to talk to him because my resident research rotation had been on mucociliary clearance in dogs. I got interested in what he was doing, he was starting to do some surgery and I made arrangements to go back and visit him and also to visit other people in Europe who were starting to do some endoscopic surgery, and spend a little time with each of them, once I had also developed a little experience

 

Jason Tasoulas: And how do we go from this early this interest early on to developing essentially a whole new field? We, to a great extent, use endoscopes today because of what you did. What did it take to get this to become the standard of practice. Did you face a lot of pushback from the establishment? How was that for you?

David Kennedy: Yes. There was a lot of pushback. On the other hand, sinus surgery had high morbidity in those days. With open sinus surgery, the results were not that good. It was pretty obvious to me that we could do better. We got some experience and I asked Dr Heinz Stammberger to come over and do a course with me. We then started putting on courses at Hopkins and later in Graz, Austria. They were sold out. And the people that came were very, very interested and wanted to be early adopters.

On the other hand, at a national level, I had a huge amount of pushback. Both people that published against the new techniques and lectures where I got pilloried for talking about these new techniques. So it was a mixed bag, and sometimes pretty tough. There were early adopters, and there were those established people who really did push back very hard against these different concepts. And I think actually it was probably more eagerly adopted overseas than it was in the United States in some ways. We did a lot of courses overseas and  they seemed to be very well received over there. And there were early adopters in every country, I think.

 

Jason Tasoulas: Was it mostly Europe or other places as well?

David Kennedy: No, no, it was all over. So it was obviously difficult for the developing countries to get the equipment. But no, it was really all over in the East and elsewhere. Japan actually was early on doing some excellent endoscopic sinus surgery techniques under local anesthesia. So there it really took off. I've had a great relationship with the Japanese Otolaryngologists ever since.  It was actually in a meeting in Japan where I first introduced the concept of endoscopic orbital surgery.

 

Jason Tasoulas: And what would you say was the tipping point, if you can identify one that after that you were able to overcome the pushback.

David Kennedy: I don't know, I think slowly people started to take it on. And even people who had really objected to it early on, soon found that they needed to say that they were doing it, even if they weren't! So we found people who were doing it primarily with a headlight still, but would pick up an endoscope, and then they would say they were doing endoscopic sinus surgery. We know that that was absolutely not true. And in fact, one very well-known sinus surgeon from New York published his results on doing tumors endoscopically at a time that I know he never did a tumor endoscopically!

 

Jason Tasoulas: So they slowly started to to adopt.

David Kennedy: Adapt and adopt. Yeah!

 

Jason Tasoulas: You mentioned tumors. I know that within the field there are two main “subfields” -and maybe this is not an appropriate term. There is sinus surgery, and there is anterior skull base surgery that includes the oncologic surgery and the more extended approaches. I was wondering what your thoughts are about the development of the field from now on. And if you see this going into two distinct fields with allergy and sinus surgery being one, and skull base being another, in close relationship with head and neck, or if you see them remaining as one. What would you foresee for the future?

David Kennedy: That's a very good question, Jason. The answer is, I really don't know. It is obvious that there are not enough skull base cases for everyone in every institution to be doing them endoscopically and maintain good skills. On the other hand, I do think that fellowship trained rhinologists do better complicated sinus surgery. And the more complete sinus surgery you do, the better the results. So it is possible that that it will split into the two areas. I'm just not sure at this point in time whether that's going to happen. But it's an interesting concept. I think the question is, can the general otolaryngologist really get trained well enough to do perfect sinus surgery? Because it really does need to be done extremely well. And are they willing to take the time to do the necessary medical therapy that's required to manage a chronic inflammatory disorder. I don't think we know that at this point in time. There are certainly some that do it really, really well. But that's not true for everyone.  I think that this concept of ongoing management of difficult disease is particularly important as primary care moves towards mid-level providers who are likely to have less familiarity with otolaryngologic disorders.

 

Jason Tasoulas: I see. So you're saying that it definitely requires or most likely requires a fellowship to be able to adequately manage those conditions, but it's not necessarily true that we will end up splitting into two separate fellowships.

David Kennedy: I don't think it necessarily requires a fellowship, but it does require a, some a at least a fairly special interest  to really manage these patients well. And we need to manage them so that they don't get recurrences. And I think we can do that with the spectrum of medical therapies that we now have available.

 

Jason Tasoulas: You’ve been through and been part of all these transformative experiences in the field.  What would your advice be for residents in training? How can we get the most out of training? What should we focus on? How can we balance research and clinical training? I really want to hear your advice.

David Kennedy: During residency, obviously clinical care is critical – both surgical and medical.  I think there are two other things that are important. One is the numbers of papers. And I think that people do look at the numbers of papers and it's important to put out papers, even if they're clinical and not of major significance. But I also think it's important for a resident to get involved in at least some translational research. Because if you want to go into academics afterwards, that's going to be the basis of what you do subsequently. So, I mentioned that I did mucociliary clearance work on dogs with Dr Proctor at Hopkins, and I had no idea that that was ever going to be important to me later, planning to be an otologist. But it turned out to be extremely important. It was the only reason that Dr. Messerklinger was interested in talking to me, because we could talk about the mucociliary clearance aspect and how that really worked, and obviously that then translated into the whole concept of doing things endoscopically.

Jason Tasoulas: You mentioned papers is one, but you said there is two things. What would be the other one?

David Kennedy: It would be to try to get involved with some basic research. I think that that's important. Try to find a mentor that you can work with, to do some not necessarily basic, but at least translational research, something which would later give you a leg up towards developing a research area during fellowship or even as a junior faculty member somewhere. I think that's really very helpful.

 

Jason Tasoulas: And what would you say about the balance between clinical training and clinical developing a clinical skill set and a research skill set? How important are the clinical skills and how one should balance between the two?

David Kennedy: The clinical skills are obviously paramount. We used to think of surgeon scientists being 50/50. And that really does not work well. So what you really need is someone who has superb clinical skills, but can maintain them on perhaps only 30% clinical practice. And that's not everyone, by any means.

 

 

Jason Tasoulas: I see what you're saying: a good starting point could be 50/50, but then the research component would ideally maximize as you develop the ability to maintain your clinical skills by doing even less than 50% clinical.

David Kennedy: Yes. I think if someone wants to go the R01 route to get basic research funding, they need to be more than 50% research. But that's not the route that most people will go in academic medicine.

There are a few that do that- one of my former residents and fellows, Noam Cohen at Penn, did this very well. He's someone with superb clinical skills, who can maintain a clinical practice but be primarily in the lab. And, that's not the way for most people. For most people, it really is being primarily clinical, but also understanding and cooperating and having that desire to work with people in basic science to bring the area forward.

 

Jason Tasoulas: I'm curious to hear what your opinion about that is, but I see two models now for surgeon scientists. One is the surgeon-scientists that do run their own lab themselves, and the other one is that some surgeon-scientists work with a PhD, and they co-run the lab while spending some time in clinic while the PhD is 100% research.

David Kennedy: So I think there are very few people who can do clinical and spend most of their time in the lab. That's really few and far between. For the majority of us in academics, it's understanding research, having a background in research, and then knowing where you want to participate. I think getting a K01 as a junior faculty member is really very helpful, providing that background. The concept of the K01 is really for someone who's going to go and develop an R award—I don't think that's necessarily the way that everyone needs to go. I think the K Award helps you cooperate with people in basic research and provides that background and enables you to put input into people who are primarily in the lab. I mean, it might be your lab, but in many cases it will not be, but you've got to have good basic scientists.

 

Jason Tasoulas: I see what you're saying, and I think, or at least my understanding from this very junior standpoint that I am on right now, is that surgeon-scientists are quite a rare breed. And I'm wondering if you think they will still continue to exist, at least in major academic institutions, or if it's a dying breed. I know that there are some concerns from people that it's not sustainable to be good at both things. And obviously you and other people are an example of the opposite. But do you think it will continue to exist and Departments will continue to seek out these people with this dual training background?

David Kennedy: Yes, I absolutely do think they will continue to seek that out. But as I said, I think it's for a very limited number of people because it's difficult to maintain surgical skills even within a small subspecialty. Unless you are pretty talented with only about 30% clinical and having a limitedfocus of expertise. It's much easier within medicine, where you don't have to practice surgery, but within surgery it is difficult, because of the importance of maintaining surgical skills. But yes, I do believe it's going to continue. I think that places are going to look for people that can do that. But I think for the majority of us, it's understanding research and being able to participate with basic scientists who are doing that area or doing innovation, which is the other thing I think is really important within the specialty.  There is still plenty of room for innovation and cooperation with industry.

 

Jason Tasoulas: Besides leading the Oto-HNS Department at Penn for many, many years, I know that you've had healthcare leadership experience as well as the vice dean at UPenn. And I was wondering if you would be willing to discuss a little bit about that. How different is it to manage this side of things compared to a Department? And what did you learn from this?

 

David Kennedy: So I think it was actually really very similar. You know, if you run the department well, it really is a very similar experience at the health system level. It was helpful for me, I think, to find out how to run other Departments, other clinical departments, what the issues were in other clinical departments, to try to introduce appropriate reimbursement for the physicians in other departments so that that became a bit more standardized across the health system, and also how to standardize appropriately  the support for different Departments, so that it was  more fair. Prior to that, I think it had been whichever chair negotiated best ended up getting more support. What we tried to do is to really standardize it and put out a model within academic medicine for providing support to the Departments and making it, you know, one size fits all across the health system.  We also moved towards standardizing incentive systems and productivity expectations at the faculty level, so that it was more fair and inline with market expectations. It was also nice to participate in the health system development, satellite strategies and the design of a major new institutional outpatient center.

 

Jason Tasoulas: And do you think that the same people that are running the show from a research standpoint, meaning the surgeon-scientists, the highly accomplished academicians, can be the same people that actually lead and take the managerial positions as well? Or in your mind, are these usually different types of people with different characteristics?

David Kennedy: So when I went from Hopkins to Penn, I had to really make a decision. I didn't think that I could be a real triple threat with the time available. So basically, I gave up research at that point in time. I think I gave up research to do administration and clinical work. That was a tough decision. I think I could have also done research and administration. But I think what the clinicians look for is someone who is active in that area. So for me at least, I didn't feel I could do all three. I made a difficult decision, which was to basically give up the research area, obviously continuing to publish, and work with others. But I gave up all of the basic research that I was doing when I took that position. And I think, honestly, in this day and age, what the chair position is, is primarily is administrative and clinical. I really do. But they've got to have that background in research to know how to keep that element going and really get a good vice chair for research as well. So there is someone to lead the research endeavor.

 

Jason Tasoulas: During your career, you've hired for positions at all different levels. And I'm curious to hear, what are you looking for when you're hiring someone, whether it's at the resident level, junior faculty, or senior faculty? What are the characteristics and qualities you're looking for? And I understand that they might be different depending on the position, but I’m wondering whether there might be a generalizable theme there for you.

David Kennedy: Well, obviously the first thing you look at is the CV, and that gives you a background about whether they are willing to push themselves. And that's why I say, as a resident, the number of publications is important because you want someone who is pushing themselves. And that's probably the first level that you look at. You want to find out, do they have good clinical skills if they're looking for a clinician? And do some follow-up on that. And then how they're going to fit into the Department is obviously really critical. One of the things that the former Dean at Penn used to do when hiring Chairs was always to do a reverse site visit. And I often thought if I was in a Dean position, although it was probably a day or two days away out of your Dean time, it was actually worthwhile because you would find out things about people by talking to others – for instance how they treat people under them. When you're looking at the Chair level, that's so important for an institution not to make a mistake in who you hire as a Chair. So, I actually think that he spent his time well, doing that. And if I were a Dean, I would, I think, recommend taking that time out to do it. You find out from assistants and research associates and, you find out from other people, you know what someone is really like. At a faculty level, I don't think that's so important. But as that Dean used to say, the chairs are really the princes of the kingdom, and you have to make really good choices for the chair.  A bad choice as Chair can be really expensive in terms of faculty and in terms of costs and lost opportunities to the health system.

 

Jason Tasoulas: So he would go on site and spend some time there and talk to people on all levels?

David Kennedy: To make a Chair decision. He would spend at least a day or so at the institution finding out the truth about the individual, things that are not in the CV and not necessarily in the recommendation letters, and don't show up necessarily during interviews.

 

Jason Tasoulas: How does the institution gravitas weigh in compared to the residency program gravitas? So coming from a great institution versus coming from a great residency program. Those two do not necessarily always overlap. How does that weigh in on your decision? What would you prioritize?

David Kennedy: You mean looking for a faculty member?

Jason Tasoulas: Yes.

 

David Kennedy: I think you do look at where someone did their medical school and where they did the residency, but that's not really the ultimate arbiter of who one should pick by any means. And I think obviously you want someone with good clinical training. That's clearly true above almost everything else, but you also want someone who you think is going to be moving an area forwards.

When someone joins a faculty and then if they're later looking to move up and move to a different institution, it's what they do during their years on faculty that's more important than where they did their residency or medical school. We've seen people who did not go to great medical schools, but who have done extremely well. And I would put myself in that category, you know. I don't think that coming from the Royal College of Surgeons in Ireland as a foreign medical graduate is an ideal entree into the US residency or into faculty positions after that!

 

Jason Tasoulas: Well, I do echo that sentiment coming from a medical school in Greece. I'm an international graduate myself, as you know, so I can definitely understand where you're coming from saying that.

David Kennedy: Yes. And when I was program director at Hopkins, we had residents from overseas at Hopkins and fellows from overseas, and they have often turned out to be the leaders. So it's really not what's important. You have to look a bit deeper than that.

 

Jason Tasoulas: Dr Kennedy, is after this incredible career that transformed the field, what if you had to pick one thing, what would you like to be remembered for? What would you like your legacy to be academically?

David Kennedy: So the legacy has to be for the people you teach. I mean, it is what really makes you proud. I'm proud to have helped people who have gone on to be leaders within the specialty. And that's what's by far the most important. The people that you work with and what they think of you is really important, not what people overseas think of you orpeople who only see publications. . What you want is when people come and visit with you, you want them to find out that you're actually better than they thought that you were from the publications. And I think that that's important. So, teaching by example would be my primary legacy. Obviously, I'd like to be remembered for having reduced morbidity within chronic sinus surgery. But it's really primarily the people that you teach and develop relationships with. I was absolutely delighted a couple of years ago when all my former fellows had this huge thing for me in LA. And that's I think what's really very gratifying – and when they still say that they hear my voice in their head!

Jason Tasoulas: Dr Kennedy, my last question for you is why did you decide to go from Penn to Jefferson?

David Kennedy: So I was at Penn and I decided age-wise, it was probably time that I stopped doing surgery. And I think it was the right decision, although extremely difficult because as a surgeon, you just love doing surgery. But after I did that, they put me out to Penn Medicine, Washington Square. And there the equipment was not good for what I did. Beautiful building, but the equipment was really not good. I couldn't teach medical students because I didn't have video towers. I couldn't teach residents or even students with that level of equipment. And we didn't have a fellow there. As I mentioned, what I really enjoy within academic medicine is the involvement with the residents and with the fellows. Jefferson gave me that opportunity and involvement, and it the new Honickman Center is beautifully equipped.  The rhinology team is also excellent, so I have been delighted to make the change and I hope that it's going to go really well.

 

Jason Tasoulas: I can tell you from the resident side, we're extremely, extremely proud and extremely excited to have you!

David Kennedy: I'm. I'm delighted to be here. And it's it's great to be working with the residents again. And I'd love to spend more time with you guys.

Jason Tasoulas: Thank you so much for doing this, Dr Kennedy.

 

Dr Duvvuri - NYU Grossman School of Medicine

 

Umamaheswar Duvvuri, MD, PhD

Mendik Foundation Chair of the Department of Otolaryngology

NYU Grossman School of Medicine

 

Dr Duvvuri earned his MD and PhD at the University of Pennsylvania and completed a residency in Otolaryngology-Head and Neck Surgery at the University of Pittsburgh. He then trained in Head and Neck Surgical Oncology & Reconstruction at the MD Anderson Cancer Center. Currently he is the Chair of the Department of Otolaryngology at New York University. Dr. Duvvuri has over 190 published papers and more than 8,000 citations. He has taught in many countries around the world, trying to improve the quality of head and neck cancer care.

 

 

 

My first question is somewhat generic, and I intentionally include it in most of my interviews. This is because I believe it's valuable and helps me gain a good understanding of your background and perspective. So I wanted to know why you choose to subspecialize in head and neck surgery after after residency. What drew you to this field in particular?

So, in fact, I would say for me it was a little bit the opposite. I was drawn to the field because of head and neck surgery. You know, I have always had a very strong desire to help people. Clearly, that's why we're going to medicine. But specifically coming from India and having my background, - head and neck cancer is a very big problem in India- I thought that at some point, I would like to return and contribute by educating, training, developing, and establishing scientific enterprises there. And I thought the best way to do that would be for me to be trained in an area that was of particular relevance to India. And so, I was always drawn to head and neck cancer from that perspective. I was also drawn to cancer because my uncle unfortunately died from lung cancer when I was younger. So I was always sort of tuned to the cancer and the oncology world. And it was a confluence of events. I remember thinking about this. I could have pursued head and neck cancer as a general surgeon, plastic surgeon, oral and maxillofacial surgeon, etc. And I was talking to people about what the field of head and neck oncology looks like in this country. And they said that most of it is done by otolaryngologists, and so you should do otolaryngology first, and then you specialize in head and neck. So I realized that that's what I wanted to do and I applied to ENT.

 

That's very interesting! Is there something that you dislike about the subspecialty?

Well, to be honest with you, one of the things I think is hard to swallow is that it is one of the more underappreciated of cancers, in the sense that it's not consider such a big problem in the US, right? It doesn't get the same attention as other cancers. And I am not comparing it to lung or colon or breast cancers, which are very, very common. But if you think about it, pancreatic cancer has about the same incidence as head and neck. Right? Same for glioblastoma. But it feels that those diseases tend to get a little bit more press. I hope that answers your question.

 

You did! Like I said, these first two questions are somewhat generic and I constantly keep thinking about whether I should keep including them in my future interviews. But the kind of answers that I get, how different they are and how fascinating they are always convincing me to keep them in there. Moving on to the next question, you have a somewhat unique background. My understanding is and you were born in India, but you actually grew up in two different countries: India and Jamaica. And then you came to the US to pursue higher education. So I wonder how this diverse background shape you as a surgeon, as a leader and as a person, and what did you learn from it?

Oh, that's a very interesting question. I would say that I learned a couple of things from this. One is I learned that we often end up in very, very different scenarios than you think you might project yourself to be in. So, I started it in India. Then we moved as a family to Jamaica. And when I moved there, I realized that there's a whole different world, which is very different from what I knew. And yet people are still very much the same. So number one, it taught me the real value of diversity and harmony. The best way to put it, is the national motto of Jamaica “Out Of Many One People”. You know, in Jamaica you'll find people of Indian heritage, Asian, Chinese, East Asian, African heritage, Caucasians, Europeans, etc. And they are all melded into this this pot. So it really is a very, very interesting country from that perspective. And, you know, when you come from a very homogeneous country like India, where a lot of people look very similar, it's very different! So, it really taught me the value of diversity and respect for other cultures. And that I think this has carried over into my work and to my professional life.

The other thing that I've done a lot in my career is that I've traveled a lot and I've taught all over the world. I've operated in lots of countries. I've operated in Antwerp, Singapore, India, and Brazil. You're gonna learn from your patients- you can learn from everybody. And you have to be able to be a good doctor, and a good surgeon. You have to be able to relate to people on their level and make them feel trust and confidence in you because they're giving us an awesome privilege of literally cutting on their body. They’re putting their life in someone's hands. I just don't even have words to describe it. It's one of the most awesome and fantastic privileges to have. We shouldn't take that lightly. That's a very, very profound level of respect and trust that people place in us.

And so going back to your question, growing up in different parts of the world and operate in different parts of the world, I've been able to see how the different cultures interact and how we can take from each of those cultures. And learning to be worldly allows us to then meet people on their levels, so that you're not talking down to them and really develop a rapport and build some trust in us. I’m not sure if I answered your question, but I think that's probably the best one I have.

 

Thank you! Yes, you absolutely did! The uniqueness of your background is not necessarily limited to this aspect of your life. You have a PhD in biochemistry and molecular biophysics, and you also did your your fellowship training at MD Anderson. You are, by definition, a surgeon-scientist. You could have probably been very, very successful in one of these areas individually, but you chose to do both. Why is that? What drew you to try and combining them throughout your career?

This is an interesting, and colorful, and funny story. It really started when I was an undergraduate student at Penn. I studied engineering because I wanted to be a scientist. I wasn't really that keen on medicine. It wasn't my passion. But I liked the medical aspect of engineering and trying to have an application relevant to healt. So my interest was not just building bridges, but doing something that was relevant from a healthcare standpoint. So we had to do a senior design thesis as undergraduates. And I found a person in the medical school to work with.

His name was Jack Leigh. He was in biophysics and he was also in bioengineering. And Jack was an amazing guy. He was a complete iconoclast. I had worked with him as an undergraduate and I had written two papers with him. I was very proud of myself for that. And I asked him: “I want to go to graduate school. Would you write me a letter of recommendation?”. And I was fully expecting him to say yes. And he looked me straight in the eye and said no! And I said, “Why not? I've worked so hard. I wrote two papers- one as first author. I mean, most undergraduates don't do that!”. And he looked at me and he said: “listen, there are three kinds of people in this world. There are the ones that can build a hammer to solve a problem. These are the scientists and the engineers. The nails are the problems that need to be solved. There are the ones that use these tools to see the problems to be solved. The doctors, the dentists, the nurses, the people that actually take care of patients. And then finally, he said there's a third category, a very small group of people, that does both. He looked at me and said, “So if I gave you a choice right now, which one would you want to be?”. I looked at him and said, “Well, if you put it that way, then I want to be number three- the one who knows the problems and solves the problems”. And he looked at me and said, “Right, so I'm going to write you a letter of recommendation for an MD-PhD program. That's what you're going to do”. And that's why I did what I did.

But that story stuck with me my entire life because, you know, we do sit on that very cool interface between straight clinical, which is knowing the problems; and straight science, which is solving the problems that you think you know the answer to. But the hardest thing to do is to actually understand what the real problems are. You know, a lot of scientists stay in the lab, and they do great work. They write really, really impressive papers, but they don't necessarily truly understand what the problems are that the patients or the physicians are dealing with. I think we need to train even more people to do this. That's why I've always tried in my career to straddle that fence and be both clinically active and scientifically active. Yes, I could have maybe been a bigger scientist had I only done science, or maybe been a bigger surgeon had I only done surgery. But being on that on that interface, I think has given me the opportunity to see the best of both worlds.

 

This story is truly amazing. Wow! You said you could have been maybe a bigger scientist or a bigger surgeon. But in reality, you are producing a lot of very impactful papers every year, and I understand that you are also very clinically busy. So, what does it take? What does it actually take to stay on top in both of those two areas?

I’ll have to go back to my mentor, Jack Leigh, again, who as you can tell, had a profound impact on my life. You need mentors. That's really, really important. But Jack also gave me a very good piece of advice as I was a young trainee in his lab. He looked at me and he said, “you know, there are three kinds of people in this world, who are successful. There are those that work hard and they're successful. Then there are those that work very hard and they're even more successful. And finally, you have the top of the top, the best of the best, most successful people, and they display prodigious effort”. So the key here is, a) you have to be passionate, and b) you have to display prodigious effort. And that's the only way to be successful in this. There is no other secret sauce. There is no other magic. There's nothing else. The environment is of great importance. Because you cannot be prodigious and successful if you are in an environment that doesn't support that. You have to have mentors who recognize this. People who recognize the value of doing this. Because it's much easier to have a straight clinician on your faculty, for example. Now that I'm a chair, I see that. It's much harder to recruit physician-scientists. It's hard to give them that environment. It's hard to put them in that in that space. It's easier to have a scientist. Us physician-scientists, surgeon-scientists are in this weird amalgam. But we also have a lot to contribute. To be able to translate from the bench to the bedside and so on and so forth. I think is really, really important. As a young person, look for a place that has an environment to allow you to develop.

 

I've never thought about that in this in this particular way, but it makes makes a lot of sense. I can definitely see that. Now, you talked about you being Chair- you recently began your new appointment as the NYU Langone Chair. So, I wanted to know what is your vision for the Department.

The way that I feel about it now is that we've got a great clinical Department, with amazing people. They're doing great, great clinical work. There are also amazing people here doing tremendous scientific work. My vision is to try to leverage those strengths, build on those amazing, strengths and attributes to try to push us towards areas that we have not traditionally done here. Or to tackle problems with, with a slightly different light. As a physician scientist, I would be lying if I didn't say that I was committed and excited about developing the physician-scientists and developing abilities to treat people in that model. And I want to be clear: being a physician-scientist doesn't mean you have to be an MD-PhD. You can, but it doesn't even have to be that, you don’t have to be in the lab. You can be a physician-scientist in population health and clinical research and clinical trials. You can be a physician scientist in comprehensive general otolaryngology, or in a subspecialty. But, I don't want to present this as if physician-scientists are the pinnacle of greatness. No, that's not that's not the point. We just have a role to play like everybody else.  Like a football team. Everybody can't be a striker. Everybody can't be a goalkeeper. Everybody can't be a quarterback. Everybody has a role to play. This is just one of the roles. It's not better than anybody else. It's not worse than anybody else. It's just different. But you need some of those people to try to help develop the science aspect of things.

Most importantly the translational science aspect of things. I'd love to see NYU Otolaryngology under my tenure to grow in those areas. Surgical innovation, driving clinical growth and productivity as well, providing high value care. My slogan is: I want my Department to be patient centric, outcomes oriented, innovation driven.

1)    Patients first: Make it easy for patients to get their care.

2)    Excellent outcomes and high quality care.

3)    Innovate. Research innovation drives new technologies that will improve outcomes, push us to the higher levels while being patient-centric. So it's kind of like a triangle. All these three things should go together.

Another great mentor that I had was a surgeon scientist at Penn, Dr Doug Fraker, who did amazing amazingly high volume surgery and was a scientist. I asked him how he did that and he said “you need to make the operating room your laboratory. You need to find a way that your science comes from the OR. So your clinical practice gets folded into your science and into your investigation. That becomes how you do science, whether it's clinical trials or surgical innovation or taking the specimens from the OR to the bench to study it. These are the ways where your clinical work informs your science, and that's what I've tried to do.

Robotics has been my area. That's not all I do, but that's what I write about. Every patient that I operate on, I find a way to get their information, study that, write about new techniques, write papers on this stuff, and hopefully people will find it useful and it will help to be a force multiplier going forward by training other generations and other sets of people to push this forward.

 

And it probably allows you to create unique cohorts, unique samples, unique populations. Because you are actually seeing these patients. Like you said, you're seeing the problem that they're facing. Then you go back to the lab and try to create the right questions because you have the samples.

The biggest thing that that young people need to know is that they have to be able to say ”I'm not just going to keep doing something the way that I'm doing it, because my professor told me that's the way it should be done”. You need to ask the question, how could I do this better? Or is this the best way of doing it?. If we all thought the best way of treating cardiac disease was by giving everybody aspirin and just having them lie down with their feet off the bed, then we would still be having the same mortality that we did 50 years ago. It's because people said, well, is there some other way to do this? Is there some better way to do this going forward? That's why we invented stents, catheterizations, statins etc. That's why the survival for patients is so much better now.

We've moved because we've asked people to say, is there a better way of doing it? People have to ask that question. So that's what I think young surgeons need to know. And that's what, again, going back to your question about NYU, that's where I would like to go with my program for residency. I want to train the next generation of people who are not just great clinicians. They are going to be great clinicians performing standard of care as we have now. But at the same time be inquisitive enough to ask questions. I want to encourage them to think outside the box and to say, is there a better way of doing this? Because those are the people that are going to really change the field long after I'm gone.

 

Is it talent or is it character that makes a good surgeon, in your opinion? It's easy to say that it's both, but I know you're not keen on the on the easy choices.

I think here it is both, because both things play a role here. I think that it's hard to pick which one of those two very important things are there. I'll answer it this way. There's a famous quote that that I heard from Claudio Cernea, who was a maestro of head and neck surgery from Sao Paulo. And Claudio told me this when I was a young surgeon: one who works with his brain as a scientist, one who works with his hands is a craftsman, one who works with his heart is an artist but, the one who works with his heart, guiding his brain through his hands is a surgeon.

Compassion, intellect, character, and technical talent, are all really important aspects of being a surgeon. But what's what's more important in my mind is the thought behind that technical talent. There was a famous saying, I think it was by Halsted, that said, I cannot wait for the day when an academic institution will enroll in their faculty a surgeon without hands.

Because what we do with our hands is by far the least important of being a surgeon. It's all between the ears. It's all up here. This is where surgery happens. It's not the hands. So when you say talent, I think talent comes with character. I think it comes from people that display prodigious effort, which I think is character that asks the question why? Why aren't we doing it better? How can I do this differently? Or is this the best I can do? That's also a character, right? Caring for your patients is character. Wanting to do the right thing, even when it is easier to not. This is character. And this is right. This is why we see many, many talented surgeons do bad things and get into trouble. We see fraud of all kinds, not because these individuals are not talented, but because they lack character. And so I think that if you were to pin me down, I guess I would have to say both are important, but character is what defines surgical greats.

 

Thank you. What, in your opinion, is a predictor of success in residency? What are you looking for in an applicant, and what do you use to make an assumption about whether they're going to do good/ great/ poorly.

I think really what it comes down to is asking the question I mentioned earlier- somebody who is appropriately inquisitive and appropriately questioning will be successful. And so what I'm thinking on this, is how do we develop better versions of those in residency? The question we ask is, how do you know someone's going to be a good resident? Are they inquisitive? Are they thoughtful? Do they have character? Do they have the fortitude to actually do the right thing?. And are they willing to display prodigious effort to be great? Because you can coast through residency and be fine. Or you can work really hard and be great. And that is ultimately the measure. What residency is doing, in my opinion, is not just ending your training. You're just in the middle of your training, because you're going to continue to refine your art for your career. That's why it's called the practice of medicine. You're not done with residency. You're just learning how to think. That's my job- to teach you how to think. So if you can learn how to think, then you can continue to develop that.

At the end of the day, I'm looking for that. I'm also looking for people that actually want to drive some change in the field. That want to make an impact. And that impact doesn't have to necessarily be in the science or the bench. You can make an impact in your community by just being a great doctor that's practicing great cutting edge care in a rural community or in an urban center like New York.

 

So it sounds like you're looking for the foundation to build upon those qualities.

Yes. And I think some of these are qualities that people will develop over the course of their lives. I was lucky to have Jack as a mentor, who taught me and showed me that this is what I should be trying to aspire to. If I hadn't had that, I wouldn't be who I am now. I acknowledge that 100%. I owe much to him. And so, hopefully when I was applying to residencies, people saw that. And we're looking for that, but also acknowledging that not everybody is going to be like me and that's fine. Not everybody in residency has to do the same thing. We don't want everybody to do head and neck, or everybody to do general, or Peds. But some common themes in this are this desire to really be excellent.

 

What would you like to be remembered for as an academic surgeon? As a scientist? As a professional?

Wow, that's a great question. I don't know how to answer that one. I guess, there are a couple of ways. You know, people always talk about, what's my legacy going to be? People want to think of it from that perspective. I don't know that I necessarily think of it that way, but there are two things that come to mind. One is Satya Nadella, who is the CEO of Microsoft. He famously said once, “I didn't ask to be the CEO. That wasn't my next step. I just did the job in front of me as best as I could, at every point in time”. I think that's a great way of looking at it. I'm not looking at what my legacy is going to be. What I want, though, is to have the ability for people to say, you know, he did a great job at wherever he was at this point in time. Of course, I recognize that not everybody is going to like what I do. Not everybody like what anybody does. That's just life. But, I think there's opportunity for us to continue and push this forward.

So do the best job to be recognized as somebody that deeply cared about the people that that worked with me, my residents, my trainees, others. There's an old saying that the student of a master is a master and a half. I firmly believe that my goal is to train the next generation of surgeons, who are going to be even better than I am. Another great mentor of mine, who I'm very fond of, is Gene Myers, who was just amazing and gave me great mentorship. He was very proud of the fact that I became chair because he looked at me and said, “you know, you're the the last of the breed of the people that I trained”. And because I was that tail end of that career for him, he said, “you're the 28th chairman that I've trained”.

He was very proud of that. And why shouldn't he be incredibly proud of that? I would be, if I had that. He trained all of these chairs, and division chiefs and leaders. And so one should be proud of that. I think that there's great value in knowing that I contributed in some significant measure to that success for someone. And most importantly, going back to my slogan, patient centric. Feel that my patients benefited from my care for them as well. The most important reason we're here is to take care of the patients, to be patient centric, to do the right thing for the patients. And so if I innovate, if I develop, whatever I do, it should be with the idea that it's going to actually help people, not just write a paper for the sake of writing a paper.

 

I appreciate you sharing your thoughts.

Well, thank you for asking the questions. Good questions. Interesting. And I hope that it was useful to you and hopefully it'll be useful to other people.

Dr Michael Topf - Vanderbilt University

Michael Topf, MD

Assistant Professor of Otolaryngology-Head and Neck Surgery

Vanderbilt University Medical Center

 

Dr Topf earned his MD at the University of Rochester School of Medicine and Dentistry and completed a residency in Otolaryngology- Head and Neck Surgery at Thomas Jefferson University. He then trained in Head and Neck Oncologic Surgery at Stanford. Currently he is an Assistant Professor at the Department of Otolaryngology-Head and Neck Surgery at Vanderbilt University. Dr Topf is a pioneer in 3D surgical specimen mapping. He has over 60 published papers and more than 700 citations.

 

 

 

Why did you choose to subspecialize in head and neck cancer surgery after residency? What drew you to this field?

I have always been a bit of an oncology geek. I like clinical oncology, Kaplan-Meier curves and both non-surgical and surgical clinical trials. So, I think what, what drew me to head and surgical oncology fellowship was the care of cancer patients and the field of oncology as a whole.

 

Is there anything that you don't like about the subspecialty?

 I don't like that head and neck squamous cell carcinoma as a solid malignancy still has relatively poor outcomes, and that we have really not improved significantly in the last 2 to 3 decades. And with that comes patients that unfortunately don't do well from an oncologic standpoint. That's always challenging.

 

You're doing a lot of work with 3D specimen mapping. You've published a lot there. Honestly, I think it's quite amazing. I was hoping that you could share a few details about this, and also share how you see this technology involving evolving in the coming years.

Yeah, thanks for the question. It really started with a clinical unmet need. You know, as a fellow at Stanford, I saw difficulty in communication among members of the multidisciplinary cancer care team. This was seen in multiple phases of care. Intraoperatively, when we have anatomically complex resection specimens with multiple different types of tissue, that often require a face-to-face interaction between surgeon and pathologist. Particularly if the approach to margin analysis is a specimen driven approach. And this is time that the surgeon is not scrubbed in in the operating room advancing the case. So, I just wondered if we could do better with regards to intraoperative communication and delivery of frozen section results. If you think about it objectively, compared to other fields, why are we still delivering frozen section analysis results via telephone call without any visual aid in 2023?

You get a pathology report back a week or two after surgery for these complex cases, and inevitably there's some margin that may be close, hopefully not positive, but it happens- probably a fifth of the time for complex, locally advanced specimens. And we're again, left to written descriptions of the margin sectioning and the description of the specimen to try to reconcile those margins. The fact that there is a margin that is positive or close is concerning and potentially, an indication for adjuvant therapy. However, sometimes additional tissue has been resected that supersedes that area. And without a visual aid, those conversations between surgeon and pathologist are very challenging. These are also conversations that are had at multidisciplinary head and neck cancer tumor board, when we're dissecting through the pathology reports.

So, I thought there was a real clinical unmet need for creating 3D visual models of this specimen. I'd like to acknowledge a medical student who came to me with the background in 3D scanning: Kayvon Sharif, who really over a two-year period worked out a way to do this in real time with me and not interfere with normal surgical pathology workflow.

With regards to the second question, which is where I see it going, there are two barriers to widespread adoption. When I show people these scans and the protocol and the technology, I think everyone says “Wow, that's really cool. This is better”. But we still need to prove value, right? We need to prove the value of the technology because there are costs associated with it. So, we need to demonstrate value and that's going to be an academic and personal goal of mine over the next ten years. The other major hurdle is that the hardware and the software is not quite ready for the primetime yet. The vast majority of 3D scanners are not designed to 3D scan human tissue or resected specimens. And there are nuances that come with that. Similarly, the software that we use to annotate our 3D specimens to create these models and visual representations of the processed specimen is not designed for that use. So, we need to create software designed specifically to annotate virtual models of resected tissue. And when both the hardware software improves, I think that it's going to transform surgical oncology.

 

Having a background in Dentistry, when I hear you talking about this, there is one thing that comes to mind: dentists use these 3D scanners to do intraoral scans and they have multiple different software platforms for that. I wonder if you've had any experience with those or if there is any ideas from there that you could maybe apply to the 3D specimen mapping.

I think there's opportunity there. We have an active and ongoing study looking at an intraoral scanner that is used in the dental and oral surgery communities. The major issue is that the soft tissue resolution of a small handheld 3D scanner is not ready for intraoral 3D scanning. It’s really capable for scanning teeth, but when you start moving off of the teeth and start trying to scan the palate or the tongue, the resolution is poor. So in our hands the intraoral 3D scanners are not ready, but I'm sure that the hardware is going to improve in the next few years. In the future we could be using some sort of pencil 3D scanner in a patient's mouth to scan their tumor preoperatively!

 

Thank you. Now I want to transition to something different. Your department is consistently ranked as one of the top in the country. And my question for you is what did you and the rest of the team at Vanderbilt do to get there? And what do you do now to stay there? Because it's one thing to be ranked first, and it's another thing to consistently rank on top for so many years.

Yeah, I'd like to acknowledge that Vanderbilt's reputation and ranking is no thanks to me. I think you have to look at the people and individuals that built the Vanderbilt Department of Otolaryngology. It's a relatively young Department that started in the 1980s. But look at the previous Division Chiefs, Dr Ossoff, Dr Netterville, Dr Garrett, Dr Rees, Dr Haynes, and some of the early faculty members -some of them are still here- that built this Department and expanded it to what it is today. I think it starts with the Vanderbilt culture- we have a really good working environment. Everyone treats each other with respect. It sounds simple, but when you start with the working environment, you can create amazing things. I think that there's excellent support both for residents as well as fellows and faculty for research. There's a strong clinical research coordinator staff within the department that helps take clinician ideas and turn them into actual studies and produce meaningful prospective clinical trial results. Going back to our former chair Dr. Eavey, I think his vision for the Department and the residency training program, and his encouragement of faculty to pursue additional degrees, really had an impact in this place. I'm about to finish a masters of science in clinical investigation. When you look at the Department’s faculty, many of us have additional master's degrees. And I think that, that puts us outside our comfort zone and makes us better clinicians and academic researchers.

 

It is very, very interesting to hear about this approach. Now, I'll go to a different direction: is it talent or is it character that makes a good surgeon?

I would say it's both. But I would say character is probably more important than talent. Inevitably in surgery - particularly head and neck cancer surgery- you're going to have complications. How you handle those complications and the interactions with patients and their families is truly what makes you a good surgeon.

 

What, in your opinion, is a predictor of success during residency? What are you looking for in a resident?

Yeah, that's a good question. I don't know this literature as well as others, but there have been several studies that show that we can't necessarily predict who's going to be a good resident or a bad resident. And I think that the definitions of a good resident or a bad resident are something that is still a little unclear. But, you know, when I'm looking at residency applications, my favorite place to look at is the letters of recommendation. Perhaps I know the letter writer, but even if I don't, I think that you can learn a lot about an individual in a personalized letter of recommendation. And to me, that's where you get most excited to meet one of the applicants. I think the personal statement can also get me really excited to meet a prospective applicant!

 

What qualities are you looking for in a resident? What is important to you? I understand that the letters, based on what you said, are very important to distinguish and realize who's who. But what, what kind of qualities are you looking for in someone?

It might sound simple, but my answer is reliability and trustworthiness. I think you have to start there. My subspecialty is doing large cancer operations and reconstructions on patients. The perioperative care of those patients requires trust. Faculty aren't able to be in the hospital 24/7 but there is a resident in the hospital at all times. You need to trust that individual. So, for me, trustworthiness and reliability are the two most important qualities that a resident should have.

 

How important is research for you when you're evaluating someone. Does it play a role at all?

Yeah, it plays a role. For us at Vanderbilt, as a larger academic department of otolaryngology, it's great to see students that have participated in research. We now have a research track position, under the leadership of Justin Turner, one of our rhinologists. And that particular resident spot is really meant to train clinically and also academically a future surgeon-scientist that's going to have a career of discovery. And that could be in any aspect of research: clinical, translational or basic science. We just had our first match last year and look forward to future matches.

 

Are there any red flags for you in an application or during the interview? Things that are an immediate dealbreaker for you?

I don't know if there are any things that are a complete deal breaker for me on an application or an interview. Our approach to interviews and applications at Vanderbilt is very much a democratic process. We have several faculty reviewing applications, an entire committee, and the majority of the Department interviews candidates. So, I think it's more of a team approach. I trust my partners, and my residents who are also participating in this process. Certainly, if someone said something that I didn't like, that may be reflected in my perception of an applicant. But it's the whole body of the Department's review that I think is most important. Everyone's vote counts and is equal.

 

What are your goals for the next decade as an academic surgeon?

Clinically, I'm in my fourth year of practice now. I look back at how much I've grown as a surgeon, as an oncologist, and I look forward to future growth. Academically, I have aspirations to transform the way we approach surgical oncology, even beyond head and neck cancer. We're now using our protocol in breast oncology and musculoskeletal and bone and soft tissue sarcomas. I look forward to future collaborations in these areas. And personally, my daughter Madelyn just turned one this past week. So, I think further development of me as a father will be important over the next decade. That's what I'm most excited about in the next ten years. And I think I'm at a perfect place to do all three because I have wonderful senior partners: Eben Rosenthal, Sarah Rohde, Kyle Mannion, Robert Sinard, Alex Langerman, Jim Netterville, to develop me as a surgeon, as a clinician, as an oncologist, as a father and as a researcher. So, I'm, I'm very fortunate.

 

I know you have a strong presence on Twitter.  I'm just wondering how important having a presence there is and how influential it can be, in your opinion. I can tell you that from the perspective of a junior trainee it has been very helpful. But I just wanted to hear what you think about that.

Social media is very important for me. I look at social media as a way to learn. Gone are the days of receiving a in print journal as a way to stay up on the literature. I stay up on the literature by going to meetings, but also by social media. I follow JAMA Oncology, Lancet Oncology, Head and Neck, Laryngoscope, JAMA Otolaryngology etc. and that's how I learn my literature. I look at what they've recently published, I click, and I then I read the article. I am often told by or asked by trainees and colleagues, how do you stay up on the literature? And I say Twitter. It’s a powerful tool to learn. I also like to use it to disseminate our team's research. There is data to suggest that researchers that are more active on social media are going to have more reads of their paper. We do research to help our patients and also for people to learn about our research. So, if there's something that is going to apply to a broader audience, then I'm going to do it- particularly if it's if it doesn't take much time, which I don't think social media does. So, that's my approach to it. Also, you can learn from other people posting their experiences or their reviews of papers and trials. It's an awesome way to stay up to date.

 

Thank you so much Dr Topf!

Thank you.