Episode 296: Master Clinician Part 3: Mike Essandoh
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Hello, and welcome back to ACRAC. I'm Jed Wolpaw, and I'm thrilled to be doing another one of our Master Clinician episodes. As you all know, these are people who have been nominated by the people around them, their trainees, their peers, who have said, and not just one, but multiple people who have said, you know, this is really a Master Clinician. This is someone we trust, who we go to for advice, who we value their teaching. And we are really lucky to have another one of those Master Clinicians with us today.

Frequent listeners of the show will recognize him because he has been on the show quite a few times, and his name is Dr. Mike Essendoe. He is just an incredible person who's had a storied career already, much more to come. He's done a lot of incredible things, more than 14 years in clinical anesthesiology, doing cardiothoracic and vascular anesthesia, transthoracic echo. He has over 200 peer-reviewed publications.

He has been on ACRAC multiple times, my favorite part of his CV. He has had leadership roles, including the Assistant Dean of Graduate Medical Education and Associate Director of Anesthesiology Clinical Research at The Ohio State University, where he works. He has even worked with medical device companies to innovate and solve clinical problems, and he has been on editorial boards of various respected journals. So he really has done it all, and I am thrilled to get to talk to him about that today. Mike, welcome back to the show.

Jed, thank you so much for having me on Accra once again. To be honest with you, I don't consider myself a master clinician. I did some reconnaissance work and I discovered that one of a few of my fellows, but specifically Dr. Jordan Holloway, she emailed you and suggested that I come on the show. So I'm really humbled. It's a great honor. And it's also a great reflection of Ohio State and what we're doing here. And I hope I can share some insights with you.

on some of the work we do, some of the work I've done, and hopefully it can be of value to your global listeners. Well, I appreciate your humility. I will say that we never invite people on as master clinicians with just one recommendation because, of course, we get tons of people writing in and saying, oh, my favorite attending is so-and-so, right? And so you should know that while Jordan did write in, she was not the only one, and we had multiple people who felt strongly about you being here, so I'm really glad that you are.

Tell us a little bit about what your current role and career looks like. What do you do and how did you get there? Thank you. That's a fantastic question. So I've been in practice for 14 years. So just a little backstory. I did my...

what we call undergraduate medical education at, you know, Pennsylvania State University, Penn State. And I went to Cleveland Clinic to do my residency, obviously in anesthesiology. And I followed that with a cardiothoracic anesthesiology fellowship for reasons that are obvious. The clinic had all the resources, all the brain power. I just felt overwhelmed.

during my residency that the groundbreaking work was being done there. Specific example, Dr. Toby Cosgrove, who ended up being the CEO, was one of the cardiothoracic surgeons. And I was just amazed by how he went about his work.

He just made discoveries based on everything he did in the OR. He ended up creating the Cosgrove ring. He has a Cosgrove Edwards valve. He has a retractor for the mitral valve. And all these were from observations he made from his daily work. And Dr. Colleen Cook was my attendant. She used to be at Hopkins. She's moved on from there.

Robert Savage. So I had phenomenal mentors. So I really had a great foundation at the Cleveland Clinic, and I moved from there to Ohio State. And Ohio State has also served me very well. And over just for just perspective, when I...

Arrived at a high state, I had one publication. I had the great fortune of meeting great mentors and sponsors. I will list a few. Dr. Ernie Mather-Ferry was very, very influential. He helped me more in the leadership perspective. He invested in me by helping me get coaching. He just, from just the relationships we formed, he's an interventional cardiologist and we used to do procedures together. I guess he saw something in me that

Maybe I didn't even see myself, but he invested in me from a coaching perspective and he helped me get into the GME space to be the assistant dean of graduate medication. And from a research perspective, Dr. Sergio Bergezi, he's now at, he left Ohio State, he's in Stony Brook, New York.

He was in charge of the clinical research lab and him and Dr. Hamdi Awad, when I was a junior attendant, would just inspire me, give me stretch assignments, just would tell me, hey, you cannot just put patients to sleep. You have to do a little more. So they inspired me and inspired

You know, I wasn't even that interested in research at that point in my career because my kids were little. I had a lot of other obligations, but I slowly learned from them and that snowballed into multiple research endeavors.

And so that is what got me into the clinical space, sorry, the research space. And the clinical work is, and teaching and learning, as you know, it's just rewarding to have residents, fellows, who push you on a daily basis to get better. We learn from them, they learn from us, and we're able to, you know, drive the whole mission. And more of the innovative work was another mentor and sponsor, you know, Dr. Emil Dowd and Dr. Raul Weiss.

They actually are EP Physicians.

And when just a little backstory on that was I would be in the EP lab and they always wanted me to do better. They said, you have the potential to just be more than a clinical anesthesiologist. So they inspired me and we worked together on the SICD. We worked together on ablations and then we ended up innovating in that space. So I hope this provides a little framework of some of the work that

we've done and how I arrived at some of these leadership clinical research opportunities. Yeah, thanks, Mike. And what I'm hearing you say, kind of two big things. One is the importance, and we've heard this over and over, the importance of mentorship and sponsorship, of finding people who will help you, who will have your back, who will help guide you, who will believe in you. That's huge.

And then the other, as you said, is that it really is a willingness to kind of think a little bit outside the box in the sense of a lot of ways. But even with mentors, in other words, a lot of your mentors that you just mentioned were not anesthesiologists. And so that's okay is to find other people, whether they're cardiologists, surgeons, whoever, who you work with, who you get along with, and maybe you can do some interesting things with and maybe who could be mentors to you as well. So I think those are really important lessons in the areas you talked about. Yes. And I want to actually say probably...

The most influential mentor was actually my resident. His name is Dr. Nasser Hussain. He's now a pain management physician. When he joined our residency, I just saw something. He had something that I didn't have. He had a statistical background and he had published many high impact publications. So I gave him a stretch assignment. He was a CA1. I had a VAD article. It was an invited review. I gave him a deadline of five days to send me a draft.

He sent it to me in two days. He had never been in a cardiac room. It was one of the finest work I'd seen in research. So I learned from him. He was a master of performing systematic reviews. So I just knew that I was not strong in systematic reviews. So I actually learned from him. So it was a trade, teaching him anesthesia, and he was teaching me how to be a researcher and perform large-scale systematic reviews. And based on that, we were able to solve other bigger problems,

For example, when I was a fellow, when we do lung transplants, we never, every attendant had a pulmonary vein velocity that they felt was a comfortable threshold that they didn't, that they felt the anastomosis was patent. And from 40 attendants at a Cleveland clinic,

The numbers were statistically just all over the place. So I shared that with Nasser when he was a CA1. We assembled a dynamic group. You're aware of Nick Kumar, who was actually an anesthesiology technician. So it's just a diverse group of people.

Folks with different backgrounds, different experiences, different thought processes. Dr. Minoja, we formed like, we called it like a band. We basically, everybody has a say on how we break the work. We share the honors, you know,

you know, equally. And we've been able to systematically identify and solve clinical problems. And it's been really a joy working with this group at Ohio State. That's awesome. All right. Let's talk about kind of some of the essential clinical skills that you think anesthesiologists should have. What comes to mind? What do you recommend people think about and work on? Perfect. So the, in my opinion, a real

Excellent clinical anesthesiologists should have like a broad global view of medicine. It starts off with relationships. It's always great when you have a great relationship with the OR technicians, the nurses, the

Even the people that clean the OR and then the surgeons. That just creates, like, it's like being a social architect. It creates an environment where people are able to do their best work. And so when residents come in that environment, they can learn, they can share data with you, and they don't feel the stress of always feeling they are not working to their best of their abilities. The technical aspect is critically important.

If you will be anesthesiologist, you have to be great at these skills, whether it's intubations, intravenous catheters. I know Dave Berman placed a, you know, a cortis in somebody's, you know, was it a poppiteal vein or something from the prior master clinician series?

I haven't done that yet, but it's every day I tell my residents, every day you come to work, you want to leave by learning an additional skill. So it's either you're learning and refining what you know technically and also making observations. The observations, I think, is something that is underutilized because we get in the space. We all know you have to innovate, get the alliance in, be efficient, you know, make it.

know how to use inotropes, vasopressors, echocardiography. That's cardiac anesthesiology in a nutshell. But how do you make an observation that would help

this patient and the next patient. That is another aspect that I think a true clinician should aspire to be daily. And it doesn't just end in the OR. You still have to go and you have to keep up with the literature that's coming up. For example, if you really think back, I graduated from fellowship in 2010. Every pacemaker and defibrillator that was

available is out of commission now. Now we have leadless devices. We have subcutaneous devices. We have extra vascular devices. It's our duty to learn these newer technologies and take better care of patients and also teach them to our learners. Yeah, all that is so important. Let me ask you specifically about a couple of them. So when you think about building relationships with

everyone around you, as you mentioned, but let's talk about surgeons at first. Any tips? You know, I think this is something that residents especially feel. They know they're intimidated a little bit. They, especially if it's, you know, if there's a little tension with the surgeon, they aren't necessarily comfortable. Maybe they're a little more comfortable with a surgical resident, but certainly the surgical attending who they're in there with. Do you have tips for either trainees or for young faculty? How should, how can they build effective collegial working relationships with surgeons?

Perfect. That's something I struggle with and something I try to build on every day. I think it starts with having self-awareness, knowing yourself, knowing your deficits, and

Working hard to refine how you communicate. Communication is key. For example, in cardiac surgery, the surgeon wants to know what inotropes and vasopressors you're administering. You don't want to get to the highest scale of the vasopressor inotrope with the heart not working, and then you convey that message that we need mechanical circulatory support. It has to be incremental. So these relationships start with being respectful. To be honest with you, hubris does not work in any way.

aspect of life, from your home life to your professional life. It starts with humility. I think if you're humble and you are receptive to feedback, over time, you would be able to build these relationships. And you want to build them every day because especially for residents, you're in cardiac, next day you're in neuro, you're in PEDS. It's dynamic environments, but you have to be able to read the room, be respectful. There will be times that you have to be

You know, people may say things to you that you wouldn't, you know, you may want to respond differently, but you have to also have a little bit of a thicker skin. I'm not saying just be a pushover, but find a way to build, you know, relationships because the relationships, these are the people that would vouch for you, especially if you're looking for a leadership position in a bigger, broader academic setting like Johns Hopkins, right?

The anesthesia division may know you, but nobody outside the walls of anesthesiology may know who, let's say, Jed Wopar is.

It may be an interventional cardiologist, maybe a surgeon who knows your skill set. So they want to see your competence. They want to see how you communicate. They want to see how you're receptive to feedback and they put it all together. So whenever an opportunity comes around, they will say, we know one person who would be great at this. So it's a daily thing. You're never going to master it. Just when you think you've mastered how to foster relationships, you will meet a surgeon who is amazing.

Not the nicest, and you have to rebuild that relationship all over again. But it's a constant, you know, learning and refinement. But I think it's something that I really, you know, I tell my residents, be humble, communicate effectively, and the rest would, you know, fall in place.

Yeah, that's all great advice. And I love how you emphasize the communication and building those collegial relationships. I think a lot of that starts with simple things that we sometimes overlook, like introducing yourself, saying, hi, my name is Jed. I, you know, nice to meet you, Dr. So-and-so, if you're talking to the attending surgeon. Yeah.

You know, making sure you say your name, have the make sure you introduce yourself to the nurses. And if especially in those kind of moments before the case starts or at the beginning when things are not stressful, everybody's calm. If you, you know, have a conversation, ask how things are going, you know, again, make sure you've introduced yourself. Then you kind of make it it becomes more of a person to person thing rather than just, you know, us and them. I think that can make a big difference.

You're absolutely correct. And I also, you know, stress to my residents that when you come into the cardiac space, you have to know your why. Like before you ask a surgeon a question, you at least should have a background knowledge about the fundamentals. So I always encourage them, read, read, read. When you can have an intellectual discussion with any cardiac surgeon, it's a very stressful job for them. And if you can have an intellectual discussion with them, even...

Send out a page the day before and say, what's your approach to cannulation? What strategies would we have should encase the patients? If you have a terminal heart failure patients, what MCS strategies may we use? That alone breaks the ice. The surgeon will come into the room and say, that's impressive. I have a resident who is really going above and beyond. Whatever you do, you would end up, they would...

Look at you optically, they would give you the benefit of the doubt rather than not saying anything, being quiet in the back room. People want to see your competence. They want to see your confidence. They don't want to see arrogance, but they want to see your confidence, your competence and your collegiality. So you're absolutely correct.

Yeah, couldn't agree more. I think you can also even start like I email the surgeons the night before every single day that I'm going to be in the OR the next day. I send an email the night before I say, here's what I've looked at the patient's chart. Here's what I'm thinking. What are you thinking? Any concerns? And then that just starts that back and forth, that communication even earlier. And then the next day, often, you know, the surgeon will come into the OR and say, oh, thanks so much for reaching out. It was great to great to have that conversation. And I think every I think at least every attending should be doing that.

I absolutely agree with you. So, Mike, what about any thoughts on building productive relationships between physicians and CRNAs or other APPs? You know, that's often we have those interactions all the time. It often can be, I think, a little tricky, especially for brand new attendings who are working with CRNAs maybe for the first time as a supervisor. Any thoughts on how to do that well?

Yes. The APPs are a great foundation of what we do in anesthesiology. There's a shortage of providers. We have to work together. When you're a junior faculty, it's a little challenging because you always, you may work with a CRNA or an AA who's been practicing before you got, you know, before you even got out of college and your job is to, it's not a power thing. It's,

Find a way to, like you said, communicate effectively, respect them. You may be the boss. Hierarchically, you're the highest in the room, but also respect what they bring to the table. Respect their thought process. If they have any suggestion, even if it doesn't align with yours, find a way to be the bridger, bridge the gap between you may have the highest level, especially if you come from cardiac, you may have the highest level of knowledge with hemodynamics and all that stuff because you just came out of training.

They may be practicing, they may have been practicing for a decade. So they just have the intuition as to what they've seen enough. They have the experiential learning. So you always have to be respectful of your APPs. A lot of them have been practicing in that hospital for a longer time. They have way more

tight a relationship with like the surgeons. So if you treat them disrespectfully, they are not going to vouch for you. I think respect is key. We are all there for one mission, the patient, the patient, the patient, and then the rest is us and the safety and well-being of all the other practitioners. So I think we always have to be respectful of our APPs and vice versa.

Yep, absolutely. All right. So one of the things that I think often, you know, residents as they transition into being faculty are trying to do is really build even more than they were able to do maybe in residency, sound clinical judgment to really become experts clinically to be seen by their colleagues as clinical experts. How do people build that sound clinical judgment? What advice do you have about that?

Yes. Sound political judgment starts from, I always tell the residents, you have to be around to get better. Tom Brady became Tom Brady by playing multiple games. Patrick Mahomes is Patrick Mahomes and the great Michael Jordan. They just practiced their craft. You have to refine your skills. Every at your line, you place yourself.

Whether it's successful or not, you have to learn something. So you have to find your skills. And the sound clinical judgment comes from experiential learning. Obviously, you have to read, you have to know the literature, and then you have to bring the research, innovation, all that stuff, and you have to apply it clinically. If you apply one strategy and it doesn't go the way you want it, you have to learn from it and think about how you can make it better. So learn from your peers. And one other thing that I always emphasize is

Do not be afraid to call for help. I think it's actually a reflection of a sound clinician who would actually call somebody to give them other insights, especially when you're younger. Like, what do you think would be the best way to approach this? Perhaps even have a mental eye. When I was, I had a great fortune when I got to Ohio State. Dr. Hamdi Awad has also trained at a Cleveland clinic. So he,

Just out of nowhere, him, Mike Andritzo, Scott Jeter, all these other folks serve that sound of what they would always ask me before I go to induce a patient. You know, it's a critical lesion. What are your thoughts? What are the strategies do you have in mind? So I think it's very, to get that database of clinical judgment, you have to obviously be in the clinical space. You have to have that knowledge base first.

Really use your sponsors and mentors. Find somebody that you trust because oftentimes, especially if you go to another hospital different from where you trained, you're not sure who do I ask? How would they feel? Because there's a lot of emotionality to it. But I think to really build that sound clinical judgment,

You have to be clinically available. Don't just let the resident or the CRNA stay in the room all the time. Be around because you gain experience by being there to make observations and treating the patients appropriately. Yeah.

Yeah, I think that's absolutely right. And it's so important to approach when you're doing procedures or managing a patient or anything, not to fall – I tell our residents this all the time – not to fall into kind of the just doing things the way you kind of always do it. Think – let every opportunity, like you said, every A-line, if you just kind of do it and don't think much about it or you pull out the ultrasound and just take a look –

You're not going to learn as much as if you kind of deliberately approach it. I tell residents, you know, if you're going to use the ultrasound, that's great, but maybe mark on the wrist where you would go if you were going blind and then put the ultrasound on and see how your guess was, right? So use every opportunity to learn. That's what I hear you saying, and I couldn't agree more.

Absolutely. Every day, even for an attendant, it's a lifelong learning. When I trained, I'm not sure when you trained, there were no ultrasounds. I had to learn ultrasound technology for access and for all this, even 3D, 4D echo. Every day there's innovation and it's our responsibility. If we want to provide the best care to our patients, we have to learn every day.

Yep, absolutely. All right. You've done a lot and you mentioned earlier how important innovation has been to you in terms of when you've seen it in others and when you've done it yourself. Talk about that. What role do you see for anesthesiologists and how should they go about trying to be innovators? Stay with us. We'll be right back.

Wow. What's up? I just bought and financed a car through Carvana in minutes. You? The person who agonized four weeks over whether to paint your walls eggshell or off-white bought and financed a car in minutes. They made it easy. Transparent terms, customizable down and monthly. Didn't even have to do any paperwork. Wow. Mm-hmm. Hey, have you checked out that spreadsheet I sent you for our dinner options? Finance your car with Carvana and experience total control. Financing subject to credit approval.

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Okay. This is something that I think the Cleveland Clinic was very instrumental in giving me the opportunity, that foundation that you can innovate as a physician. Because when I was at Penn State, the notion was working in partnership with the industry just seemed like they had this dogma that it wasn't really, if you work with the industry, they are the bad guys, sorry to say, quote unquote. But then I get to the Cleveland Clinic and

The clinic's mantra was, if you want to innovate, you want to work with people who are smarter than you, people who had more resources, and then you want to partner with a

group of people with the same vision mission to create something. So a perfect example was I was on call and a patient had an AFib ablation at an outside facility, came in with a fistula between the left atrium and the esophagus. It's a really close to fatal condition. I think current literature states about 80% mortality rate. So

Dr. Dowd, the EP physician was around. Dr. Cristinallo, I still remember it like yesterday was in 2012. So essentially we took a patient to the operating room and the thoracic surgeon was Dr. Daniel. We corrected the fistula, went on bypass, corrected the fistula and then the patient did well. But there were a lot of morbid morbidities still associated with it.

So post-procedure, so we did publish this and Dr. Kaplan actually made it a case conference and invited a few other physicians from outside hospitals to comment on it, an EP physician and an anesthesiologist. And then Dr. Dowd further assembled the rest of us and said, hey, AFib ablations are done, it's ubiquitous. Every hospital does many AFib ablations. Why is that?

to this day and age, why is thermal energy destroying that relationship between the left atrium and the esophagus? And we, you know, upon further deliberation, we included our engineering team and we came up with the fact that if you have an exoskeleton

At transphageal echocardiogram, you can deflect the esophagus a little bit. Why don't we model a device analogous to that? So it involved a lot of work. It did come with a little bit of work. We were in the animal lab after clinical work at night, modeling and modeling different iterations. And then we did animal studies. So we came up with a product.

predicated on how the TE works, you know, physics wise, but not just, you know, because it doesn't have piezoelectric crystals or anything else. And we're able to create this device and then involve travel to Argentina to do some, you know,

human, you know, preliminary work. And then we went to the FDA, which is also quite fascinating. Being able to get to the FDA, share your idea. Then we did the investigational device exemption trial. And long story short, we were able to create the e-solution. What the device does is when you ablate in the pulmonary veins, it can deflect the esophagus remote from the site of ablation. So the energy is not trapped in the esophagus.

So when we did the analysis, the patients that had just luminal sulfageal temperature monitoring versus those that had the e-solution device, the risk of a sulfageal mucosal injury in the control group was 35%, whereas in the device study group was 5%. Wow.

further complications from that is just not something that we want our patients to have. So to summarize, the device received FDA approval September of last year. And just to impress on the audience, especially the residents, it came with just a small case report, an intraoperative observation. And that snowballed to multiple papers, multiple refinements, and an FDA-approved device, which

I think, you know, now we're trying to work towards, you know, getting it scaled up in production. But it was really great to learn and partner in with S4 Medical as the medical technology company that we partnered with. So it helped Ohio State. It obviously is going to help patients and it also helped with innovation. So we always have to think about what we observe in the OR can have a global influence.

Yeah, and what I love about that is it's such a great example of, you know, how many people have had done ablation cases and just kind of said, okay, 35% risk. This is one of the risks. It's, you know, if risks benefit, let's make sure the patient's aware. Okay, they consented. Let's do it. And so many people go through that without stopping to think, well, wait a minute, right? Why is that a risk? And is there a way to ameliorate that risk? But that's what you did is to kind of say, well, look, you know,

Let me think about other things I do, this transesophageal echo, you know, how does that apply? And putting those pieces together. And I think the first step there that I hear you saying and that has got to be there, and I'm not particularly good at this, I think a lot of us are not, is...

kind of taking a step back from our everyday production pressure, just get through and to say, well, you know, what could I do that might make this work better? Think outside the box, push boundaries, push paradigms, challenge the way we do things. And sometimes you come up with, with something like you did that turns out to be able to really have an amazing impact. Yes. And, and I want to shout out Nick Kumar also. He's also been on your, on your, on your show. It's,

Once again, another innovation. We were doing lung transplant. We were finishing. Nick was an anesthesia technician. He was not even a med student. And I was assessing the pulmonary veins. And he asked the questions like, why are you fixated on the pulmonary vein velocity? And said, if the pulmonary vein velocity is high, I said, quote unquote, high.

It means that the blood is coming into the lung, but may not be effluxing out. And that may lead to congestion. It may lead to the pneumocytes, you know, infarcting and the patient's lung may not survive. And the survival rate, if you have a pulmonary vein, if it's a stenosis from a surgical suture, they can, you know, obviously correct it. If it's a torsion, we don't want the patient getting to the ICU and then the lungs are congested and not functioning well.

So Nick asked me just a simple question. He said, what velocity do you use to make your decision? And I paused. It was like two in one. I said, wow. I was like, well, Dr. Savage said 1.2. Dr. Cook said 1.4. And he said, okay, what do you use? I was like, well...

He's like, why don't we just do more? So, assemble the band. Nick Kumar, Nasser Hussain, Antoine Flores, Eric Stein, Mino Jair. And we did a systematic review. And we basically discovered way more than what we even understood home nerve vein to be. It became more, is it, we need the diameters, not just the velocity. Because it's

You may have a high velocity, but if it's a hyperdynamic state, that high velocity is not a reflection that the anastomosis is small. And we just, based on that work, that was accepted by Journal of Heart and Lung Transplantation. But the most important

And the best part of all this work was Nick, the anesthesia tech, because we do a meritocratic system at Ohio State. Whoever does the work, whoever brings up the idea gets the record. So he was an anesthesia technician and was the first author of the paper and journal of heart and lung transplantation. So another intraoperative, I tell the residents, we are privileged to put people to sleep. I know sometimes we just...

It's anesthesiology is just a phenomenal specialty to be in. And every day we're delivering anesthesia, there are observations that we can make and that I want them to, you know, they, people always struggle with how do I come up with research ideas? Just look around you. There is something that can be changed. And I'm really lucky to have had this group of people where everybody was thinking, you know, a lot of great thinkers making great observations and we've been able to innovate at a high state.

Fabulous. That's such great examples of a way to kind of a type of thinking that can really be beneficial. Let's talk about technology and AI. I know you're interested in and have been involved in that too. This is clearly the future. Where do you see the ability to integrate technology and AI in anesthesia practice and how can people start thinking or getting involved in that? Perfect. This is a phenomenal question because

Even my daughter always tells me, just use Grammarly. You're always writing so much. Why can't you leverage technology or use OpenAI? And I'm like, Zoe, you're too young. Do not get into that stuff. But based on the kids and how they think, I've actually pivoted and I've loaded all the AI platforms on my phone. I have Anthropic. I have OpenAI, Cloud. And I use them regularly.

Back when you have to go on PubMed and search all these articles, now you can prompt the AI platform to basically, I want to know the dimensions of the right ventricle. And you have an answer in 10 seconds with all your references and you can do a deeper dive into discovery. So I think AI and anesthesiology is under leveraged.

There's only one company that I think has done some tremendous work and it's Edwards Life Sciences. And I've actually reached out to Edwards to see if we can partner to innovate a little bit with generative AI. So they have the Acumen. I'm not sure if you, if you know, you use it in Hopkins,

The Acumen is basically a clear sight technology. It's like a finger cuff, or you can also use it through your arterial line. And it gives you cardiac output, stroke volume, SVR, DPDT. It gives you a lot of hemodynamic variables. But it also has a proprietary generative AI technology where it can give you what is defined by the company as a hypotension predictive index.

And it's actually pretty accurate. It can give you some framework as to your likelihood of being hypotensive. And then further give you some guidance. Is it SVR related? Is this myocardial function related? Is it preload related? So a little bit more deeper dive. So that is the only true AI technology that I'm aware of. But again,

Talking to Edwards again, I think we have the opportunity to expand it, especially with hemodynamic monitoring. I'll give you a specific example. Like currently, if we place a left ventricle assist device, a durable LVAD,

Patients that develop RV dysfunction, a lot of them, even if you put a right ventricular assist device in place, a lot of them don't survive because we don't have strict protocols. We have protocols, but when you wean in the RVAT, it doesn't tell you how much of the myocardium of the right ventricle has truly recovered.

And we use metrics like the Ponellac Repositivity Index, which Nasir and Nick also helped define thresholds for LVAD implementation. We came up with a threshold of two. However, that's a fixed number. We still don't have a generative AI or technology that's telling you what the true mindsets are doing, give you some prognostication, and better guide you. So I think...

Edwards is doing their best to integrate the pulmonary retropalsy index now as a parameter. So you don't have to calculate it because you always have to calculate it, which depends on your time because it's PA systolic minus diastolic divided by right atrial pressure. And you have to keep calculating it. And without work, you really may not have the time. But being able to use AI to give you all these additional hemodynamic data would be very transformative. Yeah.

And also weaning patients who are on VA ECMO back to native heart function, whenever we wean them, I know I'm a little too cardiac focused. So to the audience, I'm sorry, I'm just giving examples from what I'm used to. We still don't have any technology that tells you that this patient would really survive after you wean it, or you're going to need X amount of iatropes, or you may potentially have to reinsert the ECMO. Maybe AI can help us. So in anesthesiology, I think

The opportunities are there. We just need to find a way to integrate the clinicians like you and I who work in this space on a daily basis with the companies like OpenAI and Microsoft.

You know, anthropic. Those that really have the AI technology have to merge with us. And I think IBM is doing a phenomenal job in radiology where they're using generative AI to assist radiologists in making diagnosis and in reading all these images. So, yeah.

I think the future is very bright, and I hope the younger audience that are listening, Acroch is by far the best platform. There's no doubt. I'm from Ghana. I hear people email me because I've been at Acroch. They should all listen to what you have to say and also find a way to develop the next technologies to make our life easier and to make patient care better. Yeah.

Yeah, I am excited. I am such an AI novice. I just, you know, don't know much about it at all, but I'm so excited to see what comes of it. And I think it's going to be our younger generation, the current med students and residents who are really coming of age with this technology that are going to usher us into the exciting future that this will bring. So I'm equally excited as you, Mike, to see what comes.

Let's talk about, you mentioned before the importance of mentorship. You've had some really impressive leadership roles institutionally, locally, regionally, nationally. How do you recommend people who are interested in leadership, in getting involved in these kind of roles, what should they keep in mind? What's good to know about how this kind of thing can be part of your career?

Perfect. I think to basically get these leadership opportunities, you have to be, you have to start off by taking little assignments because you,

Your credibility, you have to be flexible, you have to be collaborative. All these things, all these traits on leadership, because I know quote unquote leaders, a lot of people say some leaders are born, but even Steve Jobs and all the other great leaders that have come and gone, you cannot do anything alone.

And it's always, you know, and self-pity doesn't work. So oftentimes you're like, oh, I have an MBA. I have all of this, but nobody's giving me an opportunity. It's because people don't know you. In a bigger bureaucratic academic system, people have to know you. People have to sponsor you. People have to vouch for you before people would give you the opportunity. Your skills, your knowledge, your wisdom is just one component.

If nobody knows who you are and nobody knows how you work well with people, you're not going to get these opportunities. So I think you have to be – you have to stay prepared.

If you're a first year, you know, attendant and they need somebody to help with resident lectures, take on that role. You would even learn a lot of skills of managing people because leadership is management is one aspect that still is needed in leadership. But the main thing about leadership is you have to be able to have a vision. You have to be able to inspire people and you want to be able to create leadership.

The next, whatever your mission is, you want to be able to co-create it with others. So the days are gone where the hierarchical, I'm the leader, follow me. No.

People want others that they can work closely with collaboratively to have a joyful. And also they want people that will hold them accountable. They don't want people that would just, you know, follow them, whether they're doing the right thing or not. So when you start, take any stretch assignment, any assignment that would give you the opportunity to improve yourself and then seek fulfillment.

the next opportunity. You have to also seek opportunities. These academic centers are vast. You have the brightest minds all in one geographic location. You think you're the smartest guy or whatever or girl. It doesn't matter. You may not get that opportunity. You just have to make yourself available. You have to seek the next opportunity.

find a way to essentially work well with others because that's how you form mentors. That's how you form sponsors and never limit yourself to only your institution. I still communicate with people that train me because the people that trained you always actually have your best interest. They want you to do better. So I still communicate with Dr. Savage, Dr. Cook, uh,

all the guys and girls that trained me at the Cleveland Clinic. And whenever there's an opportunity, even at the SCA, Savage helped me with that opportunity. I didn't even know that opportunity was available. So that's how you grow. And as you're also getting these opportunities, you have to pay it forward. Bring others along. It's not just about you. It's not...

It's not a solo performance. It's more about getting opportunities, sharing with others and helping them also come to your level. And they would help you get the next leadership opportunity. And also, if you have an opportunity that really doesn't fit what your goals are, you just don't have to take it just because you want to have a leadership title because you'll be miserable doing it. And you've had multiple CEOs leave it.

you know, jobs after a year or two because they just didn't align with the goals of that industry. Yeah, absolutely. And I, you know, I love that you said this. I've heard this a lot before. I give the same advice. When you're starting off,

You know, it's I think not the right strategy to say I'm only going to say yes to something if I see exactly how it's going to lead, you know, through 10 different steps to where I think I want to be in 10 years. I think you don't know that. And it's hard to know where things are going to take you. So like you said...

Say yes to things up front, even if you're not quite sure where it might take you, because it's going to build credibility. If you say yes and you do a good job, even if you don't end up kind of following from that to some obvious next step, whoever you did that job for, if you did it well, they're going to think, oh, you know, that was impressive. This is somebody who I want to keep in mind for the next role or whatever. And the other thing I would add to that is I think sometimes –

people even right out of residency or fellowship, you know, they want to only say yes to things if it comes with, you know, protected time or extra money. And I wish they all did. I mean, it'd be great if that was the case, but it's not. And I think, you know, there's still a lot of advantage to doing things, even if they don't initially off the bat get you time or money. It can be something like you said that can help you build credibility, prove that you're a hardworking, talented person, and that can pay real dividends down the road.

You're absolutely correct. And the great Michael Jordan said it. I mean, when you played high school basketball before the NIL deals and all this stuff, right? You played high school basketball, college basketball and made no income until you made it to the NBA. It's just building your skills, your wisdom, your talents. So it's the same. Take opportunities, learn from it, teach others, learn.

bro. It's, it's all up. I don't want to use the analogy that's a performance. You build in yourself, you build in your brand. It's like, so just treat your career. Like it's a limited liability company. If you had a corner store, how are you going to manage it? Same thing. Just learn, learn, learn, and you'll be able to progress to the next level. Cause you,

You cannot really be prescriptive as to where you want your career to go. I actually never... I've never... I don't even think two, three days ahead of where I want to be. So my family always still make fun of me. Like, you just...

You really don't have it. My daughter is always strict. She's not strict. She's always like tough. It's like, dad, what's your vision? I'm like, so enough. I'm almost 50 years old. I think I think I'm doing OK. So, yes, take what comes your way. If it's a great learning opportunity and you build skills and knowledge and you get wiser and the next big thing would come. Awesome. Mike, anything that we didn't cover that you want to say and leave people with before we move on?

I just want to instill, especially in the younger folks, that there's not that, you know, hard work and experiential learning is critical, especially in this modern era of medicine where there is really, and you stated it, you know, very well, that we don't have protected time because politically we're short.

So you may have to work a little bit on nights and weekends if you want to achieve something academically. It may not be palatable, but it's really off of your duty to do that. So if there's a case that is meaningful or some research endeavor that you want to do, it's okay to use a little bit of your nights and weekends. You will learn from it. It may snowball into something that's bigger. And another thing that I would share is

For example, the impella was made by this company, Abumad, FDA approved two years ago. And Dr. Adam Dahlia, he's at MGH. He also trained at High State. He called me and said, hey, let's collaborate on a paper. Because we didn't understand it deep enough, but we have to use it. So we approached the company. We did get some data and we did create a few articles on it.

Long story short, now him and I are partnering with a company to educate an anesthesiologist on it. So we are learning and we did benefit from spending a little bit of time to do deeper dive, learn a little bit more about how the device works. And it can come with some further advisory board, editorial board, all these things. So sacrificing a little bit of time and effort to learn, discover, and build yourself is very meaningful. And I think...

That is, and the experiential learning. Don't try to just, if you're on call and there's some case and you're not even the primary provider, you can go in there and help. You will learn something. And you want to see cases before you have the ultimate responsibility for the care of the patient. Yes. Yeah, absolutely. Love it. Thank you, Mike. Let's turn to the portion of our show where we make random recommendations. What would you recommend the audience check out for fun?

I think the last dance. It's the 1997-98 Chicago Bulls under the leadership of Michael Jordan, Scottie Pippa, and Phil Jackson. Just if you need anything to inspire you to do better, it's great. I know the younger generation, we find Michael's leadership to a little bit tough. It was a tough love, but he knew...

the composition of his teammates. And he knew how to, he was very methodical at how to inspire every person in that group. I mean, if you can inspire Dennis Rodman to show up for a game and win a championship, you are the greatest leader that I've seen. So I think that is, I've seen that series a few times. And I think it's just, if anybody hasn't seen it, it's on Netflix. And I think they should also watch it. I strongly, strongly recommend it.

Awesome. Thanks, Mike. Yeah, that's amazing. I often see clips on social media of Jordan, you know, from back in the heyday, and he was just awesome.

I mean, just amazing. And the other thing I'll say is along those lines, if you haven't, if you weren't old enough to remember the Michael Jordan Gatorade commercial, Be Like Mike, it is such an awesome commercial. And I would just Google it and watch it, especially if you never have seen it. It's just an amazing commercial that came out probably, when do you think that came out? Probably back in the...

Was it the 80s? Yeah, it was the 80s. Yeah. It was fantastic. Such a great commercial. Well, great. And then, you know, I'm going to recommend a comedian. If you don't know Nate Bargatze, I would highly recommend checking him out, whether it's just watching clips or his specials on Netflix or going to see him. He's been touring. I don't know if he's touring right now, but he does tour from time to time. He is, his last name is B-R-G-A-T-Z-E, and he is hilarious. And one of the nice things about him is that

He's completely clean. Like you can watch him with your kids because he doesn't, he's like one of his thing. He doesn't swear and he doesn't, you know, he doesn't go into anything kind of inappropriate. And yet he's hilarious. Just kind of talking about everyday stuff. So you can watch with kids. You can watch on your own. It's hilarious. I recommend checking out anything by Nate Bargatze. All right, Mike, thank you so much for coming on the show and for all you do. And we'll see you soon.

All right, Jed, I just want to say I can't conclude without giving a shout out to the Buckeyes. Thanks for having Ohio State on your show again. We really appreciate all that you're doing for our profession. And thanks again. Well, as someone who grew up in Cleveland, I've always got a special place in my heart for Ohio State. So thank you, Mike. I'll see you soon.

Thank you. All right. Hopefully you got as much out of that as I did. That was really fantastic. Let us know what you thought. Go to the website, akrak.com, where you can leave a comment. Others can learn from what you have to say. If you are a fan of the show, you can follow us. We're on Twitter. We are on Facebook. We are on Reddit. And we are on Instagram. I'm at jwolpa on Twitter. And we're at Akrak Podcast. And you can find us on all those other platforms as well.

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Thank you so much for the great work that you do. Our original ACRAC music is by Dr. Dennis Kuo. You can check out his website at studymusicproject.com. All right. That is it for today. For the ACRAC podcast, I'm Jed Wolpaw. Thanks for listening. Remember, what you're doing out there every day is really important and valued.

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