112. Narratives in Cardiology: Advocacy for Women’s Heart Health and Empowering Women in Cardiology with Dr. Gina Lundberg

CardioNerds (Amit Goyal and Daniel Ambinder) join Dr. Gina Lundberg (Associate Professor of Medicine at Emory University School of Medicine, Clinical Director of the Emory Women’s Heart Center, and Chair Elect for the ACC WIC Section) and Dr. Zarina Sharalaya (interventional cardiology fellow at CCF, CardioNerds Narratives FIT Council Member) for a Narratives in Cardiology episode. Dr. Lundberg highlights the disparities that exists with representation of women in cardiology and cardiology subspecialties, and how to navigate the challenges that exist for women in cardiology. Dr. Lundberg takes us through her career journey and gives several pearls for fellows-in-training regarding achieving career goals, networking, mentorship, and the use of social media to further your career. Special message from Dr. Annabelle Volgman. Audio editing and episode introduction by Gurleen Kaur.

QuotablesShow notesGuest profilesAbout Narratives in CardiologyProduction team

Claim free CME just for enjoying this episode!

112. Narratives in Cardiology: Advocacy for Women’s Heart Health and Empowering Women in Cardiology with Dr. Gina Lundberg

Quotables

“Improving the work environment for women is going to be really important for job retention and for encouraging more women to go into EP, interventional cardiology, and heart failure…”

“One of the words of wisdom I say to a lot of early career women is slow down. You don’t have to drink the whole thing in your first 10 years. You can just slowly ease into it- there’s a time and a place for everything, a season for everything.”

“So start building your network. Build your ‘otter raft’ and by otter, I mean that group of people, men or women who really support you and lift you up, who might recommend you for a position or a lecture that might share opportunities with you”

Show notes

  1. What are some strategies to improve female representation in cardiology?
  • Practicing cardiologists, both men and women, need to mentor and sponsor trainees to attract more female into the field.
  • Improving the work environment is key to retention of women in cardiology (allowing for more flexibility to meet needs such as child-care etc.).
  • We need to build the pipleline to start recruiting females early on, even in high school.

2. What are some strategies to network as a fellow-in-training?

  • Start building your network early – attend ACC and AHA meetings. The ACC Legislative Conference is great because it’s a bit smaller and allows for more opportunities to meet leaders in the ACC.
  • Share your story with other people (example your old high school or sorority/fraternity) as an opportunity to mentor and inspire others.
  • Build your “otter raft”… that group of people who really support you and lift you up, who might recommend you for a position or a lecture that might share opportunities with you.

3. What is the role or value of social media for professional development?

  • Social medial democratizes the landscape, giving everyone a voice regardless of level of training, background, or beliefs.
  • It is invaluable for connecting and networking, on a global scale.
  • It empowers individuals to share – be it powerful stories, their thoughts, and of course education.
  • We of course need to be responsible with protecting our patient’s privacy, be discerning consumers, and be professional in our interactions.

CardioNerds Narratives in Cardiology
CardioNerds Narratives in Cardiology

The CardioNerds Narratives in Cardiology series features cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. Discussing why these faculty chose careers in cardiology and their passion for their work are essential components to inspiring interest in the field.

Each talk will feature a cardiology faculty from an underrepresented group, within at least one of several domains: gender, race, ethnicity, religion, national origin, international graduate status, disadvantaged backgrounds, etc.

Featured faculty will also represent a variety of practice settings, academic ranks, subspecialties (e.g. clinical cardiology, interventional cardiology, electrophysiology, etc), and career paths (e.g. division chief, journal editor, society leadership, industry consultant, etc).

Faculty will be interviewed by fellows-in-training for a two-part discussion that will focus on:

1) Faculty’s content area of expertise
2) Faculty’s personal and professional narrative

As part of their narrative, faculty  will discuss their unique path to cardiology and their current professional role with particular attention to challenges, successes, and advice for junior trainees. Specific topics will be guided by values relevant to trainees, including issues related to mentorship, work-life integration, and family planning.

To help guide this important initiative, the CardioNerds Narratives Council was founded to provide mentorship and guidance in producing the Narratives series with regards to guests and content. The CardioNerds Narratives Council members include: Dr. Pamela DouglasDr. Nosheen RezaDr. Martha GulatiDr. Quinn Capers, IVDr. Ann Marie NavarDr. Ki ParkDr. Bob HarringtonDr. Sharonne Hayes, and Dr. Michelle Albert.

The Narratives Council includes three FIT advisors who will lead the CardioNerds’ diversity and inclusion efforts, including the current project: Dr. Zarina SharalayaDr. Norrisa Haynes, and Dr. Pablo Sanchez.


Guest Profiles

Dr. Gina Lundberg
Dr. Gina Lundberg

Gina Price Lundberg MD FACC FAHA is an Associate Professor of Medicine at Emory University School of Medicine and has served as the Clinical Director of the Emory Women’s Heart Center since it was founded in 2013. She is a Preventive Cardiologist and specializes in heart disease in women, lipid abnormalities and cardiovascular risk reduction. She founded the first women’s heart prevention program in the state of Georgia in 1998. Dr Lundberg’s service at Emory University includes improving outcomes for women with cardiovascular disease but also improving gender equity for women in cardiology and encouraging more women to choose cardiology for their careers. She attended the Medical College of Georgia at Augusta University and trained in Internal Medicine at Atlanta Medical Center. Her cardiology fellowship was at Rush University in Chicago. She is active with the ACC, AHA, and NLA. She is the Chair-elect for the ACC Women in Cardiology Leadership Council and is the co-chair for the WIC Communications and Social Media Committee. She is the Co-chair for the NLA Social Media and Communications committee and the co-Chair for NLA DE&I Committee. She serves on the AHA Clinical Cardiology Communications and Social Media committee and the AHA Familial Hypercholesterolemia and Hyperlipidemia working group. And she serves as the Social Media Supervisor for JACC Case Reports.

Dr. Zarina Sharalaya - CardioNerds
Dr. Zarina Sharalaya

Dr. Zarina Sharalaya is an interventional cardiology fellow at the Cleveland Clinic. She completed medical school at The Ohio State University and then completed her residency at The University of North Carolina Chapel Hill. She moved back to her home state of Ohio to do general cardiology fellowship at The Cleveland Clinic. Zarina has been very involved with the Ohio ACC and this year has served as co-chair of the FIT Council. She is passionate about the Women in Cardiology initiative has been able to help formulate the first WIC chapter for Ohio ACC. She enjoys traveling, music, and spending time with her husband and new puppy Zuma.


Narratives in Cardiology Production Team

108. Narratives in Cardiology: Physician Scientists & Women in Electrophysiology with Dr. Christine Albert and Dr. Rachita Navara

CardioNerds (Amit Goyal and Daniel Ambinder) join Dr. Christine Albert (Professor of Medicine, Founding Chair of the Department of Cardiology at Cedars-Sinai, and President of Heart Rhythm Society) and Dr. Rachita Navara (FIT at Washington University, soon to be EP fellow at UCSF) for a Narratives in Cardiology episode. We learn from their experiences as physician scientists and women in cardiology, and specifically in electrophysiology.

Claim free CME just for enjoying this episode!

Narratives in Cardiology: Physician Scientists & Women in Electrophysiology with Dr. Christine Albert and Dr. Rachita Navara

Show notes

1. Over the last several decades, what have we learned about the contribution of lifestyle factors to atrial fibrillation?

  • Particularly in women, the development of obesity (BMI > 30 kg/m2) is associated with a 41% increase in the risk of developing atrial fibrillation (AF). Even short-term weight gains are associated with a 18% increased risk of developing AF. Fortunately, losing weight could modify or even reverse this elevated risk [1]
  • Exercise is beneficial for reducing the risk of AF, but higher frequency of vigorous exercise is actually associated with an increased risk of developing AF in young men and joggers. This risk decreases with age, and is offset by the other benefits of vigorous exercise on AF risk factors [2]
  • The link between alcohol consumption and AF was first described in 2008: for healthy middle-aged women, consuming two or more alcoholic drinks is associated with a statistically increased risk of developing AF [3]
  • The recent VITAL trial is the largest and longest randomized trial on primary prevention of AF, following over 25,000 men and women over five years. As recently presented at AHA 2020, Dr. Christine Albert and her study team found that neither vitamin D nor fish oil prevents the development of AF [4]

2. What is some practical advice on giving presentations and preparing research grants from Dr. Albert, renowned physician-scientist, and leader in electrophysiology?

  • Whenever possible, Dr. Albert recommends memorizing your presentation to avoid referencing notes frequently, and to allow for continued eye contact with the audience. Practice delivering your presentation multiple times prior to the scheduled talk.
  • When preparing a grant, start early and seek feedback and edits from those in and out of your field.
  • In many cases, a grant review involves individuals who may not be in your exact scientific field, so the priority is to interest the grant readers regardless of their scientific background.

3. Whether in research or clinical care, what are the common features of a well-oiled clinical team?

  • In an ideal team, every individual adds value and has a clear role. Team members show mutual respect and provide the autonomy for other team members to demonstrate their expertise.
  • Don’t be intimidated by the individuals on your team who are extremely talented or experienced in a given domain – this in turn elevates you by being on the same team!
  • Leaders are most successful when they enable others to succeed. The spirit of collaboration and respect comes from the top, so leaders need to demonstrate respect for every team member and give each person a role, eliminating the need for team members to compete with each other.

4. What is some advice for female trainees navigating a male-dominated field (e.g. electrophysiology)? What makes a good mentor and mentee?

  • It is very important to seek female or otherwise relatable role models in your field. While representation increases, it can also be valuable to seek female mentors outside your specific field.
  • It is just as important for male mentors to continue to support female trainees, especially in fields where females are underrepresented.
  • Often, as a mentee you may change your area of interest or seek a new area of specialization that may no longer be fully aligned with your mentor’s expertise. A good mentor will continue to mentor you and connect you with those who can help you explore your new interests.
  • A good mentee also recognizes that mentors often have very limited time, so it is best to package all of your questions together and prepare for each meeting so that shared time is most high yield.

CardioNerds Narratives in Cardiology
CardioNerds Narratives in Cardiology

The CardioNerds Narratives in Cardiology series features cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. Discussing why these faculty chose careers in cardiology and their passion for their work are essential components to inspiring interest in the field.

Each talk will feature a cardiology faculty from an underrepresented group, within at least one of several domains: gender, race, ethnicity, religion, national origin, international graduate status, disadvantaged backgrounds, etc.

Featured faculty will also represent a variety of practice settings, academic ranks, subspecialties (e.g. clinical cardiology, interventional cardiology, electrophysiology, etc), and career paths (e.g. division chief, journal editor, society leadership, industry consultant, etc).

Faculty will be interviewed by fellows-in-training for a two-part discussion that will focus on:

1) Faculty’s content area of expertise
2) Faculty’s personal and professional narrative

As part of their narrative, faculty  will discuss their unique path to cardiology and their current professional role with particular attention to challenges, successes, and advice for junior trainees. Specific topics will be guided by values relevant to trainees, including issues related to mentorship, work-life integration, and family planning.

To help guide this important initiative, the CardioNerds Narratives Council was founded to provide mentorship and guidance in producing the Narratives series with regards to guests and content. The CardioNerds Narratives Council members include: Dr. Pamela DouglasDr. Nosheen RezaDr. Martha GulatiDr. Quinn Capers, IVDr. Ann Marie NavarDr. Ki ParkDr. Bob HarringtonDr. Sharonne Hayes, and Dr. Michelle Albert.

The Narratives Council includes three FIT advisors who will lead the CardioNerds’ diversity and inclusion efforts, including the current project: Dr. Zarina SharalayaDr. Norrisa Haynes, and Dr. Pablo Sanchez.


Guest Profiles – Physician Scientists Women Electrophysiology

Christine M. Albert, MD, MPH
Dr. Christine M. Albert

Dr. Christine Albert is currently President of Heart Rhythm Society. She recently transitioned from Professor of Medicine at Harvard and Director of the Center of Arrhythmia Prevention at the Brigham to now Founding Chair of the Department of Cardiology at Cedars-Sinai. She is an Epidemiologist and R01-grant funded physician scientist with over 200 peer-reviewed publications – with landmark contributions demonstrating the role of lifestyle and genetics on heart rhythm disorders. She has served as PI for numerous large-scale award-winning clinical trials, her latest studying primary prevention of cardiovascular disease and cancer in 25,000 patients across the country. She has served as the associate editor for Circulation, and continues to serve on the editorial board of numerous journals in not only cardiology but also epidemiology, clinical nutrition, and endocrinology and metabolism.

Rachita Navara - CardioNerds
Dr. Rachita Navara

Dr. Rachita Navara is a bioengineer and senior cardiology fellow at Washington University in St. Louis. She is excited to enter her dream specialty of electrophysiology at UCSF, the birthplace of catheter ablation for arrhythmias. Her interest in EP emerged during bioengineering training at the innovative Olin College of Engineering. She went on to medical school at UT Southwestern, where she was the lead singer of her med school band “The Pacemakers.” Dr. Navara completed her internal medicine training at Stanford University, where she was accepted into the inaugural Biodesign Pathway of Distinction and researched complex atrial fibrillation mechanisms under the mentorship of Dr. Sanjiv Narayan. She joined cardiology fellowship at Wash U, where she researched novel noninvasive cardiac radioablation under the mentorship of Dr. Phillip Cuculich. Dr. Navara’s startup company “SafeBeat Rx LLC” was competitively selected into BioGenerator’s Grants-to-business program, and she recently submitted her first NIH STTR grant. She was appointed as the youngest member of the National ACC EP Leadership Council, and she is currently an HRS representative to the AMA. Dr. Navara aims to lead a research lab conducting trials on EP devices and mapping/ablating technologies she has designed herself. In her free time, she enjoys painting, singing and tandem biking with her husband, and competitive scrabble tournaments (nerd level: ultimate).


References – Physician Scientists Women Electrophysiology

  1. Tedrow, Usha B., David Conen, Paul M. Ridker, Nancy R. Cook, Bruce A. Koplan, JoAnn E. Manson, Julie E. Buring, and Christine M. Albert. “The long-and short-term impact of elevated body mass index on the risk of new atrial fibrillation: the WHS (Women’s Health Study).” Journal of the American College of Cardiology 55, no. 21 (2010): 2319-2327.
  2. Aizer, Anthony, J. Michael Gaziano, Nancy R. Cook, Joann E. Manson, Julie E. Buring, and Christine M. Albert. “Relation of vigorous exercise to risk of atrial fibrillation.” The American journal of cardiology 103, no. 11 (2009): 1572-1577.
  3. Conen, David, Usha B. Tedrow, Nancy R. Cook, M. V. Moorthy, Julie E. Buring, and Christine M. Albert. “Alcohol consumption and risk of incident atrial fibrillation in women.” Jama 300, no. 21 (2008): 2489-2496.
  4. VITamin D and OmegA-3 TriaL (VITAL) results presented at AHA 2020 ahead of publication:  https://www.cedars-sinai.org/newsroom/study-vitamin-d-fish-oil-dont-lower-atrial-fibrillation-risk/

105. Narratives in Cardiology: Racial Disparities in Advanced Heart Failure with Dr. Bryan Smith and Dr. Shirlene Obuobi

CardioNerds (Amit Goyal and Daniel Ambinder) join Dr. Bryan Smith (Advanced Heart Failure and Transplant Cardiologist at the University of Chicago) and Dr. Shirlene Obuobi (rising cardiology fellow, CardioNerds ambassador for the University of Chicago, and creator of ShirlyWhirl, M.D.) They discuss the story of a patient with end stage heart failure due to peripartum cardiomyopathy that highlights racial disparities in healthcare and advanced heart failure. They emphasize the importance of providing mentorship for Black and Indigenous People of Color (BIPOC) and share personal stories of their journey to Cardiology. Dr. Andi Shahu joins us to read his AHA blog titled “Let’s Ban the Phrase “Social Issues”: Social Justice and Advanced Heart Failure Therapies”. Audio editing by CardioNerds Academy intern, Pace Wetstein.

Collect free CME/MOC credit just for enjoying this episode! 

105. Narratives in Cardiology: Racial Disparities in Advanced Heart Failure with Dr. Bryan Smith and Dr. Shirlene Obuobi

Quotables:

“One of the reasons why I went into Heart Failure is because I connected a lot with these young patients, a lot of these young black men and black women who were terrified of the hospital. As a resident and a fellow I would go talk to them and really understand their fears and where they are coming from. I think a lot of times these patients can be labeled as ‘noncompliant,’ or ‘withdrawn,’ or ‘aggressive,’ but a lot of times you just have to understand where they’re coming from. And I really found that just sitting down to talk to them, and to get to know them, I was able to help get them better, or a lot of them went on to get VADs or transplant. And, to be perfectly honest, I’m in touch with a lot of these patients who I met as a fellow who…I feel are part of my life….You have to meet patients where they are. Meaning you need to text them, interact with them on social media, and really connect with them in a way they understand.” Dr. Bryan Smith (12:10)

“Being black in America means not getting the benefit of doubt. …I can’t help but wonder if unconscious bias among providers is imposing…unreasonable scrutiny on patients of color.” Shirlene (21:15)

“There are many different ways to combat [racial] disparities. As a Heart Failure physician we have these multidisciplinary meetings where we discuss patients for transplant. And I think it’s…important to highlight to our providers that how we discuss patients really matters. Language definitely matters. Heart failure is art in addition to science. …Sometimes when discussing these patients…charged words are used, like ‘withdrawn,’ or ‘aggressive,’ or ‘ghetto’ even. And it’s all coded, racist language. …Part of our responsibility is to educate everyone with implicit bias training….and to make sure we’re able to advocate for patients in the right way.” Dr. Bryan Smith (22:30)

“I’ve felt like I’ve been paying the minority tax…which is doing the necessary but unpaid and frequently seldom recognized labor of mentorship, community engagement, etc, and also of being hyper visible and acting as a symbol…” – Shirlene (24:52)

It’s really easy when patients are in the hospital to think of them only as patients and forget that they’re people too, and that people are complex, they have complex emotions, they have reactions to things, sometimes those reactions aren’t necessarily what we would think are appropriate for their medical situation, but they’re what make us human.” – Shirlene (9:50)

Notes:

1. What are some of the racial disparities in diagnosis and outcomes of peri-partum cardiomyopathy, and what are some factors that might be contributing to those disparities?

  • CVD disease is the leading cause of pregnancy-associated mortality in the US. Black and American Indian/ Alaskan Native women are 3-4x more likely to die from a pregnancy-related cause than white women. (1,2)
  • The incidence of peripartum cardiomyopathy (PPCM) is 4x higher in black women than in white women. Black women may make up to 40% of the cases. (3,4)
  • Black women with PPCM have lower LVEF at the time of diagnosis, lower rates of recovery of LVEF, higher incidence of mortality and need for LVAD/ transplant. (1,2)
  • Studies looking for genetic reasons for this disparity have come up short.
  • Black women are more likely to have comorbid conditions (i.e., gestational HTN, preeclampsia).

2. What is it like taking care of younger patients with LVEF, especially young black patients?

  • Working in Advanced Heart Failure gives cardiologists the opportunity to work with younger patients due to the prevalence of CMs that present at younger ages.
  • Younger patients tend to feel more invincible, and to have more distrust of the medical system.
  • It is important to get to know these patients, meet them where they are, and communicate with them in ways they understand (text, social media).  

3. How can we help to break the black patients’ distrust in the medical system?

  • Understand the history: medicine has historically excluded and abused black patients. (ie. the Tuskegee study withheld treatment from black sharecroppers, gynecological surgery experimentations on black slave women, a legacy of segregation, etc.)
  • Listen to our patients and try to meet them where they are.
  • Understand the social determinants of health (SDOH) that may influence their ability to “adhere” to therapy/ appointments (i.e., difficulty finding childcare, employment restrictions)
  • Partner with community initiatives (i.e., Urban Health Initiative at University of Chicago)
  • Hire and train members of the community to work in the hospital!
  • Invest in Pipeline programs and mentorship.

4. Why is diversity in the medicine important?

  • Concordance of race between providers and patients improves trust, quality of care, and improves patient outcomes! (5)
  • Black patients are less likely to be referred for catheterization, AICDs, etc., despite our best efforts to provide equitable care.
  • Language is important! Consider the use of coded language and racially disparate expectations for patients when discussing issues such as transplant candidacy.
  • Recruit physicians who are interested in disparities research, and make research into disparities a basis for promotion.

5. How do we engage the rest of the cardiology community to be invested in the recruitment and mentorship of underrepresented minorities in medicine (URiMs)?

  • URiMs frequently pay the “minority tax,” or the necessary but unpaid and seldom recognized labor of mentorship, community engagement, etc. That can be a heavy load to carry, especially considering only 5% of cardiology fellows identify as being Black.
  • “You can’t really be what you can’t see” – there’s a responsibility that URMs have in cardiology to be visible to inspire future generations.
  • However, mentorship of URiMs should not be limited to only URiM faculty. Centers should try to recruit and establish a culture that values diversity.
  • Diversity shouldn’t be limited to just attributes like race/ gender, but also in interest. Without diversity of thought, you may not have adequate mentorship and community engagement.

Show notes updated as of 3.2.2021


CardioNerds Narratives in Cardiology
CardioNerds Narratives in Cardiology

The CardioNerds Narratives in Cardiology series features cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. Discussing why these faculty chose careers in cardiology and their passion for their work are essential components to inspiring interest in the field.

Each talk will feature a cardiology faculty from an underrepresented group, within at least one of several domains: gender, race, ethnicity, religion, national origin, international graduate status, disadvantaged backgrounds, etc.

Featured faculty will also represent a variety of practice settings, academic ranks, subspecialties (e.g. clinical cardiology, interventional cardiology, electrophysiology, etc), and career paths (e.g. division chief, journal editor, society leadership, industry consultant, etc).

Faculty will be interviewed by fellows-in-training for a two-part discussion that will focus on:

1) Faculty’s content area of expertise
2) Faculty’s personal and professional narrative

As part of their narrative, faculty  will discuss their unique path to cardiology and their current professional role with particular attention to challenges, successes, and advice for junior trainees. Specific topics will be guided by values relevant to trainees, including issues related to mentorship, work-life integration, and family planning.

To help guide this important initiative, the CardioNerds Narratives Council was founded to provide mentorship and guidance in producing the Narratives series with regards to guests and content. The CardioNerds Narratives Council members include: Dr. Pamela DouglasDr. Nosheen RezaDr. Martha GulatiDr. Quinn Capers, IVDr. Ann Marie NavarDr. Ki ParkDr. Bob HarringtonDr. Sharonne Hayes, and Dr. Michelle Albert.

The Narratives Council includes three FIT advisors who will lead the CardioNerds’ diversity and inclusion efforts, including the current project: Dr. Zarina SharalayaDr. Norrisa Haynes, and Dr. Pablo Sanchez.


Guest Profiles

Bryan Smith MD - CardioNerds
Dr. Bryan Smith

Dr. Bryan Smith is an Advanced Heart Failure and Transplant Cardiologist at University of Chicago. Dr. Smith completed his medical school training, residency and Cardiology fellowship at University of Chicago, then traversed Lake Shore Drive to complete his advanced HF fellowship at Northwestern. At University of Chicago, he serves as the director of the hemodynamic Cath lab, on the Chicago board for AHA, and as a faculty mentor for SNMA (Student National Medical Association.) Dr. Smith’s interests lie in community-based interventions for heart failure management and racial disparities, and he is the face of several mentorship programs, including the Heart and Vascular Mentoring program here in Chicago.

Dr. Shirlene Obuobi - CardioNerds
Shirlene Obuobi, MD

Shirlene Obuobi, M.D. is a current PGY3 IM resident and rising cardiology fellow. Born in Accra, Ghana and bred in Chicago, Hot Springs, Arkansas, and The Woodlands, Texas, Shirlene completed her medical school training at University of Chicago Pritzker School of Medicine, and has remained at the University ever since. She is passionate about narrative medicine, health equity, and health disparities, and espouses these passions via her medical comic platform, ShirlyWhirl, M.D. Outside of medicine, she also loves to write. Within Cardiology, she is most interested in Prevention, but is remaining open minded.

Dr. Andi Shahu
Andi Shahu, MD, MHS

Dr. Andi Shahu is a resident physician in the Osler Medical Residency in Internal Medicine at Johns Hopkins Hospital in Baltimore, MD. He will begin General Cardiology fellowship in July 2021 at Yale University. He is interested in the intersection between cardiovascular outcomes, health equity and health policy. You can follow him on Twitter @andishahu


References

  1. Irizarry OC, Levine LD, Lewey J, et al. Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non-African American Women. JAMA Cardiol. 2017;2(11):1256-1260. doi:10.1001/jamacardio.2017.3574  (https://jamanetwork.com/journals/jamacardiology/fullarticle/2657313)
  2. DeFilippis EM, Truby LK, Garan AR, et al. Sex-Related Differences in Use and Outcomes of Left Ventricular Assist Devices as Bridge to Transplantation. JACC Heart Fail. 2019;7(3):250-257. doi:10.1016/j.jchf.2019.01.008  https://pubmed.ncbi.nlm.nih.gov/30819381/
  3. Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. 2016;133(14):1397-1409. doi:10.1161/CIRCULATIONAHA.115.020491 (https://pubmed.ncbi.nlm.nih.gov/27045128/)
  4. Lewey J, Levine LD, Elovitz MA, Irizarry OC, Arany Z. Importance of Early Diagnosis in Peripartum Cardiomyopathy. Hypertension. 2020;75(1):91-97. doi:10.1161/HYPERTENSIONAHA.119.13291 (https://pubmed.ncbi.nlm.nih.gov/31707840/0)
  5. Jetty A, Jabbarpour Y, Pollack J, Huerto R, Woo S, Petterson S. Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations [published online ahead of print, 2021 Jan 5]. J Racial Ethn Health Disparities. 2021;10.1007/s40615-020-00930-4. doi:10.1007/s40615-020-00930-4 (https://pubmed.ncbi.nlm.nih.gov/33403653/)
  6. Takeshita J, Wang S, Loren AW, et al. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open. 2020;3(11):e2024583. Published 2020 Nov 2. doi:10.1001/jamanetworkopen.2020.24583 (https://pubmed.ncbi.nlm.nih.gov/33165609/)

100. Women’s Heart Health & Women in Cardiology with Dr. Nanette Wenger – Special Go Red Encore

CardioNerds (Amit Goyal & Carine Hamo) discuss the past, present, and future of Women’s Heart Health & Women in Cardiology with Dr. Nanette Wenger, Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine. Dr. Wenger is a true leader in the field of women’s heart health and a strong proponent for women in cardiology and medicine. Her passion, dedication, and advocacy have inspired countless trainees to carry this torch and continue to build on her truly impactful work. Special introduction by Dr. Martha Gulati. This is a special encore in recognition of the Go Red campaign and celebration of women’s health.

Collect free CME/MOC credit for enjoying this episode! 

Dr. Nanette Wenger Women's Cardiovascular Health: Past, Present, & Future
Episode graphic by Dr. Carine Hamo

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

This episode initially ran as part of the CardioNerds Prevention Series which we produced in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention!

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

References and Links

1. Wenger NK (2005) Women in cardiology: The US experience. Heart.

2. Douglas PS, Rzeszut AK, Noel Bairey Merz C, Duvernoy CS, Lewis SJ, Walsh MN, Gillam L (2018) Career preferences and perceptions of cardiology among us internal medicine trainees factors influencing cardiology career choice. JAMA Cardiol.

3. Wenger NK, Speroff L, Packard B (1993) Cardiovascular Health and Disease in Women. N Engl J Med.

4. Burgess S, Shaw E, Zaman S (2019) Women in Cardiology. Circulation.

Meet Dr. Wenger!

Dr. Nanette Wenger is Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine. Dr. Wenger received her medical degree from Harvard Medical School in 1954 as one of their first female graduates followed by training at Mount Sinai Hospital where she was the first female to be chief resident in the cardiology department. She is among the first physicians to focus on heart disease in women with an expertise in cardiac rehabilitation and geriatric medicine.

Dr. Wenger has received numerous awards including the Distinguished Achievement Award from the Scientific Councils of the American Heart Association and its Women in Cardiology Mentoring Award, the James D. Bruce Memorial Award of the American College of Physicians for distinguished contributions in preventive medicine, the Gold Heart Award, the highest award of the American Heart Association, a Lifetime Achievement Award in 2009 and the Inaugural Bernadine Healy Leadership in Women’s CV Disease Distinguished Award, American College of Cardiology. She chaired the U.S. National Heart, Lung, and Blood Institute Conference on Cardiovascular Health and Disease in Women, is a Past President of the Society of Geriatric Cardiology and is past Chair, Board of Directors of the Society for Women’s Health Research. Dr. Wenger serves on the editorial boards of numerous professional journals and is a sought-after lecturer for issues related to heart disease in women, heart disease in the elderly, cardiac rehabilitation, coronary prevention, and contemporary cardiac care. She is listed in Best Doctors in America.

95. Introducing Narratives in Cardiology Series: Dr. Pamela Douglas on Diversity & Inclusion

CardioNerds (Amit Goyal and Daniel Ambinder) introduce the CardioNerds Narratives in Cardiology Series which will feature the stories of amazing cardiovascular faculty and trainees representing diverse backgrounds, subspecialties, career stages, and career paths. To kick this series off, Dr. Pamela Douglas, who heads the Diversity and Inclusion task force for the American College of Cardiology, provides valuable insights in the field and shares her personal story. We are joined by the CardioNerds Narratives #FIT Advisors, Dr. Zarina Sharalaya, Dr. Norrisa Haynes and Dr. Pablo Sanchez for this very important discussion.

Special messages by: Dr. Vanessa Blumer, Dr. Robert Harrington, Dr. Richard Chazal, Dr. Nosheen Reza, Dr. Neha Pagidipati, Dr. Mary Norine (Minnow) Walsh, Dr. Melissa Daubert, Dr. Gerald Bloomfield, Dr. Angela Lowenstern, Dr. Ralph Brindis, Dr. Michael Valentine, Dr. Anna Lisa Crowley, Dr. Malissa Wood and Dr. Geoffrey Ginsberg.

95. Introducing Narratives in Cardiology Series: Dr. Pamela Douglas on Diversity & Inclusion

Show notes

  1. What is “Diversity” & “Inclusion”?
    • Facets of diversity are all aspects of human differences. 
    • These include gender, race, ethnicity, age, physical ability, gender identity, national origin, language, religion, sexual orientation, socioeconomic status, and more.
    • Inclusion is making everyone feel welcomed and included.
    • Inclusion requires having a culture & environment where everyone can thrive regardless of background differences. 
    • This inclusive culture fosters respect & belonging in which we hear, appreciate, & value everyone and their perspectives.
    • Inclusive organizations work with individuals to recognize and eliminate both explicit and implicit biases. They may do this with intentional efforts like professional & skills development as well as addressing awareness, education, and policy. 
    • Diversity measures representation by counting the presence of varying identities and characteristics. But Diversity itself is not the final goal.
    • Diversity is the metric while Inclusion is the goal. For now, while representation is so disparate among certain groups, diversity is an important metric. It’s hard to be truly inclusive with such professional inequities. 
    • “Ultimately what we want is for people to belong. So not just be asked to the dance and sitting around and staring at everybody else but really feeling like you can go out on that dance floor and dance, like nobody’s watching and it’s fine because this is your  community.” – Pamela Douglas
  1. Why is achieving diversity important?
    • Diversity is a virtue in and of itself. 
    • But more than that, diverse groups make better decisions, are more innovative, are better at problem solving, and have an expanded talent pool.
    • Cardiovascular medicine benefits from having a diverse workforce. Science performed by diverse groups has greater scientific novelty and produces higher impact papers in higher impact journals.
  1. Is there a link between professional diversity and healthcare inequities?
    • YES!
    • Physician diversity reduces healthcare disparities and improves healthcare quality.
    • Physicians who train in diverse environments are more culturally competent when treating underrepresented groups.
    • Underrepresented physicians are more likely to serve underrepresented populations.
    • Underrepresented patients are more likely to follow the recommendations of physicians who look like them. This enhanced trust is critical to an effective patient-physician relationship. 
    • In the context of clinical trials and guidelines, underrepresented physician scientists help diversify our clinical trial participants, resulting in a more robust and representative evidence base. 
  1. How are we doing in cardiology with respect to diversity?
    • There have been improvements but we have a long way to go.
    • Women comprise 43% of internal medicine resident physicians by only 22% of general cardiology fellows and even lower proportions within procedural fields.
    • Underrepresented minorities–specifically Blacks, Hispanics, and Native Americans–make up about 32% of the US population but only 13% of general cardiology fellows.
    • Benchmarks for other racial and ethnic groups and for other facets of diversity like socioeconomic status, sexual orientation, gender identity, IMG status, and others are even less clear.
    • Inequities amplify in advanced career and leadership positions. 
      • Only 11%, 9%, 11%, and 24% of Asian, black, Hispanic, and white women, respectively, are full professors compared with 21%, 18%, 19%, and 36% of Asian, black, Hispanic, and white men, respectively (Albert 2018).
      • In the top 40 ranked cardiology programs, there are no female cardiology chiefs (Albert 2018).
      • There were no women editors-in-chief for US general cardiology journals between 1998 and 2018 and only 1 woman editor-in-chief for a general European cardiology journal (Balasubramanian et al., 2020).
    • Such benchmarks are helpful for measuring representation, but remember the ultimate goal is Inclusion. We want to be more holistic in our approach to Inclusion.
    • Let’s focus on competency and quality. Given the benefits of a diverse workforce discussed above, Diversity itself is a competency. If someone brings a different background & perspective, they are valuable to the group, just as someone else with specific leadership and interpersonal skills. 
  1. How do we create a more diverse Cardiology?
    • This requires a multi-pronged approach that spans deep pipeline projects through to career ascension.
    • We must deliberately address implicit bias and both systemic racism & sexism.
    • Among other efforts (detailed below), we have to create a welcoming environment, showcase a culture conducive to work-life integration, and ensure equity in compensation, opportunities, and promotion. 
    • According to a survey of internal medicine trainees, the top perceptions of cardiology careers were adverse job conditions, interference with family life, and lack of diversity. Women and those residents who had already chosen noncardiology careers more strongly valued work-life balance and had more negative perceptions of cardiology than men or future cardiologists. Compared with men, women trainees placed greater value on stable hours, family friendliness, female friendliness, and positive role models (Douglas et al., 2018).
    • Understanding these perceptions was a key motivator for the CardioNerds Narratives in Cardiology series! The CardioNerds “Narratives in Cardiology” series will feature cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. The faculty will be interviewed by fellows-in-training (FITs) to discuss both their clinical expertise and their individual career narratives with the goals of showcasing diversity within the profession, inspiring interest in the field, and demonstrating the more positive culture of modern cardiology.

Show notes updated as of 12.30.2020


CardioNerds Narratives in Cardiology
CardioNerds Narratives in Cardiology

The CardioNerds Narratives in Cardiology series features cardiovascular faculty representing diverse backgrounds, subspecialties, career stages, and career paths. Discussing why these faculty chose careers in cardiology and their passion for their work are essential components to inspiring interest in the field.

Each talk will feature a cardiology faculty from an underrepresented group, within at least one of several domains: gender, race, ethnicity, religion, national origin, international graduate status, disadvantaged backgrounds, etc.

Featured faculty will also represent a variety of practice settings, academic ranks, subspecialties (e.g. clinical cardiology, interventional cardiology, electrophysiology, etc), and career paths (e.g. division chief, journal editor, society leadership, industry consultant, etc).

Faculty will be interviewed by fellows-in-training for a two-part discussion that will focus on:

1) Faculty’s content area of expertise
2) Faculty’s personal and professional narrative

As part of their narrative, faculty  will discuss their unique path to cardiology and their current professional role with particular attention to challenges, successes, and advice for junior trainees. Specific topics will be guided by values relevant to trainees, including issues related to mentorship, work-life integration, and family planning.

To help guide this important initiative, the CardioNerds Narratives Council was founded to provide mentorship and guidance in producing the Narratives series with regards to guests and content. The CardioNerds Narratives Council members include: Dr. Pamela DouglasDr. Nosheen RezaDr. Martha GulatiDr. Quinn Capers, IVDr. Ann Marie NavarDr. Ki ParkDr. Bob HarringtonDr. Sharonne Hayes, and Dr. Michelle Albert.

The Narratives Council includes three FIT advisors who will lead the CardioNerds’ diversity and inclusion efforts, including the current project: Dr. Zarina SharalayaDr. Norrisa Haynes, and Dr. Pablo Sanchez.


Guest Profiles

Pamela S Douglas MD is the Ursula Geller Professor of Research in Cardiovascular Diseases in the Department of Medicine at Duke University. She has led several landmark and pivotal multicenter randomized clinical trials and outcomes research studies funded by government, professional societies, and industry. She is renowned for her scientific and policy work in improving the quality and appropriateness of imaging in clinical care, clinical trials, and registries and through development and dissemination of national standards for imaging quality, utilization, informatics, and analysis. Dr Douglas helped to establish several important specialty areas including heart disease in women, sports cardiology, and cardio-oncology. Dr. Douglas’ wealth of experience includes authorship of over 500 peer reviewed manuscripts and 30 practice guidelines, service as the President of the American College of Cardiology, President of the American Society of Echocardiography, and Chief of Cardiology at both the University of Wisconsin-Madison and Duke University. She has also previously served on the faculties of the University of Pennsylvania and Harvard University. She has served on the External Advisory Council of the National Heart, Lung and Blood Institute and the Scientific Advisory Boards of the National Space Biomedical Institute and the Patient Advocate Foundation.

Dr. Zarina Sharalaya is an interventional cardiology fellow at the Cleveland Clinic. She completed medical school at The Ohio State University and then completed her residency at The University of North Carolina Chapel Hill. She moved back to her home state of Ohio to do general cardiology fellowship at The Cleveland Clinic. Zarina has been very involved with the Ohio ACC and this year has served as co-chair of the FIT Council. She is passionate about the Women in Cardiology initiative has been able to help formulate the first WIC chapter for Ohio ACC. She enjoys traveling, music, and spending time with her husband and new puppy Zuma.

Dr. Norrisa Haynes is a senior cardiology fellow at the University of Pennsylvania (UPenn). She attended Yale University for her undergraduate studies where she received a Bachelor of Science (BS) in Molecular and Cellular Biology. She went on to complete her medical school and internal medicine training at Columbia University College of Physicians and Surgeons. During medical school, she received a Master of Public Health (MPH) from Harvard University. After residency, she worked for Partners in Health (PIH) in Haiti for 2 years at Hôpital Universitaire de Mirebalais (HUM) as a junior attending. During those two years, she also worked as a Harvard Medical School instructor and Brigham hospitalist. After spending 2 years in Haiti, she started cardiology fellowship at UPenn. She is interested in imaging and is currently obtaining a Master of Science in Health Policy (MSHP). Dr. Haynes is a member of the ACC/AHA joint guidelines committee and is a member of UPenn’s Women in Cardiology group (WIC). Dr. Haynes also serves the fellow representative to the board of the Association of Black Cardiologists (ABC).

Dr. Pablo Sanchez is a cardiology fellow at Stanford University Medical Center. He completed medical school The University of Arizona, in Tucson. He completed Internal Medicine training at Brigham & Women’s Hospital, and served as Chief Resident from 2018-2019. He is devoted to furthering diversity and inclusion, and passionate about using compelling and effective methods to aid medical education. His clinical and research interests encompass critical care cardiology, end-stage heart failure, respiratory failure and ARDS. He plans to pursue further training in critical care medicine. Outside of medicine, his time revolves around his wife/family, friends, Latin American music and mambo/salsa dancing.


References

1. Albert MA. #Me-Who anatomy of scholastic, leadership, and social isolation of underrepresented minority women in academic medicine. Circulation. 2018;138(5):451-454. doi:10.1161/CIRCULATIONAHA.118.035057

2. Douglas PS, Rzeszut AK, Noel Bairey Merz C, et al. Career preferences and perceptions of cardiology among us internal medicine trainees factors influencing cardiology career choice. JAMA Cardiol. 2018;3(8):682-691. doi:10.1001/jamacardio.2018.1279

3. Douglas PS, Williams KA, Walsh MN. Diversity Matters. J Am Coll Cardiol. 2017;70(12):1525-1529. doi:10.1016/j.jacc.2017.08.003

4. Damp JB, Cullen MW, Soukoulis V, et al. Program Directors Survey on Diversity in Cardiovascular Training Programs. J Am Coll Cardiol. 2020;76(10):1215-1222. doi:10.1016/j.jacc.2020.07.020

5. Poppas A, Albert MA, Douglas PS, Capers Q. Diversity and Inclusion: Central to ACC’s Mission, Vision, and Values. J Am Coll Cardiol. 2020;76(12):1494-1497. doi:10.1016/j.jacc.2020.08.019

6. Mehta LS, Fisher K, Rzeszut AK, et al. Current Demographic Status of Cardiologists in the United States. JAMA Cardiol. 2019;4(10):1029-1033. doi:10.1001/jamacardio.2019.3247

7. Balasubramanian S, Saberi S, Yu S, Duvernoy CS, Day SM, Agarwal PP. Women representation among cardiology journal editorial boards. Circulation. 2020. doi:10.1161/CIRCULATIONAHA.119.042909