Absite Smackdown! · Absite Review--Colorectal


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Jessica R: Hey guys. Welcome back. It's me, your host, Jessica for the Absite Smackdown podcast. And with me today is Dr. David Kashmer. Hey Dr. David!



Dr. Kashmer: Hey, Jessica. Welcome. Welcome back. I was going to welcome you like it's not your show! I'm not sure why...but anyhow it's great to be back on the podcast with you.



Jessica R: 'Cause I like letting you take the lead all the time. So you're getting used to it. It's getting comfortable. My master plan is working.



Dr. Kashmer: Like how you usually have me do the intro. Hahaha. I know. I know. Well, it's good to be back with you.



Jessica R: Wonderful. Okay. So what we're talking about today is we've been hearing, especially right now with us working on version three with all the residents, how much COVID has impacted the way we're doing things including the ABSITE. And I know we're talking about COVID so much, but that's not really what I'm focusing on this time. It's just kind of adding to it. So when I'm doing research and trying to figure out how it's affecting it and how we've made changes, how it's affecting our residents, what they're doing differently, I ran across this article on AMA and it was just diving into like what they're doing, what they're doing and on helping the residents with, you know, during this pandemic and everything going on. And it, and it got into things a little bit. And not just their physical health, but their mental health. And I just found it really interesting.



Jessica R: And I want to talk about that, because things are very different today than when you were a resident, which obviously, you know. Like the work weeks are shorter, the way we do things, the technology, the ABSITE tools, some of the stuff...I'm not saying the residents now have it easier. That's not what I'm saying, but I am saying it's very different. And so I kind of want to talk about that a little bit. You know, how it's helpful, what we're doing for the mental health, the changes we've made during the pandemic, especially compared to your general surgery residency. What you've done as a general surgery program director, how your experiences combined with today include making changes. So are you on board with that?



Dr. Kashmer: Let's do it. A couple of things. Jessica, as we start off. All this means we need to be better. The whole work hours changes that came so many years ago. Now, it's been a while and we keep talking about these. And not just you and me, but we keep talking about them. Like it's fresh! That's in part because it's so different, but they've been here a while now. It means we need to be better. What I like to say is we used to teach by what's sometimes called a brute force approach, which is "hey just do a lot of stuff and you'll learn". We still had didactics. We still had all these things, but now that ability to do a more brute force go do a lot of it mentality is less. And the residents still do a lot of everything.



Dr. Kashmer: We now need to almost be different than that, or better than that, you may say. Because we need to do a really good job with a more limited time. And you may say we perhaps weren't using time to the best of our ability before, but whether you agree with that or not, we can probably all agree that it's now different. So happy to talk with you about it today. It has been a huge impact, not just those hours, but now the black swan of COVID. Black swans are these rare events that happen. There's a long story behind why the saying Black Swan came out, but these are basically rare events that you weren't really thinking about too much. And then you get blindsided by COVID. We knew there would be some pandemic, probably eventually these had been predicted since I was in medical school with things like the flu or some other virus being put forward as the culprit, but it really wasn't on our main radar perhaps as much as it should have been. So anyway, here we are, and here you and I are, and I'm happy to talk about it with you.



Jessica R: Wonderful. Okay. So when I was reading this article and it was going through not just surgical residents, but all different kinds of residents in different fields and what they were doing and, you know, their work hours and, how they had scaled and done things differently. I know we do talk about the hours a lot, but, when we were talking with Dr. Carlos, he had talked about, that they could do things about helping the residents like game nights, getting them out of the hospital, making sure that they have rest, that they have ABSITE study time back with their mothership during general surgery residency. I love using that term "mothership". I'm such a nerd. Anyways, all of that and how different that is. And so, you know, with you managing a whole residency and being a general surgery program director, what did you find yourself doing because of how difficult it was when you were a general surgery resident? I mean, you've told me the stories that we may not ever talk about on here about the things you did.



Dr. Kashmer: Yeah.



Jessica R: And later you did things so that no one has to everything that you did. Being a residency director is to make it better for the coming generations. Like everything you do is to make it better and easier and not just for ABSITE review. So what have you adapted? What have you done to help general surgery residents with this pandemic.



Dr. Kashmer: Yeah. Well, first, yes, there are definitely some stories that I probably will not share on here. But I'm going to tell you, a lot of what you asked is really spot on. And when you say, what did we do when I was a program director to help...what did I do? Well, Absite Smackdown! You guys were great about helping set this up. And why did we do it? We did it because I really saw coming, not COVID, but things that were going to require us to have asynchronous lectures from anywhere on any device. And boy, wouldn't it be great if that also had an ABSITE review book that it matched? And boy, wouldn't it be great if we could do this like we said anywhere anytime throughout the year and spread it out? So, beyond just the book, the whole approach to Absite Smackdown that you guys have been so good about, with incorporating social media in a positive way and all these things, that's some of it, but that's not all.



I also thought it was very important to help general surgery residents get to know themselves. And, these colleagues are people who've been through college and medical school. They're high performers. They really are, and most know how to study and succeed when it comes to things like ABSITE review. Pretty much all of them or else they wouldn't be where they are. And so the next question is how do you coach them to help them get to the next level and become lifelong learners? How do you get them to enter general surgery as a field in a way that will be sustainable so that they don't experience symptoms of burnout, emotional depersonalization, and all these things?



Dr. Kashmer: And so we set up things to learn, over time, what kind of learners we had, what are we, are we kinesthetic learners? Are we auditory? All the different types that we've talked about in other podcasts. So like you said, Dr. Carlos, when he was on with us we all talked about some of the things he does in the site that he helps run to promote resident wellness. And, we did a lot of those things too, with some wellness events. And I'm going to add one more thing. The last thing is we looked at this and talked about just how much all of these things were focused on for residents with resident wellness and everything. And we said, you know what? We use science so much in general surgery.



Dr. Kashmer: Why haven't we put any science on this wellness issue? Can we quantify how much reserve we have? And so we did some studies actually on attendings. We used trauma and acute care surgeons, because that's what I had access to. Where we used physiology, heart rate variability, resting heart rate...all these different things to see how it influenced us to make decisions, et cetera. So we took a model from pro athletes, pro athletes use this same technology, and we applied it to ourselves as surgeons. And we did that to ask and answer the question, what does fatigue look like in us and how can we best offset it? So we collected a bunch of variables. We put together a paper and we're putting it through the publishing process. Like many papers, it didn't make the first journal that we submitted to and we revised it and we're still working through that. So we do all those things. We said, let's do science, let's try science during general surgery residency, because a lot of it was things people talked about, but really couldn't quantify. And so super long answer, but those are all things we did to try to do this better for the next generation.



Jessica R: I think that's great answer. I mean, you use science for everything else in your profession. Why wouldn't you use it to make your wellness better?



Dr. Kashmer: Yeah. Let's try science. That's what we did.



Jessica R: Okay. So, you know, we've been working a lot with residents lately on the ABSITE review book. I know we've talked a little bit about how with version three, we've brought on new authors, new people contributing to it. And, you know, we've gotten so much positive feedback on the previous two books and what we're doing for this book. And, you know, there's no way to go into this version three and not talk about COVID. I know a lot of us are COVID-ed out. And we talked about it a lot, but we'd be remiss not to include it because it's been an entire year of our life whether during general surgery residency or not. And I kind of want to know, what do you think coming out of this benefited the residents? How has that helped you make better doctors that are residents that maybe wouldn't have happened pre-pandemic?



Dr. Kashmer: We talked about it briefly in a podcast before, and to my mind, it makes them better. It makes them more resilient. It's changed how we educate them often in a better way. It may even help them focus more when it's time to study for the American Board of Surgery board exam. (The qualifying exam or even certifying exam.) I think, to provide resources that we probably should have been, I think, a little better about putting out there earlier on to help with residents with things like exams, Absite score, or the students with their shelf exam, etc. The tech has been here for a while for a lot of the ability to educate at a distance during the residency program. It's preferred in some series by residents. So there's even evidence on it now, and there are different residencies (we've talked about this before) that have published on creating a didactic schedule and curriculum that utilizes technology to do these things. So I think we could have probably done some of this before and COVID pushed us to do it, which is fine. Sometimes you need to push and necessity is the mother of invention. Obviously things like the SCORE curriculum were already being used and are very valuable when it comes to examination prep and just learning Surgery overall.



Dr. Kashmer: So there it is. But I'll share with you that I think this resident group that is training now, this cohort throughout COVID, I think it's going to make them better. And not just when it comes to ABSITE performance. I think it has made them somewhat more resilient. I think they've encountered something that I never had and yet been able to maintain training. I think the residencies have, all the residents we've talked to and in working with several residencies, been very focused on making sure the resident trainees get that critical mass of cases and that hands-on stuff that they need. So they've really done well to try to ensure that. So I think any, any issues with that will be minimized. And again, I think, it has just really made for a group of residents that I'm pretty proud to work with because they've experienced something like this and they understand what it means to go through a pandemic on a global scale and all the things that can happen in Medicine. It's very different than when I came through. And I see this difference in this respect as a positive for them.



Jessica R: Right I think it kind of hints back to what you said before: often, if it's not broke, we don't fix it. And it's not just in the medical profession, it's in a lot of things. If something's working, you can kind of be slow to make changes, but because of the way this happened, we've had the technology, we've got all these things, but we didn't really adapt it because what we were doing, it worked. And now this pushed it to make changes that overall can allow more growth with more opportunities, a little bit more multitasking, getting things done. And it's all happened because of this. Like you said, necessity is the mother of invention. And so it took away the reasons not to do it and just to make it happen. And that's where we are right now.



Dr. Kashmer: I think you're seeing it with the Project Smackdown team too. You know, for the second volume, we had a great bunch of contributors and authors and the illustration team...they're really good. And for this one also very good. And I think you, in managing that team, and when you participate with that side of the work, you can probably appreciate just how resilient and interested and eager the residents are. They're looking to help each other, whether that's in developing Absite Smackdown as a resource or developing things that their colleagues can use in what is a difficult time for everyone. So residents look across their programs and have a really strong attitude about helping each other out and doing the best they can and making sure they're educated. So it's been great to see.



Jessica R: It is kind of wonderful. Like the whole community has come together a little bit, in healthcare. I love all of our residents and everyone that we've gotten to work with this whole time that I've been on the Absite team and, you know, been with the publisher, but I'm definitely noticing, and just like the last several months with this group of residents and how we're working, just kind of how like eager and grateful they are. They have such good attitudes and so positive, which, you know, you wouldn't think with how much they're working and all this going on. It's just, it's amazing to me and surprising and super awesome. And it just makes my job so much easier and me super grateful to be doing it.



Dr. Kashmer: Yeah, that's good to hear. This group for the Project Smackdown team is really fantastic to work with. I couldn't agree with you more.



Jessica R: All right. So we've touched on all that. I kind of want to maybe, well, it's up to you, want to give a little bit of hints of what's upcoming and what we have going on.



Dr. Kashmer: Let's do it. You're the boss for that part.



Jessica R: Okay. So, you know, recently around Christmas time, we did release that coloring book, which was super awesome. I can never say this word, right. Can you say it for me? Kin-es-thet-ic



Dr. Kashmer: Yeah. Kinesthetic learners. It's been good. It's they've seemed to like the coloring book.



Jessica R: Yeah. And then we released the crossword book, which was really awesome, kind of difficult. Like I work with the material every day and it even it's super challenging, but so helpful. I really, really enjoy it. And so, you know, now with us during version three, we're having all these new authors, all these new people, helping us and making more content, more coloring books, more crosswords. And then version three! Am I allowed to give away some of the newness with version three? Are we keeping that under wraps?



Dr. Kashmer: Again You guys are the boss. I'm happy to talk about it here. And I think you guys, I think, our mutual director has told me before, that I'm allowed to talk about some stuff. So I say we do it and you know, what, if they don't?



Jessica R: Okay. Well, I mean, I just need the backup, so I don't get in trouble, you know? 'Cause I'm overly eager to share stuff.



Dr. Kashmer: If they let you go, they're going to have to let me go too! So let's do it.



Jessica R: Yeah. Okay. You're more important, but all right. So, you know, we have gotten so much positive feedback from the previous books and, you know, we've made the changes, we've made the adjustments...and now we are adding two new chapters to this book.



Dr. Kashmer: Yeah. So even though spread throughout the book was stuff about, you know, the esophagus and the pancreas and things like that...we're going to consolidate it into separate chapters. Like you said before and in another podcast, feedback's tough. I know you guys are great about getting it. We, we want to use it and we want to keep making it better. The challenge with feedback is sometimes it comes from other publishers who don't really have the best interest of the book at heart.



Jessica R: Yeah.



Dr. Kashmer: And sometimes it comes from people, you know, like some of the ones we got about, the, what was the one? Oh yea, the person who said the videos don't follow the book. I will remember that one because they almost follow it exactly. And you guys said, well, did these people even look at the videos? And it turns out they didn't, none of them had even seen this. It was just kind of, you know, that low quality feedback that you get some times when someone doesn't like you, doesn't like the book, doesn't like something and kind of has an ax to grind. At least that's how it looks. So that's what's so tough about feedback. And you did that whole podcast about feedback, where we want to make changes and improvement. Which pieces do we take? How do we use feedback? It's been so true. I've learned a lot from it as part of the Project Smackdown team.



Dr. Kashmer: And so for the next one, some good feedback that seemed to repeat, was, "Hey, why don't you guys put out a dedicated chapter, even though the material is throughout the book and spread out? Why don't you put out some dedicated chapters on a couple new additional subjects? Clearly there's no review book that has every fact. It's very interesting. however, the idea was to consolidate some of the facts that were already in there and put them into some additional chapters. So yeah, we're in the middle of working on it. You know, Jessica, your Project SmackDown team where there typing everyday...type type type...and we're trying to get that done for ya. That's one of the newest things, coming out. Just some additional chapters and consolidation, but that's not all! But wait, there's more! It's like an Apple event where, you know, Steve Jobs and now Tim Cook used to come out and say "But there's one more thing". And then they'd say, "...and here's the iPhone!" So we have additional stuff coming out. Soon the monthly coaching sessions are going to start to happen. There is a conference in the works. Just so many things on tap for this year.



Jessica R: This will be a big year. Hopefully I don't get reprimanded for this. We're going to see, but they can edit it.



Dr. Kashmer: They can edit it out, you know, so we'll see.



Dr. Kashmer: Wow. Well, they don't joke around you share something like that. And bam gone. That's amazing. All right. Well, I guess I'll just wait here for just to come back. Hopefully they let her come back or maybe I'm the one who got dropped.



Jessica R: They're going to replace me with that. Nevermind. I'm ready.



Dr. Kashmer: I did audition three Jessica like robots while you were gone That's what they did. These guys don't mess around!



Jessica R: We just talked about technology and how we've made all these advances. And I may be just advancing myself or right out of a job. So



Dr. Kashmer: I feel that way every day. Every day, it's like closer and closer. First, you know, you operate with a robot at a distance and you can sit down in this console. Next thing you know, they just removed the David Kashmer from that picture. And now there's just a robot saying things like [robot voice] "l will be taking out your appendix today."



Jessica R: Okay. Dr. David, well, thanks so much day for going through things. I know we've talked about this a little bit and what's coming up and how excited we are. And again, I'm not going to say too much more or else the machines will take over. But just thank you so much for your input as always. And you know, I'm having so much fun. I love doing this. I'm looking forward to all the new stuff. All the people we have on the team now and how it's growing and just the fact that, you know, at the end of the day, even though you made this for the next generation and stuff in your head, how you want it to be easier for them. And I know that you don't really like to take credit for stuff and you are always like "Oh, you guys are the publisher and it's your work." Yes. The publishing company is awesome. But then at the end of the day you kind of helped bring us all together. And you know, you make my job so much easier and I'm so happy to share everything that you did. And so I just want to say, thank you and how much I appreciate everything you're doing,



Dr. Kashmer: Jessica. It's super nice of you, but it sounds like I'm not the guy to talk to about keeping your job after how much we just revealed. I mean, it's super nice of you. I know they threw you off the podcast for a second, and then you found your way back in, but, and it's very nice of you to say all that, but I'll tell you: I'm really mostly interested in where it goes next. I think really the main difference between this and many other review books is that the idea is to have this one be alive: alive on social media, easy to access, able to listen to it in different ways, able to learn and absorb the facts and kind of make them part of your daily review. So super nice of you to say, but it's really how you guys have executed things and where it goes next has really been great to see.



Dr. Kashmer: I will share that we're going to include the link to that American Medical Association article. And it's one that discusses all the different things around COVID at least some of the physician resources, some of the tools, tips, and techniques that different residents have used. That's going to be right down there. I've always wanted to do this down there, down there in the link section where we describe the video. So it'll be there. It makes me feel like we've come so far on the channel on YouTube, or we're getting to be okay at this. And that's really because of you guys and all the hard work you've done behind the scenes. So super enjoyable. Thanks for having me on. And I can't wait to see where it goes next!



Jessica R: Yeah. As long as you do that stuff, they don't trust me with that stuff. That's all you so you can deal with the pointing. All right. Well, thanks Dr. David and again, awesome to be here with you and for all of our listeners out there, don't forget...#AbsiteSmackdown!




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