Author + information
- aHouston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
- bWeill Cornell Medical College, New York, New York
- cSafety, Quality Informatics and Leadership, Harvard Medical School, Boston, Massachusetts
- ↵∗Address correspondence to:
Dr. Ankur Kalra, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas 77030.
This is another in the series of Fellows Pages that we occasionally select for this space. Although many fellowship programs, including ours at Emory, value monthly journal clubs, the enthusiasm Dr. Kalra expresses for Dr. Kleiman’s efforts is inspirational.
—Spencer B. King III, MD, MACC, Editor-in-Chief, JACC: Cardiovascular Interventions
Since their inception by Sir William Osler at McGill University in Montreal, Canada, journal clubs have become an integral part of postgraduate medical education (1). Their role in the development of critical thought processes for interpreting statistical design and quantitative methods utilized in original research is quintessential, and has been scientifically validated in a randomized controlled trial (2). For physicians in practice, journal clubs are vital for staying up-to-date with the current literature and keeping themselves abreast of the field’s future directions. Having experienced postgraduate training for a decade now, both in the United States and abroad (2 residencies and now 3 fellowships), I have participated in several journal clubs spanning articles in general medicine and its noncardiovascular subspecialties, cardiovascular medicine, and interventional cardiology. However, the journal club that I recently participated in during (arguably) my formal final year of training in advanced interventional and structural cardiology is by far the best and most exhilarating rendition of the journal club format in academic medicine that I have encountered. In fact, the format is deserving of receipt of a title for itself—I call it the Kleiman∗ format.
Once a month, Dr. Kleiman has an evening set aside for the interventional cardiology journal club that is organized in a restaurant space outside the Methodist Hospital premises in close proximity to the Texas Medical Center. Current (and former) cardiovascular disease and interventional cardiology fellows and faculty members from the Methodist Hospital and other academic teaching hospitals in the Texas Medical Center area, and cardiologists in the community at large are invited to participate in the journal club. The seating for the journal club is organized, not in a typical conference auditorium format, but rather in a large family dining table format to allow for “mixing and mingling” of fellows and faculty over a 3-course Italian meal with red wine and espresso as its accompaniments. The ambience, however, does not discount the intellectual and scientific rigor of the session. Three original research articles that are chosen by Dr. Kleiman are assigned to the Methodist interventional cardiology fellows for presentation and discussion. In addition, there are 2 supplementary presentations, one at the beginning of the session, and the other that concludes the evening. The inaugural presentation that occurs before the discussion of original research articles focuses on topics outside of medicine and cardiology, for example, astronomy, world cities, and so on. The evening is concluded by a discussion of a physics article from a peer-reviewed publication, usually assigned for discussion to a third-year cardiovascular disease fellow. The presentation format for the discussion of original research articles isn’t yet another PowerPoint (Microsoft Corporation, Redmond, Washington) slide set that is presented to the audience in a unidirectional flow of information; as fellows describe the study background and research methods to the “Illuminati” in an extemporaneous fashion, Dr. Kleiman orchestrates the scientific session by quizzing individual members in the audience in a “psychologically safe” “Socratic Method,” dissecting the paper like a fine anatomist (3). Through his interjections, the environment in the dining room transforms into a rich learning session for fellows-in-training, breeding intellectual curiosity and nurturing critical thinking as he painstakingly delves into the nuances of statistical tools utilized, inherent biases in study designs, and applicability of results in the practice of daily patient care in the cardiac catheterization laboratory, at the bedside and in outpatient clinics.
Presentations on abstract topics that include trivia on landmark astronomical feats (such as the Hubble Space Telescope) and physics principles cultivate lateral thinking in fellows-in-training and early career physicians, a crucial tool in medicine and interventional cardiology in particular. As interventional cardiologists, we interact with basic principles of physics on a daily basis in the cardiac catheterization laboratory, whether it’s the principle of elasticity in the vessel wall in a pulsatile circulatory system, or effects of use of percutaneous circulatory support devices in a modern-day cardiac catheterization laboratory on pressure-volume loops (4,5). Assimilation of knowledge garnered through the discussion of abstract topics enhances lateral thinking that has continued the process of creativity and innovation in interventional cardiology, reinventing the field to its present-day form.
Beyond learning evidence-based medicine, the format of the evening also allows fellows to engage with faculty members in a relaxed, nonclinical environment, fostering mutual respect and team building, attributes that form the core of our profession, not limited to interventional cardiology alone. The mannerisms of the question-answer–based interactions initiated by Dr. Kleiman among fellows and faculty members during the journal club presentations have a true mark of gentility, integrity, and sophistication, reminiscent of a certain Old World cadre that I saw in my father as a young kid, inspiring me to become a doctor. It’s a cadre that all of us in medicine and interventional cardiology must strive to imbibe and then pass forward as an intergenerational baton.
At the end of the journal club, everyone leaves the dining room feeling more enlightened, rejuvenated, and more importantly, connected to one another. The Kleiman format for journal clubs, not only nurtures intellectual curiosity and knowledge, it also cultivates a deep sense of camaraderie and collegiality transcending beyond institutional silos, reinvigorating effective communication and catalyzing collaboration.
↵∗ Dr. Neal S. Kleiman is Professor of Medicine at Weill Cornell Medical College in New York, New York, and director of the cardiac catheterization laboratories at Houston Methodist DeBakey Heart and Vascular Center at Houston Methodist Hospital in Houston, Texas.
Dr. Kalra has reported that he has no relationships relevant to the contents of this paper to disclose.
- 2016 American College of Cardiology Foundation
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