Roles
Professor of Clinical Anesthesiology
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Biography
The quest for learning all things heart related began very early in my life. As a congenital heart disease patient I was enamored starting in early childhood with the idea of treating heart disease. My father repaired anesthesia machines, and following him to work on many occasions exposed me to anesthesiologists early in adolescence. After learning many anesthesiologists focused their careers in heart surgery patients, my mission in this field really began then. Being the only family member to attempt college, the importance of overachievement in academics was understated growing up, unfortunately. Since high school I worked as much as I went to school. My first career as a respiratory therapist was as much about making money and paying for more school as it was exposing myself to medicine. Once certified and working as a therapist, however, I became infatuated with the men and women close to my age walking around in white coats. After finally obtaining acceptance into medical school, despite many personal adversities at that time, academics finally became my primary focus. My passion for pursuing medical knowledge blossomed, and I went on to be the recipient of the highest GPA award in medical school.
The osteopathic medical curriculum was a great place to obtain fundamental knowledge, but mentorship for a career in academia was sparse. With this in mind I focused my attention to applying to residency programs at major academic medical centers. It was at this time I rotated at the University of Pennsylvania as a visiting student and met Dr. Bob Gaiser, the residency program director. Dr. Gaiser quite literally changed the course of my life by ultimately offering me a spot into his program. Almost immediately I latched on to the cardiac anesthesia group and rotated with them in the early part of my first year of anesthesia residency. As a second year resident I started collaborating with Dr. Yainni Augoustides and Dr. Prakash Patel, and the real mentorship for my eventual career in academics began. Dr. Patel’s main focus was on coagulation management; therefore, my first clinical study focused on this aspect of care. Both my new found mentors provided institutional funding and IRB support, and by my third year of residency I was enrolling patients into my first study looking at viscoelastic testing in heart surgery patients.
Entering into my fellowship year of training another aspect of their mentorship stood out, and that was teaching. I was inspired by the way they nurtured both residents and junior colleagues interested in the academic mission. Immediately I started mimicking their efforts, teaching residents and collaborating with trainees on case reports and abstracts at every possible chance. Upon entering the faculty at the University of Miami the following year I continued with this energy. In my first year I was nominated for a teaching award and in my second year on staff I was given the award. My desire to mimic my mentors has come full circle, as now I find myself also mentoring my surrounding junior colleagues in anyway I can, including extending publishing opportunities to them.
Early in my appointment, I found myself being requested by the cardiology group to assist more and more with the percutaneous cases. This was fortuitous as Dr. Augoustides and Dr. Patel were both heavily involved in the percutaneous program at the University of Pennsylvania. I immediately found my second area of academic focus, percutaneous valve therapy. In my second year I approached senior faculty member Dr. Richard Epstein, a new recruit for the University of Miami, and asked him to mentor me in studying anesthesia for transcatheter valve replacements. We completed an analysis of anesthetic techniques and soon published it in the cardiology literature. This collaboration with the cardiology group has evolved. Another manuscript looking at data from the Florida inpatient database studying transcatheter valve access has been written, with Dr. Epstein as my mentor, and is awaiting journal submission. A preliminary database of all mitral clip patients has also been amassed by us and will be analyzed to help guide perioperative planning of mitral clipping.
My interest in coagulation management has also persisted. I started my first IRB approved trial at the University of Miami looking at point of care INR values during various phases of cardiac surgery. I have been collaborating more and more on review articles and editorials with leaders in the field of coagulation. I have narrowed my academic energy to these two arenas, coagulation management and percutaneous therapies. My own works in these fields have now been the subject of editorials and news articles featured in Anesthesiology News. My efforts have led to my appointment on the editorial board for the leading journal in cardiac anesthesia. Thomas Jefferson University, University of Florida, and the Northwest Anesthesia Seminar, have all invited me to lecture on these topics.
Finally, a new found area of interest has evolved out of my early faculty days at the University of Miami, leadership. Upon starting at the University of Miami Hospital it became quickly apparent that a lot of room for process improvement existed. In the heart surgery patients specifically, process change as it relates to quality and efficiency was obviously needed. Immediate changes to the handling of central lines, medications and the transesophageal echocardiography process were made. Where efforts had failed to make changes, perseverance saw these changes to completion. In terms of efficiency, changes were made to improve every aspect of care from entering the room, prepping patients for surgery, to getting to the ICU. Watching the heart team evolve to perform at an exemplarily level for each and every case and each and every anesthesiologist or cardiac surgeon was humbling. I was awarded both the University of Miami Hospital Leadership and Professionalism Award from the hospital leadership and the “Ushine” award from the staff within my first year on faculty. I went to become site chief of cardiac anesthesia at the hospital. These efforts have led to a number of process improvement initiatives being tasked to me, including implementing the first colorectal Early Recover After Surgery (ERAS) program at the University of Miami Hospital.
At this point I can articulate a very specific career mission. The future I hope will continue to hold prolific and vigorous academic work in my two main areas of clinical interest. I hope to mentor as many junior colleagues and residents as possible along the way. I hope my passion for both academics and cardiac anesthesia is infectious and inspires as many residents as possible to pursue a career in both. Lastly, I view this promotion as a necessary step in fulfilling my lofty goals of becoming a division chief one day, and hopefully beyond. -
Education & Training
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