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Research Digest: Healthcare Workers, COVID-19, and Burnout

While most research we highlight focuses on medicine and clinical care of patients, there is just as much value to be gained in researching the workforce and healthcare community at large. Understanding the trends and problems within our own field can lead to profound improvements in the daily lives of healthcare workers everywhere. In this alternative arena of research, UNMC ID has made major strides. Read on for digests of recent articles published by UNMC ID faculty that pertain to matters of personnel.

Dr. Selby, author of a recent paper (along with Drs. Hewlett, Rupp, and Starlin) about COVID-19 spread among healthcare professional

The hospital or clinic is not the only place that healthcare workers can be exposed to SARS-CoV-2. Just like the rest of the public, household exposures are understandably a major risk factor for contracting the virus. As data from the delta variant became available early this year, Drs. Selby, Hewlett, Rupp, and Starlin of UNMC ID conducted a study on vaccinated healthcare professionals with home exposures. They concluded that the delta variant, along with numerous environmental factors, contributed to a sharp increase in the COVID-19 attack rate. This rose from around a 20% chance of contracting the virus from a COVID-19 positive household member before the delta variant, to a ~50% chance of COVID-19 contraction during the delta wave, underscoring the large jump in infectivity possible with a mutating virus. Read the full research brief here.

Dr. Lawler, author on a recent paper outlining the ethics of ‘essential workers’ during a pandemic.

Stepping away from the healthcare workforce, Dr. Lawler and colleagues recently published a paper examining the intersection of ethics, the meat-processing industry, and COVID-19. This paper explores a group of workers who, because of their ‘essential industry’ status and working conditions which facilitated the spread of SARS-CoV-2, were expected to put their health and lives at risk during the pandemic. In the words of the authors: “This paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion.” Read more here.

Dr. Cawcutt, author of a recent article on medical burnout.

Lastly, on the topic of healthcare burnout, Dr. Cawcutt recently published an article exploring the relationship between bias, the impostor phenomenon, and burnout. A significant problem in medical fields, burnout afflicts 30% of nurses and greater than 50% of physicians. The paper argues that the interaction of these three concepts, previously considered separate, create a cycle which perpetuates burnout within the medical community. Targeting these components may then help guide interventions in the future. Read on here for more details.

Our Fellowship Leaders can’t wait to review your applications!

The following content was provided by Dr. Abbas (R) and Dr. Van Schooneveld (L), UNMC ID fellowship program directors. Read on to learn about our great program and please share with those who may be interested!

Fellowship application season is open, and as the leaders of our ID fellowship, we wanted to highlight some of the exciting aspects of our program. Our program and our division are growing. We began in 2011 with 2 fellows, grew to 4 in 2017, 5 in 2020, and our full complement now includes 6 fellows. Our faculty also continues to grow, as we now have 28 physician faculty and 4 full time ID pharmacists with diverse expertise. Dr. Trevor Van Schooneveld is the Program Director and Director of the Antimicrobial Stewardship program and Dr. Anum Abbas is the Associate Program Director. This year we are looking forward to meeting you on our remote interviews via zoom!

Dr. Casey Zelus teaching medical students about blood cultures

Fellows at UNMC enjoy a robust clinical experience that includes not only the typically complex patients seen at a tertiary referral center, but also includes extensive experience caring for immunosuppressed patients.  In addition to our General ID service, where our fellows gain experience in teaching medical students and Internal Medicine residents, we have two separate immunocompromised services that care for oncology and solid organ transplant patients.  We also have an orthopedic infectious diseases rotation where fellows gain experience managing these complex patients and work with faculty who have extensive experience in this area.  We have expanded our ambulatory offerings with the creation of a non-tuberculous mycobacteria (NTM) clinic and a travel clinic.  Fellows have the opportunity to spend time in the microbiology laboratory, as well as learn infection control and antimicrobial stewardship. The faculty at UNMC are nationally recognized experts in their field, and are also very approachable and devoted to the education and success of trainees. They have created extensive educational opportunities, covering topics from opportunistic infections in solid organ and hematopoietic stem recipients to emerging global pathogens and biopreparedness. Fellows gain knowledge in HIV/AIDS management working in our multidisciplinary HIV clinic which cares for over 1200 people with HIV. In addition to having access to world class ID expert antimicrobial stewardship, OPAT, and HIV pharmacists, our division also includes an ID pharmacy residency program and opportunities for research collaboration and rounding with pharmacy students, residents and faculty.

As new career opportunities develop for ID physicians, we have worked to provide our fellows with the skills to engage in these fields.  UNMC ID fellows receive extensive experience in the area of infection control and antimicrobial stewardship as well as dedicated biocontainment training.  UNMC also offers the opportunity to stay for an option third year to further develop a research portfolio or pursue additional clinical expertise in subspecialty areas.

Graduate Dr. Raj Karnatak presenting his research

An important part of fellowship is developing skills in interpreting and performing research, and we provide our fellows with six months of mentored research experience centered on their career goals.  A research committee assists fellows in mentor identification and project development.  Fellows also participate in a week-long UNMC sponsored research training program, and typically present their work at national conferences like IDWeek and SHEA.

Our goal as program directors is to provide fellows with an educational experience that provides them with skills and knowledge to make them successful in whatever career path they choose.  The opportunities available to ID physicians continue to expand and we hope you will consider UNMC ID.  If you are interested in more information, please feel free to visit our website where you can check out a video to learn more about us. You can also contact us at the following:

Dr. Trevor Van Schooneveld
Program Director, Infectious Diseases Fellowship
Medical Director, Antimicrobial Stewardship Program
University of Nebraska Medical Center
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: tvanscho@unmc.edu

Dr. Anum Abbas
Associate Program Director, Infectious Diseases Fellowship
Assistant Professor, Division of Infectious Diseases
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: anum.abbas@unmc.edu

BWydBw

#PharmToExamTable: What Weight Should be Used for Dosing Daptomycin in Obesity?

A #PharmToExamTable question about daptomycin dosing, answered by Terese Lewis, PharmD, a Graduate of UNMC College of Pharmacy who is now a Pharmacy Resident at UNMC.

(Reviewed by Andrew Watkins, PharmD)

Daptomycin is an antibiotic used to treat complicated gram-positive bacterial infections as it has good activity against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). At Nebraska Medicine, the susceptibilities of MRSA and VRE during 2021 were 100% and 75%, respectively. Daptomycin has been FDA approved for complicated skin and soft tissue infections, but due to its broader gram-positive coverage it is used off-label frequently. Off label uses include osteomyelitis (bone infections) due to MRSA, prosthetic joint infections caused by Staphylococcus spp. or Enterococcus spp., and left sided infective endocarditis (infection of heart muscle) due to Staphylococcus spp. or Enterococcus spp.  It is thought to work by depolarizing the bacterial cell membrane.1 The use of daptomycin in skin and soft tissue infection has dosing recommendations of 4-6 mg/kg/day. As we use the antibiotic to treat more resistant bacteria or diseases with higher mortality, dosing off-label may increase to 12 mg/kg/day.2  

Daptomycin’s most concerning side effect is a risk of myopathy. Creatinine phosphokinase (CPK) increases can be seen while on therapy, which can be indicative of stress or damage to the muscle. There is some concern about the frequency of adverse events as doses, and weights, get higher. 

Product labeling suggests the use of total body weight (TBW) to dose obese patients, but that is based on 4 mg/kg PK data for a single dose. Obese patients, however, have routinely shown larger than expected drug levels attributed to overdosing due to increased TBW. These increases contributed to changes in renal clearance.2

One trial compared obese patients who received actual body weight (ABW) vs adjusted body weight (AdjBW) dosing. The most common indications for daptomycin in this study included osteomyelitis, skin and soft tissue infections, and abscesses. Doses used in this study were <8 mg/kg/day, so extrapolation of results to doses greater than that will require more data. Treatment failure was found to be statistically equivalent between the two groups, as well as 90-day mortality, suggesting that adjusting dosing to AdjBW may not be necessary. 3

Another study concluded that does up to 12 mg/kg/day followed linear kinetics and were shown to be safe and efficacious. They found that the safety profile and clinical efficacy necessitated no dose adjustments solely based on BMI. 4

ACCP guidance for dosing in obesity recommends the use of actual body weight for obese patients to ensure treatment efficacy. They also recommend close monitoring of patients weighing more than 111 kg for increases in CPK as elevated BMI classes are inherently associated with increased CPK elevation.5

The first study that presented ideal body weight (IBW) dosing outcomes concluded that regardless of infection and bacteria type ABW and IBW dosing may provide similar outcomes. They do recommend that certain infections may favor one dosing weight over another and they recommend further studies. 6 More research with larger sample sizes are needed to firmly demarcate which specific pathogens may be better treated with altered dosing strategies.

In conclusion, even though we do not have randomized control trials or retrospective studies analyzing all doses, the data we have points to the safety of using TBW in obese and extremely obese patients. Consideration should be made to close monitoring of CPK levels.

References:

  1. Daptomycin. In: Lexi-Drugs [online database]. Hudson, OH: Lexicomp (accessed 2021, August 6).
  2. Daptomycin [package insert]. Whitehouse Station, NJ. Merck & Co., Inc. 2017. 
  3. Fox, AN, Smith WJ, Kupiec KE, et. al. Daptomycin dosing in obese patients: analysis of the use of adjusted body weight versus actual body weight. Therapeutic Advances in Infectious Disease. 2019 Jan 30.
  4. Gonzalez-Ruiz A, Gargalianos-Kakolyris P, Timerman A, et al. Daptomycin in the clinical setting: 8-year experience with Gram-positive bacterial infections from the EU-CORE(SM) registry. Adv Ther. 2015;32(6):496–509
  5. Meng L, Mui E, Holubar M, et al. Comprehensive Guidance for Antibiotic Dosing in Obese Adults. ACCP Journals. Pharmacotherapy 2017;37(11):1415–1431. 
  6. Ng JK, Schulz LT, Rose WE, et al. Daptomycin dosing on ideal body weight versus actual body weight: comparison of clinical outcomes. American Society for Microbiology. 21 October 2013. 

UNMC ID Welcomes Dr. Sunagawa to the ID Pharmacy Residency Program

Dr. Shawnalyn Sunagawa recently began her ID pharmacy residency after completing her PGY1 pharmacy residency here at UNMC. Welcome to UNMC ID Shawnalyn!

Read on to get to know this great addition to the UNMC ID team.

Tell us about the position you recently started

I recently started my second year of pharmacy residency where I am specializing in infectious diseases. This year I will receive comprehensive clinical training in both antimicrobial stewardship and infectious diseases pharmacy practice. I will have the opportunity to round with the inpatient infectious diseases consult services (general, orthopedic, oncology, transplant, and pediatric infectious diseases), work with our Antimicrobial Stewardship Program, and participate in outpatient and outreach activities (HIV clinic, Outpatient Parenteral Antimicrobial Therapy program, and our community outreach stewardship programs). 

Tell us about your background

I am originally from Kaneohe, Hawaii (aka 20 minutes outside of downtown Honolulu/Waikiki beach)! I left the gorgeous mountains and ocean for a landlocked state where I completed my Bachelor of Science in Chemistry and Mathematics from Creighton University in Omaha, Nebraska and then continued on to earn my pharmacy degree. I then completed by Post Graduate Year 1 (PGY1) pharmacy residency here at Nebraska Medicine. Safe to say the people in the Midwest have made up for the lack of mountain and ocean views!

Why did you choose to come to work at UNMC

The people! When looking at residency programs, I knew UNMC/Nebraska Medicine had a well-established infectious diseases and antimicrobial stewardship program. However, what I was blown away by was the opportunity to work with not only some of the top infectious diseases clinicians in the nation who are providing extraordinary care to patients, but who are also commited to teaching and developing future infectious diseases clinicians! The outstanding preceptors and welcoming atmosphere truly make me so grateful to be able to complete my infectious diseases training here at Nebraska Medicine.

What makes you excited about working in ID

Every patient case is a unique puzzle where you have to try to piece together the microbiology, antimicrobial resistance, stewardship, drug PK/PD, and patient specific factors to create the best treatment regimen. Every case is truly one of a kind and the opportunity to learn about all the nuances that go into creating the best possible treatment plan for each patient is exciting! There are also constantly evolving new concerns and issues within the realm of infectious diseases (multi-drug resistant organisms, pandemics, new antimicrobial therapeutics, etc.) and I am excited to be able to play a role in helping solve many of these therapeutic puzzles/challenges!

“My husband and I at an Arizona Diamondbacks game pre COVID-19 pandemic. Looking forward to being back in the stands!” – Dr. Sunagawa

Tell us something about yourself that is unrelated to medicine

I love attending sporting events, playing tennis, trying new restaurants, and hanging out with my husband and two pups! My husband and I also have a lifelong goal of trying to watch an MLB game in every stadium. COVID slowed us down a little bit, but hopefully we’ll be able to make it to a few more stadiums this upcoming year!

In Case You Missed It: Last Call for Antimicrobial Stewardship Summit Registrations

Today is the final day to register for the Nebraska Antimicrobial Stewardship Summit on Friday, August 12, at the Embassy Suites by Hilton in Downtown Omaha. Read on below for last week’s post detailing this important opportunity.

Nebraska ASAP will be hosting its annual Nebraska Antimicrobial Stewardship Summit in-person on Friday, August 12, at the Embassy Suites by Hilton in Downtown Omaha. There will be a combined morning session with speakers from CDC, Nebraska Medicine, and other organizations, followed by afternoon breakout sessions with targeted presentations in long-term care and acute care/outpatient settings tracks. Registration for the Summit is $99 per attendee, which includes parking, food, and CE credits for physicians, nurses, pharmacists, pharmacy technicians, and medical laboratory scientists. Read on below for more information and to register!

About the Summit:

With workload increases and staffing limitations due to COVID-19, the focus has been shifted away from antimicrobial stewardship in many facilities across diverse healthcare settings. Unfortunately, inappropriate antibiotic prescribing is common and can result in sub-optimal patient outcomes, development of antimicrobial resistance, and serious adverse reactions such as Clostridioides difficile infection. This summit is designed to highlight the importance of antimicrobial stewardship and focus on implementation strategies to promote facility-wide incorporation and improved antimicrobial use and patient outcomes.

Summit Date: Friday, August 12th

Location: Embassy Suites by Hilton Omaha—Downtown Old Market

Registration deadline: August 4th

For more information and to register, click here.

To see the summit agenda, click here.

Acing Interviews: Top Tips for Fellowship Interviews

It is the end of July, and fellowship application season is upon us once again. Watch the UNMC ID blog in the coming weeks for fellowship application content. We begin with a practical guide to fellowship interviews. If you know someone gearing up for this important step, please share this post. A refresher on these skills can always be useful!

Multiple ID faculty contributed to this list and thus the credit goes to the entire UNMC Division.

As faculty, we have the amazing opportunity to both mentor and interview residents applying for fellowship in Infectious Diseases, and we have seen it all. From the great, well-prepared interviewee to the one who had the institutional information completely incorrect. We wish we could mentor every resident in person, but since that is not possible, we decided to do the next best thing and offer our tips and tricks to acing the ID (or any other) interview! Tips and tricks are in no particular order. 

  • Be yourself and relax.
  • Articulate why you are interested in this fellowship program, what your ID interests are and where you think you would like your career to go (even if you acknowledge that might change or be a little vague at this time).
  • Have an idea of how the program works and ask specific questions to help deepen that knowledge regarding the education you will receive. What are the strengths, weakness and unique aspects of the program you want to know more about?
  • Remember that you are interviewing the fellowship program as much as they are interviewing you. Do your research and come prepared with questions about everything from how the fellowship will prepare you for your career as an ID physician to where you will park.
    • Need suggestions on how to curate your list of questions?
      • Look up the program and Division on their website.
      • It is helpful to know a little about the faculty you are interviewing with, so if you get a schedule ahead of time find out what their clinical/research interests are and ask them about it – you can check out their publications on PubMed or Google Scholar to focus questions on specific topics.  If you don’t get a schedule ahead of time, ask them what their interests are or what their role is during your interview.
      •  Formulate questions important to you about the program, the institution and the local area regarding resources, lifestyle and more.
  • Be prepared to talk about your successes and the challenges you have encountered. For example, if you have an unexpected break in training, use that as example to illustrate what you learned from that experience. We do not expect perfection, but value honesty and clarity.
  • If you have something on your application that might be viewed negatively (academic difficulties, etc.) take the initiative and explain how you have overcome it and why you are a good candidate now before we have to ask you about it.
  • Consider a “highlight” reel handout for faculty on an updates to your CV since you submitted your application in ERAS. This can be incredibly beneficial if you have had a new publication, presentation or other activities demonstrating your interest in ID and future potential as a fellow.
  • Be friendly and treat everyone, including program coordinators and other office personnel kindly and with respect. Your interview starts from the moment some first meets you (a current fellow, administrative assistant or staff) and ends when you say goodbye to the last person. ALL opinions count. If you are rude to anyone, trust us, we will find out.
  • Be truthful and be yourself. Don’t answer questions with what you think the interviewer wants to hear (e.g. don’t say you want to do academic medicine if you are interested in private practice). This is the only way for both you and the program to determine whether or not you are truly a good fit.
  • Tell us something interesting about yourself, even if it doesn’t relate to ID.  It is important to be well-rounded, and hearing about hobbies, experiences and interests helps keep the interview conversation fun and flowing.
  • Thank the faculty for their time; the emails and cards with a personal comment regarding a specific detail of the interview are both appreciated and noticed.

Nebraska ASAP to Host Upcoming Antimicrobial Stewardship Summit

Nebraska ASAP will be hosting its annual Nebraska Antimicrobial Stewardship Summit in-person on Friday, August 12, at the Embassy Suites by Hilton in Downtown Omaha. There will be a combined morning session with speakers from CDC, Nebraska Medicine, and other organizations, followed by afternoon breakout sessions with targeted presentations in long-term care and acute care/outpatient settings tracks. Registration for the Summit is $99 per attendee, which includes parking, food, and CE credits for physicians, nurses, pharmacists, pharmacy technicians, and medical laboratory scientists. Read on below for more information and to register!

About the Summit:

With workload increases and staffing limitations due to COVID-19, the focus has been shifted away from antimicrobial stewardship in many facilities across diverse healthcare settings. Unfortunately, inappropriate antibiotic prescribing is common and can result in sub-optimal patient outcomes, development of antimicrobial resistance, and serious adverse reactions such as Clostridioides difficile infection. This summit is designed to highlight the importance of antimicrobial stewardship and focus on implementation strategies to promote facility-wide incorporation and improved antimicrobial use and patient outcomes.

Summit Date: Friday, August 12th

Location: Embassy Suites by Hilton Omaha—Downtown Old Market

Registration deadline: August 4th

For more information and to register, click here.

To see the summit agenda, click here.

New Fellow Friday: Welcome, Dr. Timothy Jang!

We are excited to welcome Dr. Timothy Jang as a new fellow in our Infectious Diseases program! Read on to learn a little more about him.

Tell us about the position you are starting.

I am excited to be starting out as an infectious diseases fellow at the University of Nebraska Medical Center! I will be taking care of patients on both an inpatient and outpatient basis, under the guidance of a fantastic team of seasoned infectious diseases clinicians. 

Tell us about your background.

I grew up in San Francisco, went to college at UC Berkeley, and majored in European history with a focus on politics, diplomacy, and international relations of the 18th-20th centuries. I have always believed that a good understanding of history helps us understand the shaping of the modern world. History is also the study of humanity, and all of the characteristics that make us human – our adaptability, compassion, and desire to broaden our horizons. It was these aspects that drew me to medicine as a career. I attended medical school at Indiana University School of Medicine and did my residency training in internal medicine at Wright State University in Dayton, Ohio. 

Why did you choose to come to work at UNMC?

Before the COVID pandemic began, I had visited UNMC and Omaha for internal medicine residency interviews, and I was considerably impressed by the medical facilities, the strength of the educational program, and the tranquility of the city. One of the faculty that I had interviewed with for residency interviews was Dr. Mark Rupp, the chief of the ID division, and I had promised him that regardless of where I ended up for residency, I would apply to UNMC for ID fellowship. So when I matched to UNMC for ID fellowship, I knew I had matched to the right place!

What makes you excited about working in ID?

My favorite subject in medical school was microbiology, and my favorite rotation in residency was infectious diseases. I have always appreciated the depth of insight that infectious diseases consultants bring to the table. A great infectious diseases doctor once told me that it often takes a good hour of thought to complete a thorough consult for a complex patient – an important reminder that we are here to spend our time giving the best care possible to our patients. In addition, the breadth of ID spans multiple body systems overlapping with many medical specialties, and this provides the opportunity to see a very diverse spectrum of diseases.

Within infectious diseases, I am interested in antimicrobial stewardship and medical education. One of the most satisfying aspects of residency was working with medical students, and I am excited to continue teaching residents and medical students in my fellowship years and beyond.  

Tell us something about yourself that is unrelated to medicine.

In my free time, I am quite passionate about competitive gaming, particularly PC strategy games with a historical setting. This culminated in winning the E3 2019 Champion award at the E3 gaming convention. 

I also love to travel, and once the COVID pandemic dies down, I plan to continue my adventures around the US and abroad.

UNMC ID Welcomes Three New Faculty Members

Join us in welcoming three great new additions to UNMC ID Faculty: Dr. Carlos Gomez, Dr. Subhadra Mandadi, and Dr. Jonathan Ryder. Keep an eye out for more detailed introduction posts in the coming weeks. But for now, see below for a snapshot about these fantastic new faculty members.

Dr. Carlos Gomez completed his residency training in Internal Medicine at the University of Pittsburgh and fellowship in ID at Stanford University. He joins UNMC as an associate professor on the Solid Organ Transplant service line. Welcome Dr. Gomez!

Dr. Subhadra Mandadi completed her residency training in Internal Medicine at Hurley Medical Center and fellowship in ID at the University of Buffalo. She joins us as an assistant professor working on the Community ID service line. Glad to have you, Dr. Subhadra!

Dr. Jonathan Ryder completed his residency training at Indiana University and fellowship in ID here at UNMC (see his recent ‘last words’ post here). He joins us as an instructor working on the General ID service line. He is also completing a 3rd year fellowship in Antimicrobial Stewardship. Congratulations Dr. Ryder!

For a quick introduction to each new faculty member, see their linked UNMC Faculty page.

New Fellow Friday: Welcome, Dr. Catherine Cichon!

We are excited to welcome Dr. Catherine Cichon as a new fellow in our Infectious Diseases program! Read on to learn a little more about her.

Tell us about the position you are starting.

I am excited to be joining the University of Nebraska Medical Center (UNMC) as a first year Infectious Disease fellow! I will spend the next few years learning about disorders caused by bacteria, viruses, fungi, and parasites, the people affected by them, and the medications that treat them. 

Tell us about your background.

I grew up in Colorado Springs, Colorado, and I have since gone on to explore and learn from cities around the country. I studied Anthropology as an undergraduate student at the University of Notre Dame, which led me to become interested in the interplay of culture and medicine. This drew me towards public health, and as a result I completed my combined MD and Master of Public Health (MPH) at the University of Miami Miller School of Medicine (UMMSM). Over the years I continued to develop an interest in global health and “local global” health, which led me to complete my combined Internal Medicine and Pediatrics residency at the University of California San Diego (UCSD), 15 minutes from one of the busiest land-border crossings in the world. I look forward to continuing to grow my public health and infectious disease knowledge through the ID fellowship at UNMC!

Why did you choose to come work at UNMC?

(1)  The infectious disease training here is highly regarded, and I wanted to train at a location where I could learn from all branches of ID – from emerging infectious diseases (check this out: https://www.nytimes.com/2020/02/18/us/coronavirus-omaha-nebraska-medical-center.html [nytimes.com]) to antimicrobial stewardship to transplant ID…even pediatrics ID!

(2)  I have family here in Omaha, and Omaha is much closer to my family in Colorado. It’s great to be close to your support system!

(3)  Omaha itself is a great city! There is so much to eat, do, and see here. The affordable cost-of-living adds to the attraction.

What makes you excited about working in ID?

ID is a field that is rooted in history (I’m a huge medical history nerd) and yet perpetually looking towards the future. In the last few years we have seen this in action via surges of both old and new diseases – from measles to SARS-CoV-2 to monkeypox. ID specialists can work in both clinical and public health settings to address these diseases, and I am excited for those opportunities. From the clinical perspective, I am curious by nature (#medpeds), and ID cases are often the most challenging from a diagnostic and therapeutic standpoint. Finally, from the public health perspective, I am interested in exploring the ways we can address the disproportionate effect that infectious diseases have on our most underserved communities, both locally and globally.

Tell us something about yourself that is unrelated to medicine.

I am an amateur medical illustrator! Sorry, I suppose that is somewhat related to medicine. During medical school I taught myself how to illustrate digitally using an iPad, and since then I have had my art published in several papers, books, and online. I occasionally post some of this art on my social media accounts, which you can follow @DocScribbles 😊 Look forward to more ID-themed art over the next few years. 

On a totally “unrelated to medicine” note, I adopted a pandemic dog and named him Loki, just in time for the Marvel series of the same name!

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