Sono Hot Seat with Bret Nelson: On Lecture Presentations and Career Development

Bret Nelson, MD, FACEP
Icahn School of Medicine at Mount Sinai,
@bretpnelson

Questions posed by Stephen Alerhand, MD

Q: You have a long track record of education and POCUS lectures to regional, national, and international audiences. What core tenets do you keep in mind when preparing lecture slides? When walking up to the podium? 

From the beginning of my preparation, I try to focus on what my "big picture" message will be. That depends on the audience, what I've been asked to speak about, and a lot of other factors. As I get into the weeds researching the topic, preparing slides, editing, writing, and practicing, I keep coming back to that. There's no talk that can be all talks- I can't cover every angle and have to focus on my central theme or the audience and I will both be lost or bored. I keep coming back to that as I get farther along, right up until the time I take the podium. I think to myself, “What's the point?” to keep my speech simple, my message simple, my slides simple.

Q: Since COVID and the advent of Zoom lectures, how has your lecture style changed? What core tenets do you keep in mind when logging onto the group Zoom chat for a lecture?

This is such a great struggle and such a moving target. There is value in being as engaged as possible on Zoom, all cameras on, one person designated to watch the chat for messages, the speaker standing when giving the talk if able to, as if they were in person, etc. But there is also value in engaging with a Zoom lecture as one would engage with a great podcast or movie – passively listening. It is so dependent on the content, the learners, their motivation, etc. In general, I think that the audience will get less out of lots of text on slides, or smaller images, if they are watching your slides on a phone or laptop vs a huge projection screen. So I try to keep my slides simpler and rely more on my voice.

Q: You somewhat recently (?) transitioned to a system-wide position in Medical Education (I might have the role/term wrong). Did you always envision this transition? What realization or experiences led to this transition? Are you still involved as much in the US Division? If not, what do you miss the most? What do you miss the least? 

I've been incredibly fortunate to work at an institution that allowed me opportunities as my career grew and evolved. I transitioned from ultrasound director at one site, associate residency program director, to system chief of the ultrasound division and now vice chair for education. Over the years, the facets of my role I enjoyed the most involved education in one form or another, so this was a great chance for me to take a larger system role and leverage what I've learned. I am still the chief of the ultrasound division, and we have an amazing team of faculty, fellows, and an ultrasound manager who is a really gifted administrator and sonographer. And it was such a natural progression for Cara Brown to take over the role of fellowship director, after years of running our education programming at all levels of training. The ultrasound team together manages operations, education, research, and our other priorities. Nothing can be accomplished at any scale without a strong team with a clear vision.

Q: You have worn many US hats over the years. What advice would you have for a mid-career faculty member for whom certain aspects of the position have grown stale, who is looking for the next new thing?

If you can keep doing more of what you enjoy (and less of what you don't) over the span of your career, you will eventually grow your position into something that really suits you. When done well, that could mean someone more junior and hopefully more interested takes over roles that you have become less engaged with. As long as those roles represent actual opportunities for growth and advancement for someone else, it can actually be good faculty development for you both to transition part of a role. Also, sometimes you think you are one thing and you are really another. If an “ultrasound person” finds themselves deeply engaged in quality finance, operations, education, patient experience, research, etc., it is really important to look into other avenues besides ultrasound where these skills are used. Many of our colleagues started their careers looking at certain processes through the lens of ultrasound, then leveraged those same skills into leadership positions focused on how those same processes work across other portfolios.

Q: What led you to branch out into national leadership positions in POCUS? For what reasons would you encourage or discourage a faculty member to do so? What have been your most meaningful learning takeaways or experiences? How would you recommend that a faculty member explore these possibilities?

Early in your career, say “Yes” a lot. Join committees, meet people, pick their brains about what they enjoy and what they are working on. Networking allows you to calibrate your own experiences against a larger group, offers opportunities for projects, talks, etc. and helps you connect to people beyond your local circle. I found it especially valuable to work with multi-specialty organizations like AIUM and WINFOCUS, because having colleagues from other regions and specialties better informed how I worked with those same specialties at home, and kept me out of an “ED only” mentality.

Q: From when you started to now, what do you feel have been the most meaningful hurdles for POCUS toward broader implementation in the emergency department? What do you envision as the next major hurdles? The major obstacles?

I think we are just riding the curve for some things – increased education, increased use of POCUS by multiple specialties, machine improvements. Those are all steadily evolving, and many of our discussions are similar now to what they were years ago. For other things, there have been disruptive innovations that dramatically changed our landscape. For example, handheld ultrasound devices lowering the barrier to entry and democratizing POCUS across the whole world of medicine. There is also greater expectation now that POCUS would be integrated into the EHR, and less so used as a “stethoscope” or for “quick looks.” So I think our next wave of challenges will be in system integration, and managing personally vs. institutionally owned devices. I expect it will play out in a similar way to how smartphone use evolved.