Episode 82: From RFS to educator

The following transcript was auto generated.

Joshua Baker, MD: So welcome, Dr. Kuban. Thank you for being here today. We're excited to be hosting you on The Kinked Wire and appreciate you giving some of your time to the RFS.

Joshua Kuban, MD, FSIR: Yeah. Happy to be here. I don't know if you know, but I was one of the old school OG RFS chairs way back in the day. So ten years ago, maybe 12 years ago, something like that. So it was Ken Lam and myself, all kind of riding that same boat. So yeah, happy to give back to the RFS. Gave a lot to me.

Dr. Baker: Yeah. Personally, I didn't know that, but the RFS folks gave me some background information, so we'll touch on that a bit. I'm excited to hear about your time in the RFS but also to get started and tell us a bit about yourself. Where do you practice and maybe share a bit about how you got there and how your journey kind of evolved along the way?

Dr. Kuban: Yeah, so I practice at MD Anderson in Houston or UTMB Anderson, and joined there after fellowship, which I did at Brown, and I went from Baylor to Brown. So at Baylor for residency, I got very much into IR during medical school, so I knew I was going to be IR from 3rd year on.

Actually, the first time I heard about it, I got this CD from SIR. They're like, hey, we'll send you something about SIR, or what IR is. The CD rom came and I played it. I was like, oh, this sounds really cool. I actually went to SIR my third year of med school in Washington, DC. There was a dedicated track for med students and I was like, oh, this is amazing. This is exactly what I wanted. So really from there, I was kind of full on in IR. I went to Baylor just because I knew it was a place that didn't have fellows. So it was a lot of hands on experience. And my wife is from Houston, so that was also a factor. And then after Baylor went closer home to Brown, continued to kind of be involved in RFS during that time.

And I think I've always been interested in education since the resident fellows section time and involvement in that. And so coming out for a faculty position, I looked at both private and academic, but really wanted something where I could work with trainees. And Anderson had a great program director, but was looking for someone new to eventually take it over.

So I worked with a mentor of mine, Dr. McCray, and got hired here. I was the associate program director for a few years and then took over in charge of education, which I've been doing the last 11 years. So it's been a great journey and I've really enjoyed it. My time at Anderson has been great, lots of different types of cases.

I've also continued to kind of be involved in education and over the years started running the GME, running the GMEC, and then recently associate vice president for education. So very involved in education. Both the trainees, nurses, techs, simulation, CME, kind of all of those different pillars. So education has become just important as a career as IR for me.

Dr. Baker: That's great to hear. You mentioned you found IR in med school. What about the profession drew you to it? Was there a defining moment, case, mentor or experience that confirmed IR was the right fit for you?

Dr. Kuban: Again, I think it was that SIR meeting. That was it because, so I first saw a GI bleed when I was on trauma or general surgery.

I was like, where are we? Like with some bowels of the hospital of BU? And I was like, oh, this is pretty cool. I've always kind of gravitated towards surgery. I was going to do ortho. It's like, well, I went into medicine, I was going to be the Patriots team doctor. If they’re ever open for an intervention radiologist. My CV is still out there somewhere.

But I always wanted to do that. But when I saw this and how the people were interacting with each other there, it was just like a little bit better environment than I had in ortho and very different, like when I rotated on there, you'd see those GI bleeds, but then you'd also do something in someone's brain and then do someone's leg.

And so it's just lots of variety all the way from peds to geriatrics, every organ system. So I really liked that part of IR. And then what I learned, I was a little worried about is—I also, am a big believer in being a clinical physician and clinical practice of IR. And so I was always a little bit worried because where I was as a med student didn't really have that.

I didn't have clinic, didn't have the chance to round, didn't have their own patient service. But once I went to SIR and found this community of people in like Geogy Vatakencherry, who's the true believer in clinical and IR, I was like, hey, this is like the group for me. They like clinical stuff, but they do innovative, fun stuff with their hands.

And then the image—I had to kind of come around on, you know, imaging is important. But that was never my passion, to be honest. But after going through IR, you learn how important it is to be an expert imager. So once you put that hat on, the imaging becomes easier to get through and actually becomes fun in some regards.

So that was it. It was finding that perfect combination of like clinical procedural with a lot of variety. I like following patients, but I don't want to follow them for 40 years, you know, so it's just kind of the right amount of that Venn diagram overlapping perfectly with what I wanted to do. And pretty unique to IR too.

So thanks for yeah, I mean, I feel like finding IR is like hitting the lottery in medicine. You know, it's like, I don't know why everyone doesn't do it. It's so great. And yeah. So anyone I talked to him like, oh, you should definitely go into IR, which I feel lucky that I still feel like that about my job 10 or 11 years in that I'm like, I'm still in the best profession in medicine.

Dr. Baker: Yeah, yeah. Earlier you mentioned you had a mentor, and you mentioned that IR has all these opportunities, all these different things that are going on and mentorship. I think it's an important role in helping kind of guide maybe where you want to take your career. How can trainees today find and build meaningful mentor relationships, particularly, you know, residents and fellows?

Dr. Kuban: Yeah. So I think there's some easy ways to do that that are given to you or served up. Like the Resident Spring Practicum is a great way to go and interact with other people or educators in the field. But really, I got to tell you, the most effective one is for the person who's looking for mentor to be proactive and go find one.

Like cold emails. I'll get emails from someone that's like, hey, can we meet? Not because they need something from me, not because they want a job or want a residency position. Just because they know who I am and they're around and they want to like, talk about future and I'm like, yeah, sure. And then it just kind of builds from there.

If you give someone advice and they take it and they follow back up with you, it's a more organic way to start a mentor-mentee relationship, but also the younger generation has realized that they have to kind of manage up. Like the mentor is not going to set a calendar for you and make sure you show up and like set out like your goals and objectives.

It's not med school, right? It's not college. You don't have a prescribed way to do it. You have to be self-motivated to say, “Here's what I want. I want to meet with this person as part of what gets me to what I want.” And so you’ve got to really manage up and you have to be proactive. You’ve got to network, take that first initiative to send an email.

And even if you don't get a reply, send another email, because sometimes emails get lost. Or find out who their assistant is and make some time. Or find them at a meeting. And be persistent and look for people that have careers that you want to have and connect with them.

Dr. Baker: Yeah. That's great. You mentioned a lot of skills there, networking and things of that nature. And so what skills, particularly beyond procedural ones do you believe are becoming increasingly important for the next generation of IRs?

Dr. Kuban: That's a great question. Grit is always one, but I don't think it's increasingly important. It's always been important. You got to be passionate and hardworking. And those two things combined is grit. So if you like what you do and you're willing to put in sweat, right, you really need to work harder than someone else, you're going to be successful.

So I think those are two very important things. You know, a lot of people say find something that doesn't feel like work. Well, that's what if you can find that level of passion that you love doing what you're doing, then that part is easy. The second part, which is probably a little bit different and is more important in the future, is like, let me politics isn't the right word.

But yeah, maybe it is politics. Interpersonal communications. Increasingly IR is competing with everyone, right? And we compete with nephrologists in one kind of thing we compete with vascular surgery in another. We compete with oncology sometimes for different things in some ways. We work with all those groups as well. But in every space that we're in, you have to be able to stand alone to have your own patient relationships, your own referral base, to be able to offer a service that is as good, if not better than someone else based on data.

And if you're able to do all that and you have the best data, if you're not able to sell that vision to either other services or patients or referring providers, you are going to potentially lose some of those referral bases as things other people learn to do different things. So for the future of IR, you need to have a direct way to get patients into your practice or direct referral provider from primary care.

And you need to be able to provide good service and sell it. And so like that, politics, interpersonal. How you market yourself outwardly is going to become more and more important as we move out of the hospital kind of trap door IR—the old school way, you just kind of—whatever falls through the trap door into the suite, that's what you're doing.

That's not our future, or at least the future most people want. So you have been able to get on the community, you have to be able to compete. And a lot of that is how you communicate with the world around you. Yeah, that's a great point. A lot of us residents, you know, maybe we just imagine a program and we kind of work within the structure that's there in the base that's there.

Dr. Baker: How could a resident or fellow maybe prepare to enter that, that new world, any experiences they could pursue or skills they can kind of develop to be able to do that well when they leave training?

Dr. Kuban: Yeah, absolutely. So a couple things. As a resident, first of all, you're going to be very overwhelmed. You have to learn doctor, which is not easy.

And the learning curve is like this. So you really have to work to do that. And you’ve got to pass that exam and that is a real deal. But as you get to your IR years, I think is the time to more focus on those skills. And something that was very important for me is just getting into a routine of reaching out to your referring provider every like almost every case, I don't do as like every case anymore because I have a really strong referral network.

But really in the beginning, especially as a faculty, every biopsy or nephrostomy—send a text to the referring provider, “Hey, just took care of your patient. Case went great. I'll let you know if there's any issues,” right?

And just get your name out there to them as someone that offers good service. And then when something comes up in their head like, oh, think of IR, you're right there. You're saved in their phone. You're a person they can text and reach out to offering more procedures than they ask for.

So in the beginning, where I had 30 different or 25 different partners that were doing all these different things, and I need to build an ablation practice, I get a request for a biopsy. I say, “Hey, I can biopsy this but you know, if you're interested, I can ablate it like at the same time.”

And you ask that ten times and maybe one out of the ten they'll say yes. But then you follow that patient in clinic. The patient likes you, their first provider likes you, likes the service they get. And that turns into referral stream. So it's all about building individual relationships with the referring providers and patients that will help you kind of build that practice, really practice building skill set as you get out.

But there's a lot to learn those first years, so focus on that. But as you get later in IR, I think that's an important time to do that. Clinic is also critical. Need to be involved in IR clinic or DR clinic or whatever you have. Be comfortable operating in the outpatient environment because that's where the relationships are built.

They're not built on the procedure day. That's where the work is done. But the relationships are built outside of the hospital.

Dr. Baker: All good to know. We're going to transition a bit to your SIR involvement. And we're going to start with, you know, you were heavily involved in, SIR as a resident. I know you were the first chair. I think the second one. What motivated you to get involved in SIR’s RFS section, and what was that experience like for you?

Dr. Kuban: So I was always looking for, I guess maybe 15 years ago when I started doing it, maybe 15 years ago, IR was becoming clinical, and I think there was a group of people that were very much focused on it, but it felt like the RFS was like the epitome of that and it didn't exist. A lot like IR was really attractive. It's like you can do things that don't exist, right? You can make up a new procedure, make a new tool. You can be part of this program that doesn't exist for resident fellows. So I like doing things that are new and creating. So that was a big motivating factor.

And then really Dr. Vatakencherry was a mentor for me for a long time. Still is. But we'd have long conversations about what IR is in the future and what the clinical model of medicine is and what we should be doing as a specialty. And he thought very similar to how I thought about it. And he kind of pushed me to think about what an IR can be, that you are a clinician. And so the chance to kind of push that message out and to be part of like a core group of people who all believed in that model of IR was really impactful because I'm like, hey, if we do this now, if we put all this effort in now, we are the loudest voice and we keep pushing, this will be this will turn into a clinical specialty.

And it's not that we did all of that, but the people that I was in with back in the day are now program directors and chairs, and they're all running clinical programs. So it took half a generation or generational change. But I feel like IR is now predominantly clinical. Most places not it's not the exception.

And the chance to be involved with that was a huge portion of why I considered RFS to be really critical to me. Yeah. And your motivation to be involved in SIR didn't stop there. And so the SIR folks gave me some more things you're involved in. But the IR residency, practicum, you work with the Association of Program Directors in Interventional Radiology, and you're also a member on the SIRPAC Board of Advisors.

Dr. Baker: So what inspires you to keep volunteering with SIR? And then what was that transition like from your time with the RFS to SIR as a whole?

Dr. Kuban: So I think there's definitely a couple of years where I had to take a little bit of a, you know, shift down in how much SIR stuff I could do. Still very involved.

But as you get through fellowship in your first couple years of practice and you got young kids, I mean, it's a volunteer time, you're not getting paid for it. But as my practice got settled, there was another opportunity that came up that was pretty unique, which was the residency essentials. So this was a really cool opportunity. The main reason I was really motivated to do that first step and set up that outline of how that should look, was the same reason I was involved at first.

It was a chance to shape how everyone sees our specialty by making it clinically-based and kind of the right approach to how I should be to the to our trainees and then to the population. So those are the opportunities that keep me motivated, chances to make big, impactful change that has broad appeal to lots of people. Those are the ones that I'm more heavily involved with, and the spring practicum is the same way: A big group of people, the chance to talk to a lot of people and have a big impact. A lot of what we do is all that impact on a patient basis. Working individually with trainees. Now it's working with a group of trainees for me. And my other hat, it's now I'm looking at the whole hospital in education. What impact can I have there. So your scope gets bigger but your mission is always kind of the same.

Dr. Baker: Yeah. Great. We're going to transition to the IR residency practicum. You know, something that maybe some residents and fellows aren't aware. You're one of the program directors. Can you share a bit about the objectives of the IRP and why was it formed, and how is it going to help to IR trainees?

Dr. Kuban: Yeah, so this came out of the fellows spring practicum, and this is my first year being involved with the organization of the practicum. So I have to obviously give a shout out to Luke Wilkins who's been leading it for multiple years.

Joe, who's another one of the program directors, and the SIR staff Joy. Everyone else that I've known there for a long time—it’s a big team effort, not to mention all of the 15 or 20 different people that have led this effort up to this point. So, we stand on their shoulders as we talk about this. But I think that there's been some really great changes this year, going from a fellow spring practicum to more of a resident oriented idea.

And one of the big things is to change the time of year. So it's a little bit different. It's not like your primer right before practice. It's a little bit earlier in your career. It's going to be open to PG all the way from 2 through 7. And because those groups of people need very different things, there'll be two different tracks, one for juniors and one for seniors.

So the 2 through 4 will be in one group, the 5 and 7s another. Not the entire time, but they'll have groups where everyone's together. We're talking about bigger, more important things that are broadly applicable to everybody. And then as they break out into different tracks, we're going to be focusing on more basic content stuff for some of the younger folks or things that are more germane to their stage of training versus the ones that are closer to getting into their training, into their positions as faculty.

So I think that's going to be a very nice way to do it. It's going to be more hands on, more interactive sessions, better opportunities for mentorship and networking. And it's going to be earlier in the year instead of later in the year. So fall instead of spring. All of those things, I think it's going to make it a better experience that someone can come back to, you know, year after year, potentially to have a great experience and to meet people.

Yeah, I think this is the first year y'all are offering it to early career residents, to younger something that maybe younger residents who in the past heard about this program but kind of held back cannot maybe consider.

Dr. Baker: Are there any sessions you're particularly looking forward to?

Dr. Kuban: The ones I'm spearheading this year are going to be liver, which is like going to be a local therapy for liver, both cancer liver disease and metastasis. So that's going to be one that I think is good and broadly applicable. And also the Potpourri one is going to be fun. Just a little bit of everything. Different things tips and tricks to get people.

So I think those are some of the ones I'm looking forward to.

Dr. Baker: That sounds great. Let's say you have a resident that's kind of on the borderline. Should I go, should I not? What would you share with them?

Dr. Kuban: Yeah, obviously go right if you can. I would say besides the content, which is something people can learn outside of a big conference like this, it's the camaraderie, the networking, seeing how residents that are one year above you or functioning or five years above you. And some are really learning more about IR than what your program can offer, which is important for all of us to have all of our own programs. We all have our own areas of strength, but this should be able to level set everybody to give them more exposure. But I think the camaraderie and networking is invaluable. I still talk to people now, I've been talking to them today with people that I've known in networks from RFS and from SIR when I was a resident. And, you know, you stay in touch with that group, but it's really nice to have a powerful network of people.

Dr. Baker: Well, great. Sounds like a great experience. And I hope more residents can participate this year. As we reach the end, something that we'd like to include in this podcast is a quick lightning round. So quick questions, you know, quick 1 or 2 maybe sentence kind of answers to it. So if you're ready we'll go ahead and get started.

Dr. Kuban: Sure.

Dr. Baker: Alrighty. So favorite IR device or tool you can't live without?

Dr. Kuban: Coffee..

Dr. Baker: Go-to way you de-stress after a tough case.

Dr. Kuban: Run.

Dr. Baker: One skill outside of medicine that helps you in your IR career?

Dr. Kuban: Talking to people.

Dr. Baker: Okay. And then a non-medical book, podcast or show you had to recommend.

Dr. Kuban: Let’s go with an old school one. “Once and Future King.”

Dr. Baker: All right. The last question. If you had to describe IR in one word, what would it be?

Dr. Kuban: Innovative.

Dr. Baker: Fantastic. Well, Dr. Kuban, it's been a pleasure to have you on the podcast. Before we close any closing statements, last things you would like to share?

Dr. Kuban: No. That's it. Thank you for having me. Looking forward to seeing you at the practicum.