A quick #thread on the importance of #mentorship and critical #feedback in writing. I’m targeting students, trainees, and younger faculty who struggle with the #mentoring process- I’ll share some vulnerability to demonstrate a #growthmindset- I’ll also recommend 2 books.
A couple of weeks ago I was invited by @AnnalsATS to write an editorial for a paper. I loved the topic so I quickly agreed and started ordering my thoughts. It was a quick turnaround- 2 weeks, so I had to get moving.
I worked diligently on the draft and invited @vitaincerta to co-author- she is smart as a whip and a terrific writer and I knew she would really help to shape a well-written piece. She agreed and I sent her my #ShittyFirstDraft.
As an aside, I always refer to a first pass as a #ShittyFirstDraft, directly inspired by a chapter in the book “Bird by Bird” by @ANNELAMOTT . I can’t recommend that book highly enough. Entertaining and insightful. And funny. bit.ly/2WkTllG
.@vitaincerta sent her edits and it looked like a bloodbath- red everywhere. I’m not going to pretend it isn’t shocking when I open a draft this red, but I have been doing this long enough to know there is growth in discomfort.
I find many trainees feel as though red marks on their drafts are an attack on their very soul- but this could not be further from the truth. The more red, the more the person cares about the work.
Besides the edits, @vitaincerta recommended that we ask @JHartMD to co-author, as she has good insights to the topic. We were down to a week until the submission was due, and I was nervous about timing, but we went forward. Plus at this point we had a good draft.
.@jhartmd sent our draft back and suggested a major revision by disputing a fundamental assumption about the paper. A MAJOR REVISION!?!

Truthfully, I was flabbergasted and sure that she had misread the paper. (By this time I had read it about 6 times.)
I re-read the original paper on which our editorial was based. I did my best to forget my priors and look at it with a fresh set of eyes. Sure enough, there was an alternate interpretation of the paper that I had completely overlooked. I was gobsmacked by my blind spot.
This required that @vitaincerta and @jhartmd and I completely rework the draft in only a couple of days. And I was still not convinced all of the arguments we were discussing flowed well from the original paper.
We set up a call and hashed out the changes, incorporating both potential interpretations. We realized we pretty much agreed on things, but our prior assumptions and perspectives were a bit different. We tapped out a new draft, completely different than the #ShittyFirstDraft.
Lesson: Surrounding yourself with people who are only going to tell you “good job” will lead to mediocrity. This clip from the movie “Whiplash” (a terrific movie, although with a terrible teaching role model) describes this well.
Abraham Lincoln’s approach to embracing critical feedback is outlined well in @doriskgoodwin’s book “Team of Rivals”- he purposefully surrounded himself with people that would challenge his priors. The best leaders do this. And a 2nd great book. bit.ly/2Wjvbrv
And the @DeptOfDefense and other large organizations frequently employ “red teams” to poke holes in major ideas and plans to make sure that prior assumptions are not clouding decision-making. bit.ly/2FlP5vi
So, embrace red marks in drafts from your #Mentors. They almost always represent a true investment in your development as a writer and will make the ideas you convey better in all respects. I’m still learning and growing, and I am almost a decade into my career.

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More from @gbosslet

Jan 16
I worked an unexpected overnight last night

This 🧵 is an exhausted, muddy-headed takedown of the historic but continued saddling of medical trainees with ridiculous work hours

There will be no data and I will appeal to emotion a lot

Here we go!


Last night I was blessed to work with two amazing residents

We were busy with very sick patients

They were constantly working

I don't know if they ate

I arrived at 5 pm and left this morning exhausted after getting about 2-3 hours of sleep

The IM resident had been in the hospital working 10 hours prior to my arrival at 5 pm and would round for another 3-4 hours after I left

I do not think that she slept

This amount of continuous work is OK according to medical norms and training program accrediting bodies

Read 11 tweets
Jan 4
OK let's talk about hospital admissions (with a focus on #Indiana) and what we can maybe expect with Omicron

Last week I talked about ICU beds, but what about hospitalizations overall?

A new report out of the United Kingdom suggests several things:
1. Omicron seems to hospitalize at about half the rate of Delta
2. Vaccination is protective against hospitalization, and boosters are important to extend this risk

Report: bit.ly/3Hwq0fC

These data is based on a relatively small number of hospitalizations (815), so take it with a grain of salt.

These data suggest for Omicron, unvaccinated folks are 5 TIMES as likely to be admitted to the hospital as fully vaxxed folks (3 doses)

Read 7 tweets
Dec 30, 2021
If you are attending a large New Year celebration with strangers, please know that in many areas of the country you are contributing to the collapse of the health care system.

This applies regardless of your vaccination status.

I know this sounds dramatic- please read on.

I am not chicken little when it comes to COVID

I have been a proponent of pulling back restrictions and mask requirements for the vaccinated

But the goal of public health measures is to protect hospital capacity

In Indiana, we are worse than ever.

Omicron’s spread is nuts.

I’ve followed the data closely the entire time and I am floored by it.

Read 11 tweets
Dec 27, 2021
This recent COVID-19 surge has put a major strain on hospital systems

I am an ICU physician and we have felt it acutely in this area of the hospital

Indiana has somewhere around 250 ICU beds currently unoccupied in the state (out of ~2100)

How can 250 feel like zero?

A 🧵

First, a word about statewide data.

Never has there been a microscope on these data like this, and the transparency is awesome.

Both @ISDH and @HHS keep track of hospital metrics regarding occupancy.

@ISDH data: bit.ly/3qLcNJh

@HHS data: bit.ly/3erSk6l

We feel a major crunch in ICU beds

constantly moving people out of the ICU to accommodate transfers

currently there is always a list of people waiting to come to our facility from other places

many of which report that they are out of room

Read 15 tweets
Aug 20, 2021
mRNA injected into deltoid cells lasts about 72 hours and do not travel to distant sites in the body.

I get asked about this all of the time, so I went to find the primary science on this.

A couple of quick tweets

The first paper I can find on this was in @ScienceMagazine in 1990 and showed the half-life of RNA in muscle cells to be less than 24 hours- RNA encoding the luciferase protein was injected into mouse quads and luciferase was undetectable at 60 hours. pubmed.ncbi.nlm.nih.gov/1690918/

In 2007, a study agreed:

Luciferase-encoding mRNA injected into human ear dermis peaked transcription at 17h and was undetectable at 3 days (panel d).

They also looked for luciferase expression at distal sites in the ear and saw none (panel e).


Read 5 tweets
Jul 22, 2021
Earlier this summer I was adamant that school would be reasonable without masks, even for the ages for which vaccines are not available.

I have changed my tune. A quick 🧵as to why.

Most data suggest that the SARS-CoV-2 virus affects kids in a generally quite benign way.

I know people get frustrated when COVID is compared to the flu, but for kids the data suggest the comparison is reasonable. And this accounts for "long COVID" and MIS-C.

So when I suggest that masks should be mandatory in school for kids, I am not worried about the health of my unvaccinated 6 and 11 year olds.

I am worried about it causing widespread community transmission and overwhelming hospitals.


Read 7 tweets

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