The Neurotransmitters: Clinical Neurology Education

Promoting Neurophilia with Dr. Nupur Goel

July 25, 2023 Dr. Nupur Goel Episode 26
The Neurotransmitters: Clinical Neurology Education
Promoting Neurophilia with Dr. Nupur Goel
Show Notes Transcript Chapter Markers

Dr. Nupur Goel joins us to talk about her journey from undergraduate education to the Massachusetts General Hospital neurology residency program. 

We talk about the importance of creating opportunities for yourself and the power of leveraging platforms in social media to build relationships as well as creating an impact. 

You can find Nupur's podcast "Neurophilia" at https://neurophiliapod.buzzsprout.com/
On Twitter:
@NeurophiliaPod
@mdgoels

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The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

Dr. Michael Kentris [00:00:02]:

Hi everyone, and welcome back to the Neurotransmitters podcast. I am very fortunate today to be joined by Dr. Nupur Goel, and she is joining us all the way from Boston today and is starting out her neurology residency. But I asked Nupur to join me today because I was really curious to find out more about your journey to neurology. Hi, Nupur. How's it going?

Dr. Nupur Goel [00:00:27]:

It's going great, Michael. Thank you for inviting me to be on your podcast. I'm a longtime listener and you're actually one of my biggest inspirations for getting into the Med Ed space myself. So thank you so much for having me.

Dr. Michael Kentris [00:00:39]:

Oh my gosh, I'm blushing. Well, yes, I should mention Nupur is also the host of the Neurophilia podcast, which I am also a fan of and also has some very good episodes out there. And I will, of course, include a link to that in the show notes below.

Dr. Nupur Goel [00:00:54]:

Well, you have to give the link to the one that you are featured on. That's the one that needs it is.

Dr. Michael Kentris [00:01:00]:

The first, and the first episode is usually the best place to start, so I can't dispute just logical thinking. So one of the know, obviously I've known you since were a medical know OSA many months ago. We are recording this in July for those who are familiar with the academic calendar. So you started at NEOMED here locally in Ohio, in Akron Rootstown Ohio area, kind of your local stomping grounds. Makes sense, right? Medical school nearby. When you were applying to medical school, what were you thinking you would end up doing after graduation?

Dr. Nupur Goel [00:01:37]:

That's a great question. So my path through medicine was pretty nontraditional. I actually got into medical school in high school. I was the last cohort accepted into an accelerated program through the Northeast Ohio Medical University. And so I did two years of undergrad at the University of Akron, and then I went straight into four years of medical school. And so if I were to ask high school Nupur what she thought she was going to be by the end of those six years, I thought it was going to be a neurosurgeon, to be honest with you.

Dr. Michael Kentris [00:02:10]:

Okay.

Dr. Nupur Goel [00:02:11]:

So I ended up being in the same area of expertise but not as much time in the or. Going forward.

Dr. Michael Kentris [00:02:18]:

What do you think shifted that?

Dr. Nupur Goel [00:02:21]:

For me, it was really my third year experience in medical school. Being actually on the wards, getting that chance to really see what the day to day life is of different clinicians, really opened my eyes to what speaks to me and what I find fulfilling in my own personal life and professional life. And so that's sort of where I had that shift from surgery to medicine. And then it took a little bit longer to find my way into neurology, but I'm sure we're going to get to that down the line.

Dr. Michael Kentris [00:02:50]:

What was about neurosurgery or neuroscience in general? Most high school students aren't really gung ho about neuroscience per se.

Dr. Nupur Goel [00:03:01]:

Yeah, I think for me in high school, I took obviously AP biology, as most premeds and medical students do, and I was always fascinated by the neuro subject. And I remember in high school that we got to do a pig dissection, and I remember holding a pig brain for the first time, and it was sort of this love at first sight experience that I had. And I just thought it was so interesting how this piece of gray matter can hold one's entire being in it. And so from that moment, I knew that I wanted and sort of had this affinity towards the neurosciences, and I'm an individual that really enjoys instant gratification. And so I just assumed that going the surgical route meant that I could have immediate intervention in the lives of my patients and allow them to immediately improve. And so I just assumed naturally that if I took the complexity of neuroanatomy and consciousness and paired it with that instant gratification, that would be the career path that I would want to go into.

Dr. Michael Kentris [00:04:12]:

No, that makes a lot of sense. I know a lot of times neurology, as opposed to neurosurgery, does have a bit more of the long game. And I think there is still that old way of thinking, especially amongst other specialties, where there's not that much to do, you can't help these people, which I think recent research and developments in neurology over the last several decades has put the lie to that type of thinking.

Dr. Nupur Goel [00:04:39]:

Absolutely.

Dr. Michael Kentris [00:04:40]:

Did you encounter that kind of thinking as well in your preclinical and other clinical rotations?

Dr. Nupur Goel [00:04:48]:

Oh, absolutely. I mean, anytime that I was on a rotation, whether it was emergency medicine or OBGYN, I would say I'm really interested in neuro, whether that's neurosurgery or maybe neurology. And every time a physician would scoff and say, I mean, neurology, all you do is diagnose an audio. That's what the field is. And when you're a medical student trying to navigate through that system and understand where you're supposed to be, comments like that can be really defeating and sort of dissuade you from going down a path that you might actually enjoy down the line. And so it's really important in addition to having those naysayers who might think a field is something where you can't really do a lot in having positive influences that can show you the opposite side and the positives and the beauty of a field that you might be interested in is really important when you are a medical student.

Dr. Michael Kentris [00:05:43]:

Absolutely. There's a fairly large percentage of medical schools that do not have a neurology clerkship, which for those who aren't familiar right. A clerkship would be kind of a mandatory, quote unquote, elective or a period of clinical work that is mandatory for essentially all the third or fourth year medical students. In your case, we have the preclinical neuroscience course. Do you feel like obviously you're predisposed towards liking it, but just again, your vibe check for your classmates. I'm asking you to speak for a cohort of over 100 people. Yeah, but do you feel like it pushed anyone further away or just kind of kept things kind of at a neutral level or did it bring people into neurology?

Dr. Nupur Goel [00:06:29]:

I think it's actually the latter. Our neuroscience course at NEOMED is one of the most favorite courses of the first two years of medical school because we have such talented and brilliant teachers that come in and there's a lot of hands on learning. So there's all these brain slices in different cross sections and you really get to associate the clinical findings and neurological pathology with the actual anatomy. And so I know anecdotally talking to many of my classmates that they found neuro very interesting from their first year of medical school. But with no established time during that third year to really explore that passion, it quickly drops off and you get busy with so many other things that it falls to the side.

Dr. Michael Kentris [00:07:20]:

That's an excellent point. And in the area that we there's, we're kind of in this little triangle right there's. Akron, Pittsburgh, Cleveland, and then there's a lot of area in between. And so the number of neurology clinical rotation sites is also somewhat limited, especially when we're talking know not to get into the nitty gritty but affiliated versus unaffiliated sites and the timing of different electives for each student and so on and so forth. So it becomes kind of a logistical nightmare if you're looking for something very specific. So to what degree would you say it was your own persistence in seeking out that experience that led you to that?

Dr. Nupur Goel [00:08:07]:

That's a great question. I would say a majority of it was because when I got to my third year of medical school, I started out on my surgery experience and quickly realized that it just was not the right path for me. I felt like I had more fulfillment talking to patients and their loved ones before and after surgery than I did being in the procedures. And that caused a lot of cognitive dissonance because you think you know who you want to be and what you want to do, and when that doesn't line up with the actual experience that you think you're going to have, it can be a lot in medical school. And at that point I thought maybe neurology, because it's the same content matter, maybe that's something that I could find myself into. But being at a school, as you said, where there isn't established clerkships in my mind, I was just like, how am I going to get that experience to know this is what I want to do? So that in six months from now, when I have to submit my eras application, I can definitively say this is what I want to do with my life? And so for me. The point where it all changed was actually during my internal medicine rotation, where I got the chance to meet a neurologist and in meeting him, establish an elective during the later part of my third year, where I was able to spend four weeks exploring all of the different aspects of inpatient neurology. And so now looking back, I'm very grateful that I went through that process of trying to get an established clerkship. But when I was in my third year, I couldn't help that feeling of, wow. Other medical institutions have this experience just built in, and it's very easy and accessible for students to get what they need. But a piece of advice that I got from one of my mentors, Dr. Buletko, he told me early on into the application season that you should use the disadvantages as your selling point. So when it comes to applying for Neurology, if you're able to say, I created this experience, and I went out of my way to explore the field of Neurology versus it being there and finding that passion while it's already established, that reflects a lot better on you as an applicant if you're able to turn disadvantages into opportunities.

Dr. Michael Kentris [00:10:38]:

No, that's an excellent point. So basically, just a chance encounter in the hallway at a hospital is kind of what led you to eventually setting up this rotation and changing kind of your whole career trajectory.

Dr. Nupur Goel [00:10:51]:

Yeah.

Dr. Michael Kentris [00:10:53]:

Which it's crazy when you say it out loud. Right.

Dr. Nupur Goel [00:10:57]:

In retrospect, it really is. And I don't think attendings and residents sometimes understand the true importance and power they play in the lives of students because one positive interaction or on the other hand, one negative interaction can completely change how a medical student can view a specialty and whether or not they eventually choose that as a career. And so it's a lot of responsibility if you are at a teaching institution to make sure you really want to put the best foot forward when it comes to your specialty, because that might be the reason why someone might enter it or maybe the reason why someone might leave it down the you know.

Dr. Michael Kentris [00:11:38]:

It's interesting that you say that. So I also kind of had, not to get too much into my own backstory, a very non linear course to neurology as well. This was down at Wright State, and they had a neurology clerkship, so that was the interesting thing. But even with that neurology clerkship, they did not have neurology residents until 2014, which was the first class. So I was part of the first class from that residency program.

Dr. Nupur Goel [00:12:04]:

Wow.

Dr. Michael Kentris [00:12:04]:

And we saw that we would went from around, like, usually one to two people applying to neurology out of 100 plus class, usually to usually anywhere from four to six applying. So it's still small numbers, but it's a two to three fold increase if you want to put a positive spin on it.

Dr. Nupur Goel [00:12:25]:

Right.

Dr. Michael Kentris [00:12:25]:

So it really does speak to that you get these people who are, like you said, right, they're enthusiastic. They are wanting to teach. They are taking the time to improve that experience for people who are more junior than they are. And they want to. I would always say when I was a resident and I had medical students, it's like, if you express any interest in neurology to a neurology resident, it's like you have just said, like, I want to join your cult. And people immediately try to bring you in. It's like, oh, yeah, let me show you this cool thing. And they do everything they can to convince you that it is the best specialty for you to apply to. I don't know if that's been your experience in different locations as well.

Dr. Nupur Goel [00:13:09]:

Yeah, it's interesting you say that because since NEOMED is associated with a lot of community hospitals, there aren't a lot of neurology residents at these institutions. So it's a lot of just attendings that you get to interact with. And so because of that, whenever I was doing rotations at local hospitals, I would often be with internal medicine residents or emergency medicine residents, and they would always just have this disdain for neurology, that this was just an experience, a requirement that they had to check off before they can move on to the next place. And so it wasn't until I was doing sub eyes at places where there were actually neurology residents that I got to feel that passion and that love for neurology and realize I'm not crazy. It's just that I need to be surrounded by like minded individuals who also love the brain.

Dr. Michael Kentris [00:13:58]:

Right. And that kind of ties into your entire podcast, your first season's arc of neurophobia, as it were, right. The people who maybe they didn't get the experience or they didn't seek it out in their own undergraduate medical education and maybe even their graduate medical education. Internal medicine residents, they have a neurology rotation requirement. They may not have robust structured education as well. And so then you wind up with, like you said, people getting all the way through, and they never had really great hands on instruction. Like, everybody, they got their neuroscience in the preclinical years, but if you don't use it, you lose it.

Dr. Nupur Goel [00:14:38]:

Right, exactly.

Dr. Michael Kentris [00:14:39]:

So you went out and sought these opportunities. You built these rotations, but you didn't just do it through the typical structured means. I believe you also created quite a few or took a few different alternative pathways as well. Could you tell us more about those?

Dr. Nupur Goel [00:14:55]:

Yeah, so in addition to establishing an elective where I had to basically cold reach out to multiple neurologists at community hospitals, asking them, hey, can I just be with you for a week to learn more about your specific subspecialty neurology? Outside of that four week experience, I actually was able to create a lot more opportunities to delve deeper into the field of neurology actually through social media. One of the greatest experiences that I became a part of simply because someone who graduated a year before me at NEOMED told me about this opportunity is the Neuromatch community, which is such a strong online platform that was actually created during the height of COVID to help connect residency programs with applicants. And I had no idea about this platform until the application was due, like the next day. I had no idea it even existed. And I just threw my hat in the ring and was gratefully selected as one of the leaders. And I got connected with six other brilliant individuals who had different experiences from my own, some of whom who had clerkships in Neurology. And we were all put together to sort of help the upcoming application cycle get a better sense of how do we do this in this hybrid virtual world. And it taught me a lot more not only about the field of Neurology, but also the application process, which I don't think if I wasn't a part of that group, I would have had as good of an understanding and knowledge base when I was applying for residency had I not that opportunity.

Dr. Michael Kentris [00:16:35]:

In what ways? What do you think you picked up from them that isn't necessarily common knowledge?

Dr. Nupur Goel [00:16:40]:

So there's a lot of nuance and jargon when it comes to applying for Neurology. So when it comes to the first year of prelim year versus transitional year and then programs being categorical versus advanced and also there are so many online events that occur for every single program. And so being part of this platform that actually consolidated the information, it helped me keep a better understanding of what do I need to know and be mindful of when applying for residency. And I think one of the greatest parts of the platform was the chance to sit down with multiple program directors. And that's actually one of the first times I met Dr. Buletko, was we were doing a session together through Neuromatch and it was a great chance to just pick the brains of program directors and have that direct conversation that you don't necessarily get the chance to have when you are an applicant. And so it sort of allowed me to break down that fourth wall a little bit more, and I felt like it gave me a little bit of an edge when it came to applying for Neurology, where I didn't. Have that clerkship. I didn't have that pre established opportunity, but I was able to find other ways to make myself more accessible to the field.

Dr. Michael Kentris [00:17:56]:

That's awesome. And yeah, it is very fascinating. Like we were talking about before we started recording, I've met so many fascinating people in the Neurology sphere via Twitter that I wouldn't have ever met in person working where I am in a smaller community hospital. And it's been all these kind of unique opportunities. And I participated with the Nmatch the Neuromatch group last year, and I've actually been working with some folks who didn't match in this last cycle and we've been working on some projects and some of these people are, like you said, incredibly industrious and really putting in a lot of work for the next cycle. And so it's been very enriching and you just meet people from all over the country, all over the world who do have very different experiences and a lot to bring to Neurology in general. So it's been very fascinating and very rewarding in many ways from that perspective.

Dr. Nupur Goel [00:18:59]:

Absolutely. Well, it's so funny that you say that because you go on Twitter and you see these people and you see their pictures, and then you go to an event like the Aan and you feel like you're talking to your friends. You know what? Like, I remember that was the first time I met you in person and I felt like I had known you years prior just because of our interactions via social media.

Dr. Michael Kentris [00:19:21]:

Right.

Dr. Nupur Goel [00:19:22]:

If I could give a piece of advice to students who are interested in any field, whether it's Neurology or any field of medicine, be creative about opportunities for networking. And that doesn't need to be sending out emails. It can mean that. But also you could try DM-ing program directors or attendings. People are very accessible nowadays and you can really land great opportunities if you keep an eye out for it.

Dr. Michael Kentris [00:19:47]:

That's very true. Like some of the people who one of my side projects, I do narration for the Continuum Journal, and I know a lot of medical students and residents have just reached out to me and asked to be participants, and a lot of them have been. And it looks nice on a CV, but yeah, it's a way to get involved with different organizations, meet a lot of different people, learn a kind of unique skill set in the recording space. When you go to apply for Neurology, it's a nice little interesting thing to talk about.

Dr. Nupur Goel [00:20:28]:

Well, it's interesting that you say that because when I reflect back on my interview process, I got asked so many questions about my extracurricular hobbies and passions, and I maybe got one to two questions about the research I did. So it's just so important to develop yourself as an individual and really do what you're passionate about. Find your passion and really sink into it, because that's really what's going to take you the distance.

Dr. Michael Kentris [00:20:58]:

Yeah. As someone who interviewed for Neurology residence at Wright State, when I was there and the hobbies section was usually where my eyes gravitated first, I was like, oh yeah, they've published some stuff, that's fine. Good. But it's like if it's like, about proteomics or different RNA transcript, I don't know. I've got ten people's applications. I can't go read the primary literature on every application that I'm picking up here, but I can ask someone about tell me, tell me about your favorite hikes. Tell me about what you like to knit. Tell me about what are the things that you do that make you a full, complete person? And I feel like that's again, this is my own personal philosophy, so definitely many grains of salt with it. But you've gotten to this point as a medical student, right? You're obviously not you I'm talking about the collective you out there. You're obviously an intelligent person. You've done hard work. You've demonstrated that you have the drive to finish that particular climb. But what else is there to you? Are you a normal person? Right? We're going to be working in close proximity for three plus years, depending on the specialty. Are you someone who people can work with? That's really the question that I always ask myself, can I work with this person? Are they going to be under my skin or are we going to have a good relationship where everything's going to be easier because they're reliable, because they're a hard worker, because they have an inner drive to make sure they're doing what's right? And again, can we sort all this out within just like, a 30 minutes interview? Probably not, right? But that's what we're trying to do. We're down that rabbit trail now of the whole, like, what is best for residency applications. Yeah, who the heck knows? So you continued down the neurology application pathway. You started the Neurophilia podcast. Was that before or after? During. At what point during the residency application trail did that start to kind of brew in the back of your mind? And when did pen hit paper, as it were?

Dr. Nupur Goel [00:23:21]:

That's a great question. The thought process behind the podcast started pretty early into interview season. One of my first interviews is when a program director asked me what's my solution for ending neurophobia, since it was something that I was very passionate about and I put in my personal statement and I didn't have a good answer to it. And so that bothered me, and so it stayed in my mind. And I had this thought process that I wanted to potentially create a conversational podcast. And I spent maybe one to two months thinking about it and talking it over with some of my mentors and saying, is this something that is going to be meaningful? Because as you and I both know, there's a lot of phenomenal podcasts out there in the neurology space alone, let alone medicine as a whole. And the last thing I wanted to do was create something that has been done before and that was not meaningfully contributing to the field of neurology. And I know I'm not an expert. What I can bring to these conversations is curiosity and questions. And so I spent a couple of months just like, thinking it through and saying, is this something meaningful? Will it be helpful to someone someday? And actually, Penn hit the paper two months down the line when I just sent out the email to actually you, Dr. Buletko, and Dr. Itrat, asking the three of you to be on the first episode of the podcast. And I had such a clear vision of that first episode where I wanted it to be a conversation about neurophobia with neurologists. And then after that point, it was very unclear which direction we were going to go into. But I knew something that was very meaningful for me. Prior to starting this podcast, there was this experience I had at Summa, a community hospital near NEOMED. There is this phenomenal vascular neurologist. Her name is Dr. Susanna Bowling and she single handedly created the Suma Neurology department. And every single year she runs this multidisciplinary conference that lasts the whole day. And she calls it ACLs. Advanced Cerebral Vascular Life Support. And it's a session that has family medicine, internal medicine, emergency medicine, residents. And it's such a beautiful session because it's led by vascular neurologists, neurocritical care, interventional neurologists. Having those conversations, having that time to really share neurology with people who are not in neurology. And throughout that course of that one day, I saw the confidence level of these residents grow. In the beginning, in those first sessions, no one was really raising their hands. No one was really talking. But by the end of it, people were standing up, identifying bleeds on CTS and being able to identify structures on MRIs. And I thought that that was something that was so powerful and so, long story short, that's what I wanted to bring to this podcast platform was a space for that kind of collaboration and that kind of communication to occur.

Dr. Michael Kentris [00:26:53]:

Excellent. Yeah. I think in your first season, you've definitely hit that nail pretty solidly on the head. It's been very enjoyable listening to, like you said, kind of the interplay between neurology and the other specialties that you had a chance to talk with, and some of them in very interesting ways in different settings, different specialties, different considerations, certainly. And it's been very interesting to hear how people from the, so to speak, the other side, kind of view us, as it were, and what are the things that we can do better? The answer almost always is communication is kind of the glue that would fix a lot of these problems.

Dr. Nupur Goel [00:27:41]:

And not wearing as many bow ties, that's the other piece. It's communication and changing our wardrobe. That's what I've gotten so far.

Dr. Michael Kentris [00:27:48]:

That's fair. I've never been a huge bow tie person. I wear it for the derby parties and at my wedding, but I don't wear them very often otherwise.

Dr. Nupur Goel [00:28:01]:

Fair enough. You passed the vibe check, Dr. Kendrick.

Dr. Michael Kentris [00:28:04]:

You passed. But I have seen some folks with some EEG squiggle bow ties, and the temptation is there. The temptation is alive.

Dr. Nupur Goel [00:28:12]:

You know what? I'm going to get you one for Christmas.

Dr. Michael Kentris [00:28:16]:

I'll look out for it.

Dr. Nupur Goel [00:28:18]:

Okay.

Dr. Michael Kentris [00:28:20]:

It's very fascinating. So moving along a little bit you are now going to we've come from this smaller community setting. Now you're at the Hub, the epicenter of academic medicine. You're up at Mass General starting your first year of residency. And so it's, I'm sure, a bit of culture shock in terms of just the massiveness of everything.

Dr. Nupur Goel [00:28:47]:

Yeah.

Dr. Michael Kentris [00:28:48]:

Tell me a little bit how that turned. I know it's early days, but how's it been going so far?

Dr. Nupur Goel [00:28:54]:

It's been good. Something that has been a little bit of a challenge is just the impostor syndrome, as you said. Coming from a smaller institution and being around such brilliant individuals, you kind of question your place in the room a little bit, but I have to keep reminding myself that I'm here for a reason and I was chosen for a reason. And it's kind of crazy. The culture shock is real because you go from a space where there aren't that many opportunities and you have to kick the door open a lot of times to now being in a place where everything is open and there's so many opportunities and mentors and networking possibilities that you kind of don't even know what to do with. So the transition has been good for the most part. It's definitely overwhelming at times. There's a sense of imposter syndrome that I think will go away with time, but I'm just really happy to finally be in a place where I feel like the world is my oyster and I can bother and pester people to be on my podcast and to do research and things that I'm passionate about. And yeah, it makes me really happy to know that I came from a place like NEOMED, where I learned the skills of grit, I learned the importance of creating those opportunities. So now that I have them readily available, I know how to make the most of them.

Dr. Michael Kentris [00:30:26]:

That's excellent. Yes, it is. That change in mindset. I had a similar thing where I kind of went from smaller to smaller, or I should say small list. I'm a do grad, right? So we usually don't have neurology. I can't think of a single school that has neurology clerkship in the do space, but there might be some that I'm unaware of. So I went from there to residency in neurology, and then I did a fellowship at Vanderbilt, which, like you said, right, how could someone like me be accepted into a place that has that kind of reputation? I slipped through somehow. But then you go and you become like, academic faculty, and then we end up moving back to a small community hospital where I'm one of a few neurologists in a 50 miles radius. And you feel that loss a little bit where you're like, where are my colleagues to bounce cases off of, to discuss, to have these highfalutin conversations about things only neurologists care about? And so it did reemphasize to our original point, how do I bring this level. Of education, right. To my colleagues. So that the lack of neurologists. How can I help raise the neurologic awareness in the community that I am in? Right? I am here. So what can I do to help the community and kind of make those primary care physicians and the Er docs and everything like that? What can I do to help raise that consciousness and kind of working on that? So to that end, like you said, that was my impetus for starting a podcast was, what can I do to talk about neurology that people will not find incredibly dry and hopefully somewhat stimulating, but still educational? And so it's been challenging. Right. I love the conversational nature of what you've been doing, and I've veered into that a little bit as well. I try and keep it more focused on a specific pathology with more or less success, I will confess. But it is one of those things where sometimes there's no way out but through. Right. Some of this stuff is just rote memorization. You got to just hammer it home, and we got to disseminate that information to people who need it.

Dr. Nupur Goel [00:32:59]:

Yeah. Well, I think what you do in the med ed space, as well as trying to I love the way that you put it trying to raise the conscious level of neurology and people who aren't neurologists, it's such a noble effort. And I know from students who have had the pleasure of rotating with you, unfortunately, I am not one of those students, but from those who have had the opportunity, you make such an impact whether or not they even go into neurology. And so thank you for fighting the good fight and being a model educator, someone that I hope one day I can also be like. And I always think about the phrase that you used of spreading the gospel of neurology.

Dr. Michael Kentris [00:33:44]:

Yes, I've been known to be a little overemphatic sometimes. I've been reading a lot. This is kind of an aside, but I think it ties in. I've been reading books about copywriting lately, right. So bear with me.

Dr. Nupur Goel [00:34:03]:

Okay.

Dr. Michael Kentris [00:34:04]:

There's different levels of awareness that people talk about. They talk about problem awareness. Right. Is the person reading what you've written aware that there is a problem? So you have to tailor it, like, hey, you might have a problem. Let me tell you about that. And then you guide them. Right? So there's problem unaware. Like, I'm not aware that there's a problem. Problem aware. I am aware that there is a problem. And then there's, like, solution aware, solution unaware, things like that. So you kind of have to meet people where they are, which, again, is something you've talked about at length with Dr. Buletko on your podcast. And it is so true, though, and I think it's very easy for us to forget that, especially when we do have a larger department backing us, because you don't have to necessarily reach out as much. And so that's been the last two and a half years, been something that has been repeatedly emphasized by my circumstances, that I need to talk about things in a way that's understandable. Right? I remember when I was a junior attending and one of my partners here, Dr. Venkat, he was chief resident at the time, but he told me, mike, you need to stop writing your reports like this. I was fresh out of fellowship. My EEG reports, people don't know what you're right. They don't know what you mean. And so we're getting all these consults that are unnecessary. I was like, oh, crap, you're right. And so I had to think back like, well, I need to use language that people understand, right? Communication. It all comes back to communication. So using phrases, using terminology that is understandable by people and that kind of right. I'm riffing off of the American Clinical Neurophysiology Society EEG reporting guidelines. At this point, they talk about the body of the report. It should be understandable by an epileptologist or a general neurologist. The impression should be understandable by a primary care physician or someone in a similar role. So you need to make your reports comprehensible. And I think that a lot of times, like any of our other ways that we might communicate, our assessments and plans and so on, right? We need to make sure that we are communicating in a fashion that is understandable by the general public, especially now with everything we write is available to the patient and their family, right? So we need to make sure that in some situations that it's understandable to a layperson potentially, which again, is just an extra layer of awareness of our own communication. And I think more than anything else, that's becoming more and more. What we're seeing is this emphasis on communicating. And I always think back every time, not every time, but many of the times where I struggle, like, why can't I find the correct diagnosis on this patient? It's because I don't have the story. Like, either I couldn't reach someone or the patient, they weren't coherent enough to give me a proper story, or family wasn't available, or I couldn't reach someone. And then when I finally do, it's like this epiphany where all the pieces, like one of those Rube Goldberg machines where all the things fall into place and your piece of toast pops out and it just becomes that I think is the thing that draws people to neurology is like that AHA moment. It's like, I've put the pieces together, I've solved the puzzle, and now I know what to do, and it becomes one of those things. And so I think trying to share that feeling with people is how I get them interested in clinical neurology as well. At least that's my take on it. There is that just incredibly satisfying feeling of putting the pieces together and coming up with the best plan with your patient and being like, I know what we should do, and here's how we can go about it. If you're game.

Dr. Nupur Goel [00:38:16]:

Yeah, absolutely. I wish there was a way that you could bottle up that A-HA moment and give it to medical students, because your journey is also so unique in how you stumbled into neurology and ended up being so fulfilled. But it just makes me think of all the students who miss out on so many great opportunities and great mentors that can provide them with that moment, whether or not it's in neurology, but we hope that it is.

Dr. Michael Kentris [00:38:47]:

That is the bias showing.

Dr. Nupur Goel [00:38:49]:

Yeah.

Dr. Michael Kentris [00:38:53]:

But for those people, let's say if you were talking to M1 Nupur in years past out there somewhere in middle America or overseas, I'm really intrigued by the idea of neurology, but how should one go about getting those opportunities? What's the best way?

Dr. Nupur Goel [00:39:14]:

Yeah, so that's a great question. I would say the first thing would just be to see what is available. So look for if there are core clerkships established at your medical school allowing you to explore neurology. If those don't exist, usually there's faculty that are usually associated with your medical school that provide lectures during preclinical, and so they can be a great first person to reach out to about, hey, I'm really interested in this field. I don't have the chance to explore it later on. Can I perhaps shadow you during my preclinical years or maybe even during clinical years to get that exposure and recognize that even if you don't get the chance to have an established clerkship your third year of medical school, that doesn't mean that you can't go into neurology. There are so many great opportunities in the beginning of fourth year if you are set on this path, to be able to then end up where you're meant to be. The most important thing is just identifying that this is the field that is most important to you and that you want to go into, and that does require experience and exposure. And so whether that's through shadowing or whether that's through research, whether that's through just networking with neurologists and letting them talk about what they do day in and day out and what they love about what they do, can be a good starting point to get to where you want to be. And I guess the only other thing I would say is that something that I realized a lot in doing the podcast and talking to people is that I had this idea that we have to get rid of neurophobia. It can't exist in the medical community. And I don't think that's true. I don't think that we need to get rid of neurophobia. I think we need to recognize that it does exist. Even the best neurologists who've been in practice for 30 plus years experience neurophobia. But that doesn't mean you can't still love it. That doesn't mean that you can't still do it as your career. And so I think that's something that medical students need to understand is that maybe when you're going through those first couple of years where you're getting introduced to the neuroanatomy and you might find it extremely complex and difficult, that shouldn't be a reason that you don't pursue it later down the line. I don't think it's a matter of either or when it comes to neurophobia or Neurophilia. I think it's a matter of reconciling our phobia with the philia.

Dr. Michael Kentris [00:41:51]:

I would agree. I think a little bit of fear keeps you sharp but too much will paralyze you, right?

Dr. Nupur Goel [00:41:56]:

Yeah.

Dr. Michael Kentris [00:41:56]:

So it is one of those things, I would say it's kind of one of those inverse relationships. Right. It's not phobia and philia as much as it's probably like a four way axis or something like that. Where too much neurophilia does that make you overconfident? Does that lead you to making diagnostic errors due to not questioning yourself? Yeah, hopefully not, right? We tend to think of philia as being relatively good. It's like being friendly, as it were. But I think that is a good point. A little bit of a balance there is important as a neurologist myself, there are certain diagnostic workups or acute changes that they make. My stomach roil a little bit and I'm like I wish this wasn't happening and you just have to do it as it were. So you educate yourself, you get practiced, you become competent. Doesn't mean you have to like it, but you have to know it as a neurologist. Obviously, if you're in a different field you might be able to skate by and palm it off in your neurologist. But yeah, I think that's an excellent point inasmuch as a little bit of discomfort doesn't mean that you can't be good at something. Right, and I think that like something you mentioned earlier, you did mostly inpatient neurology to a large extent during your initial rotation and outpatient. Neurology is an entirely different animal. I've had former students and co residents who don't do inpatient neurology at all. They despise working in a hospital. And I remember one person in particular, she would be very unhappy in the hospital on a regular basis, let's just put it that way. But once she graduated and was practicing, her entire demeanor was different just on a regular basis. And I was just like, oh, you're like a much more chill person when you don't have to cover the inpatient stroke teams and all that kind of jazz. And it really is residency training is obviously very demanding and it's very inpatient heavy a lot of places these days and that is only one piece of the equation. There's plenty of neurologists who focus on other things and I always think one of my co residents, he's a movement disorders Dr. Suraj Rajan, if he's listening still to my ramblings. But I always like the way he phrased this as cold neurology and hot neurology, which I don't think relates to yoga, but hot neurology of your inpatient stuff, right? Kind of like your neuro interventional, stroke, kind of your acute seizures, things like that, neuroicu. And then cold neurology would be like headache, movement disorders, neuromuscular, these things that, yes, they're very complicated, very debilitating disease processes, but they move at a much slower pace, generally speaking. And they don't really require you to be in the hospital, but you can still provide a lot of value to your patients. And I think that goes back to what you were saying, that immediate gratification. There are still people who are in that mindset even within neurology. And you have the patient who comes with a stroke and you give them Thrombolytics and their NIH drops from like a 20 down to a two, and it's like, oh, man, what a feeling. But then there's the patient with Parkinson's disease and you spend weeks titrating their medications and you get them to a point where they're able to walk up and down their stairs, right? It's a small victory, but it's a victory. And maybe that's keeping that person at home and keeping them out of a nursing facility. And so you're providing value, but it's that less lauded sometimes. And I think it's very easy for us, especially when we're in training, to kind of lose sight of all these things. My background was an epilepsy in my previous practice and so obviously we get excited about doing the big epilepsy surgery evaluations and the status patient. We're doing high doses of all these medications, which I still enjoy doing. And it is satisfying. Like, you get this person, the seizures under control, they get out of the ICU, and then they eventually hopefully do better. And it's kind of the same when you have that long term patient in the clinic that you're seeing for Parkinson's or epilepsy and you get those medications dialed in, you get them the right resources, and you're able to change that person's quality of life. It just makes such a big difference. It's just very satisfying, right? You've changed the quality of life for this person. And it's one of those things like it just gives you that quiet glow of you're satisfied that you've done a good job. And that, I think, is something for anyone considering neurology out there, it's not all hustle and bustle. There's these slow side of things as well that have that slow churn that build up and then ideally the payoff, right? You do right by your patient, they hopefully can get a handle on whatever disease process, even if it is progressive. And that can make a big difference in terms of people's outcomes and how they view their own lives. And that's, I think, one of the satisfying pieces for the cold neurology side of things as well. So just to throw that out there for anyone thinking about Neurology because a lot of our rotations as students and residents are inpatient heavy, and so I think it's always good to remember that there's more to life than this, as it were.

Dr. Nupur Goel [00:48:13]:

There's more to life than just hot neurology. There's also cold neurology.

Dr. Michael Kentris [00:48:18]:

Yeah. I don't know if he took that phrase from somewhere else, but I always liked the way that it was framed.

Dr. Nupur Goel [00:48:23]:

It's a good way to put it. It's such a good way to put it.

Dr. Michael Kentris [00:48:26]:

Well, any final thoughts for us today Nupur?

Dr. Nupur Goel [00:48:29]:

I just want to say I'm so appreciative of the opportunity to sit down with you and talk to you and just hear what you've done in the space of medical education and neurology, and you're changing the world one student, one resident at a time. Michael and I just hope that this conversation inspires anyone who is interested in neurology is in neurology, has been practicing for a while. Just keep doing what makes you happy, and if it's not readily available, find the people that resonate with you that also care about what you want to do. And opportunities will come, pathways will open up, and once you get to where you're supposed to be, make sure that you offer a hand back to where you came from.

Dr. Michael Kentris [00:49:25]:

Absolutely. Yeah. Always. Don't forget to look behind you. Don't pull the ladder up behind you.

Dr. Nupur Goel [00:49:31]:

Yeah.

Dr. Michael Kentris [00:49:32]:

And that's an excellent point, right? Graduation from residency is not the end of education. It's become such a trite thing to say. Right. But being a lifelong learner, I hate to say it, but it's true, right? You should love learning, right? If you're going to be a physician, if you're going to be in healthcare, things are always changing. There's always more to learn. I am now a oh, God, like a PGY ten or something. And I feel like there's still so much to learn. Right. The body of knowledge is just rapidly expanding constantly, and I feel like it's impossible to keep up, especially when you dive into all these little niches. Even within our own specialty, there's just so much detailed information, like, well, in this very specific situation, you should do X, but in this one, you should do Y, and it becomes this thing where if you're not careful, you can certainly start questioning your judgment. But I think making good faith efforts and trying to keep up to date and continue educating yourself is so important. If people want to try and find you online or reach out to you about your podcast, where should they track you down?

Dr. Nupur Goel [00:50:48]:

The two best places are @Neurophiliopod. I do run that account, if you were wondering. And then also you can find me @mdgoyles on Twitter as well.

Dr. Michael Kentris [00:51:00]:

Excellent. Thank you so much for stopping by and chatting with our audience. I really appreciate it. And like you said, hopefully this will inspire people to one work on their neurophobia work on developing their neurophilia. And for the students and the other undergraduate learners out there, check out neurology. Go seek it out. Let's find an opportunity. There's plenty out there, and I think most neurologists are pretty easy going. I always feel bad. I think everyone knows Dr. Glaucomflecken at this point, the ophthalmologist comedian on TikTok and Twitter. But I'm like, man, who is the neurologist who hurt that guy? I feel bad.

Dr. Nupur Goel [00:51:46]:

I mean, the video where the neurologist is taking call and he's drinking med student tears, I'm like, Dr. Glaucomflecken is just spreading neurophobia rampant in our medical community. It needs to be stopped.

Dr. Michael Kentris [00:51:59]:

Maybe you should have him on the podcast.

Dr. Nupur Goel [00:52:01]:

I've thought about it. I've thought about cold DMing him... or hot DMing.

Dr. Michael Kentris [00:52:04]:

You should.

Dr. Nupur Goel [00:52:05]:

And we'll see what happens.

Dr. Michael Kentris [00:52:07]:

Yes. Excellent. Well, thank you so much. I appreciate everyone listening in. If you want to reach out to me, you can find me on Twitter @DrKentris. Or you can send me an email at the neurotransmitterspodcast@gmail.com. Thank you again, Nupur. I really appreciate it.

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