Conversations With Cardiologists: Audrey Marshall, MD

January 17, 2017 | Audrey Marshall, MD

'Conversations With Cardiologists' highlights prominent cardiologists throughout the country and shares their invaluable insight on cardiology and sage advice for Fellows in Training (FITs). In this interview, Audrey Marshall, MD, chief of pediatric cardiology and director of pediatric cardiac catheterization at Tufts Medical Center in Boston, MA, shares her advice with ACC FITs.

You have unique expertise and been instrumental in the development of the field of fetal cardiac interventions. How did you initially become involved in this innovative program?
My involvement in fetal intervention program was the result of being in the right place at the right time, and being willing to help. Having heard some talk in the program about a possibility of the procedure, I distinctly remember standing in the cath lab hallway as a few people headed off to look at candidate equipment for it. Curious and somewhat excited, I joined in to help carry some things. That moment is how I got to be a part of the first procedure. Of course, it did not hurt that the surrounding environment was rich with people exploring new ideas.

What skills did you have to develop, in addition to technical skills, to help such a program grow and be successful?
The first answer that comes to mind is procedural judgement – processing the available information in the moment to know when to push ahead and when to step back. Proceduralists develop this skill alongside their technical skills as they gain experience. I also greatly honed my communication skills. Talking to a pregnant mother about a potentially high-risk intervention with unproven benefit, and accepting her consent, requires great confidence in effectively and compassionately communicating the procedure to her. It was a real challenge, one in which I developed proficiency.

What innovations in interventional cardiology are you most excited about?
Rather than talk about a specific procedure or type of device, I think about innovations that make it safer and easier for more people to do what we do. Still, much of what we do is taught in an almost apprentice-like fashion, and is poorly standardized. Not to mention that we teach during real procedures with real patients. I am not too familiar with simulation techniques for pediatric interventional cath, but I think it would be exciting to see more of it. Given the heterogeneity and anatomic variability of what we do, it might be challenging, but nonetheless important. Along the same lines, any innovations that make devices more intuitive, easier to use, and with more fail-safes, are all of interest to me. The relative lack of consistency and control inherent in what we do continues to make it a difficult field to get into and succeed.

What should fellows look for in a clinical and research mentor?
A mentor depends on who you are and what you need. It is always good to work with someone who has a track record of success and interests that share a natural overlap with your own. Certain fellows may need someone approachable and easy to open up to, while others need structure or someone with a specific network. The availability of time is also often a practical concern.

What advice do you have for fellows interested in starting a research career?
Don't get discouraged if things don't go well the first time out. Clinical research is hard, and it requires a completely different skill set than many develop during clinical training. That being said, we all value clinical research tremendously and admire those who are successful at it. When a novice tries it for the first time, there is a lot at stake. The product may not be what was hoped for and the process may be agonizing, but I have seen a lot of fellows bounce back from a tough first project and continue to be more successful on the next. The ones who do well the first time out are lucky, and probably very talented. For everyone else, it may take a couple of tries.

How do you balance your clinical, research and administrative work?
Balancing is easy for me. Clinical work always comes first because it is my first passion. While both research and administrative work are also gratifying, the immediate pull of clinical work has always been hard to resist. Clinical work is what I think of when I characterize the work I do. This answer is probably not the most helpful, but it is a way of saying that it has never been a matter of 50 percent, 30 percent, 20 percent or any other predetermined ratio. I put my mental energy and time where I think it is needed, and given the roles I have had, it is primarily in the clinical domain.

How do you navigate life and work balance?
Satisfying personal, family and work needs, along with feeling like you have done the best you could do in those spheres, is a very dynamic process. Clearly, it is not a "scales of justice" static balance. Throughout most of my early career, I saw this issue as one of making little advances on multiple fronts, while dictated by overall priorities, urgency and enthusiasm. In general, my time windows were relatively narrow – today, this month and this year. As you get older, you look at work-life balance differently, and think in terms of years and periods of your career.