ACHD | Katia Bravo-Jaimes, MD
1. Please describe your educational and training background.
Medical School: Universidad Nacional Mayor de San Marcos, Lima, Peru
Residency: University of Rochester, NY
Fellowship(s): General Cardiology Fellowship at University of Texas Health Science Center at Houston, TX; Adult Congenital Heart Disease at University of California, Los Angeles, CA
2. What are your future career plans and/or goals?
I plan to stay in academia. I love the amalgamation of clinical care, teaching, research and innovation. Most Adult Congenital Heart Disease (ACHD) centers are located in university hospitals but private centers with an academic affiliation are also on the rise. In the ACHD field, you need a comprehensive team to care for patients, not only excellent surgeons but also congenital interventions, electrophysiology and heart failure teams. This is one of the complexities of this subspecialty – you depend on others – and part of why belonging to a large academic center may be the most palatable way to expand this field. I also have great interest in advanced heart failure since there is so much in common with ACHD. Combining these two fields fills a sorely needed niche – there are not many dual trained physicians. Extending training time is a personal decision but if the potential benefits include a significant difference in the rest of someone's career and the ability to make a difference in patients' lives as well then it is completely worthy.
3. Please describe a typical day in your cardiology subspecialty.
The most beautiful part of ACHD is the continuity in patient care. You might have a given week of outpatient rotations, where you see patients in clinic and see their history all the way from birth to now. But then, you can also see the same patient on another day during their medical procedure, where you can be an active participant. When they come with an acute medical or surgical problem (not necessarily cardiac) you could also take care of them on the consult service. At every step of the way, multi-modality imaging combining echocardiography, MRI, CT and/or angiography will allow you to better define the patient's anatomy three dimensionally and understand their physiology to best determine treatment options. Research is also a big part of this nascent subspecialty where we are still learning about risk stratification and the impact of different therapies. You can produce new knowledge with your center and even collaborate with other centers.
4. What is the most challenging aspect of your career path?
I remember struggling with how to be vocal and expressing what I think, doing this in a way that is proactive, well-received by others, and with the intention of improving the process and system. We all have different perspectives that are worth bringing to the table, but if we don't say anything then we are not promoting discussion or change. No matter where you are in your career, being vocal about how you view problems and propose potential solutions can promote change from where you are standing. I think this has been valued at the places I have trained.
Another challenge is the juggle that you do every day when you have a family with a career in medicine. It is not perfect, and we all suffer from this. The relationship between motherhood and medicine will depend on every family's dynamics. Some people have support from their parents or a nanny, but I didn't have this since my family is in Peru. My husband is in medicine as well and training in neonatology in Wisconsin, so it's currently just me and my daughter. I try to get as much help as I can. I get a morning and evening babysitter, someone who can take my daughter to school and pick her up and do what she needs to do. Once I am done with work, I can go home and be home. It is different to be home and not be present. This is something that sticks with children. I think working women become much more efficient because of this responsibility. For me, I try to be efficient at the hospital and wake up super early to use that time for myself, make breakfast for me and my daughter, and prep for the patients that I am going to see that day. I can enjoy breakfast with my daughter and then go to work. I recognize that 2020 was a very challenging year, but I am thankful that it pushed me harder and we were able to adapt. This goes back to what I said about being vocal and advocating for yourself. Women are generally afraid of what the response could be, but it's 2021 and we are seeing cardiology change. I brought up these issues about my family responsibilities with my program and they were very receptive. They knew my daughter was going to be a mini fellow of the program and they supported me all the way. Having that genuine support from your program is hard to find, but when you have it, you cherish it, and they become family.
5. How did you identify your mentor(s) and develop a successful mentor/mentee relationship?
There are two kinds of mentors: the personal mentor and research mentor. The personal mentor is one who knows you personally and can guide you through residency and your career. The research mentor is someone you work with toward a common goal to finish your product, present it, and look for more questions. When you are starting off, you don't always know what your research interests are. The best people to guide you are the fellows you are working with. These fellows get to know your interests and guide you in the right direction. Another role we haven't talked about is sponsors. These are people who put you out there and support you behind the curtains. Those people are hard to find, but if you have a successful relationship with a mentor, the sponsors will show up. In order for these relationships to be productive, you have to be honest with yourself and your mentor. You have to identify what you already know, where you need to work, and where you want to be. Humbly accepting feedback and redirecting yourself towards the path that aligns your and your mentor's vision will also make your relationship succeed.
6. What advice do you have for women and/or underrepresented populations in medicine who are interested in pursuing cardiology?
For women who want to do cardiology, if this is what you love and you are convinced this is your pathway, don't let that passion disappear because of your surroundings. Your surroundings are dynamic. You can change programs, go somewhere else, you can still be a cardiologist and do it in your own style. Don't let that passion be deterred by your timing of life milestones. We are not just doctors, we are humans first of all, and life has to continue. If you want to have kids or family, don't think that you will be unable to do that in cardiology. There is always a point where you can balance these out.
For minorities, people say you have to see it to be it. It is true. I was able to find a woman Latino cardiologist, Dr. Gladys Velarde, my mentor, who is like family to me. She knows how hard it is to succeed in this field being an immigrant and a mom. You can find someone like that too – maybe not at your own institution, maybe somewhere else. Cardiology is such a wide specialty that if we don't see it right here in our neighborhood, it doesn't mean it doesn't exist in other institutions. We have to take advantage of globalization and reach out to other mentors using social media platforms. For underrepresented populations, I would recommend looking at existing initiatives, including BNGAP (Building the Next Generation of Academic Physicians; bngap.org). They discuss how to increase diversity across many different groups, including racial and ethnic groups, women, LGBTQ, and people with disabilities. This group is working to bring this overdue diversity into academia and awareness that medical students can follow whatever pathway they want. At the end, we are all in charge of changing the face of cardiology, with the common goal of better representing our diverse population.