The Neurologist Is In, Episode 10, Part 2: Future Trends in Neurology With Dr Madhu Mona Soni

In this episode, Rachel Marie E. Salas, MD, MEd, continues her conversation with Madhu Mona Soni, MD, FAAN, to discuss future trends in neurology, wellness in the workplace, and whether or not telehealth is here to stay.

Missed Part 1 of the conversation with Dr. Soni? Click here to listen!

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Rachel Marie E. Salas, MD, Med, FAAN, FANA, is a professor in the Department of Neurology at Johns Hopkins Medicine with a joint appointment in the School of Nursing. She is board certified in Sleep Medicine and Neurology. Dr Salas is the Director of Ambulatory Sleep Services at the Johns Hopkins Center for Sleep and Wellness. Dr Salas has been the Director of the Neurology Clerkship for over a decade. She is the Chair of the Undergraduate Education Subcommittee for the American Academy of Neurology and is an appointed member of the Alliance for Clinical Education. She is the director of the Interprofessional Education and Collaborative Practice for the School of Medicine and a Co-Director for Interprofessional Teaming for the High Value Practice Academic Alliance. Dr Salas is also the founder and Co-Director of the Johns Hopkins Osler Apprenticeship Program (in Neurology), a medical education research program for senior medical students and the Johns Hopkins PreDoc Program, a pipeline premedical college program. Dr Salas is a certified strengths coach and uses a strength-based approach and coaching to connect to, support, and develop those involved with her educational mission and clinical practice. Dr Salas is a 2019-21 Josiah Macy Scholar, a 2019-20 AMA Health Systems Science Scholar and a 2021 AΩA Leadership Fellow.

Madhu Soni, MD, FAAN is Associate Professor and Senior Attending Neurologist in the Department of Neurological Sciences at Rush University Medical Center. She graduated from Northwestern Medical School and completed her internship, residency training and clinical neurophysiology fellowship at Rush- Presbyterian-St. Luke’s Medical Center in Chicago. Dr. Soni is board certified in neurology, clinical neurophysiology and neuromuscular medicine. She is head of the section of Neuromuscular Disease and Director of the multidisciplinary Rush ALS Clinic. She was Co-Director of the MDA clinic from 2006-2010 and program director for the Rush Clinical Neurophysiology Fellowship from 2008-2011. She has a busy clinical practice and also has a special interest in medical education.

Dr. Soni is director of the neurology clerkship and advanced neurology elective at Rush. She is also faculty advisor for the Rush Medical College (RMC) Student Interest Group in Neurology (SIGN) chapter. She has served as a mentor for local high school and college students, as well as for medical school and neurology trainees at Rush and nationally. During the 2017-2018 academic year, she received the RMC Neurology Preceptor of the Year Award and was nominated for the school’s Positive Learning Environment Award.

Dr. Soni is a member of the Rush Medical College Committee on Curriculum and Evaluation and was Chair of the Core Curriculum Work Group from 2007-2010. She served as Assistant Dean of Accreditation and Continuous Program Improvement for Rush Medical College from 2011-2016 and successfully led the medical school through its most recent LCME accreditation visit.

Dr. Soni Co-Chaired the American Academy of Neurology (AAN) Consortium of Neurology Clerkship Directors from 2014-2016 and she is currently Chair of the AAN’s Undergraduate Education Subcommittee. She is also a member of the AAN’s Education Committee and many AAN work groups, including for the Medical Student Pipeline and Women in Leadership. She has served as a course director and speaker at the AAN annual meeting for several years.

Dr. Soni is a Fellow of the AAN. She is also on the Medical Advisory Board for Conquer MG (formerly, the Myasthenia Gravis Foundation of Illinois), the Executive Council of the Alliance for Clinical Education, and was recently appointed to the Board of Directors for the Illinois State Neurological Society. She is member of the American Board of Psychiatry and Neurology Professionalism Committee, American Association of Neuromuscular and Electrodiagnostic Medicine, Peripheral Nerve Society, Association of University Professors of Neurology, and Association of American Medical Colleges Council of Faculty and Academic Societies.

Read the transcript:

Dr. Rachel Salas:

All right. Well, hello, everybody. Welcome back to The Neurologist Is In. I am Dr. Rachel Salas. I'm a sleep neurologist at Johns Hopkins Medicine, and I have the pleasure of having another fellow neurologist here with me today. And she's going to give you her formal title, but Mona is a neurologist that I actually met through the American Academy of Neurology. And she's a fellow clinician educator, and I'm thrilled to have her on today to pick her brain about what she's doing and where she's going. Mona.

Dr. Madhu Mona Soni:

Thanks so much, Rachel. Thank you everyone. I'm Madhu Mona Soni, as Rachel has mentioned, I am an associate professor and a neuromuscular specialist at Rush University Medical Center in Chicago. And I appreciate the opportunity of being here with everyone and talking to you about my experience and any advice I can offer.

Dr. Rachel Salas:

I know that you and I, as well as many others, especially educators, are very invested in "the Pipeline." Maybe sharing with the audience, why it's so critical and why are we so interested in the Pipeline?

Dr. Madhu Mona Soni:

Yeah, well, we are all getting older. So if we think about our future neurologists, who's going to take care of us? But also there's a shortage worldwide, not just in the US, but there's a shortage worldwide of neurologists. So the Pipeline, I like to think of it actually in two ways. One, the Pipeline into neurology. So we do want to make sure that we are providing the education to our medical students, to consider a career in neurology and optimizing our programs, pre-clerkship, clerkship are really important in that. In fact, the World Health Organization has said that neurology should be included in the curriculum for all medical schools. Recognizing the shortage and the importance of the top conditions that cause disability, including stroke, but there's others as well, neurodegenerative conditions. And so I think it's crucial for us to be thinking about the Pipeline as we think forward.

But also the other aspect of it is, think about the trainees who are not going into neurology. In fact, it's going to be the primary care physicians who are going to see patients with neurologic symptoms before they come to see us as consultants. It's so important that those non-neurologists get the appropriate training so that they recognize neurologic symptoms, know how to localize, what are the first few steps that you're going to take in terms of diagnostic testing and then treatment and then the referral to the neurologist, if needed.

So I do think that we have to be taking a step back and saying, well, our goal is not going to be to make every single medical student a neurologist, that would be great, but then we need our internists, we need our surgeons, et cetera. But that they have an appreciation and a respect and not a fear for these symptoms. And I think this has been where our effort has come through with designing curriculum guidelines, not only for the core neurology experience in the clinical years, but also in the neuroscience course.

Dr. Rachel Salas:

Yeah. And you've done a lot of work and published on these formal guidelines and recommendations, and you were the senior author, for example, on the paper that basically mapped out the goals and objectives of neurology core clerkship, that we adapted at Hopkins. We added maybe a couple more just like pertaining to our particular institution, Genes to Society curriculum, but overall, like having that laid out for us so that we can all across not only the US, but across the globe, be a little bit more standardized in what we're teaching medical students at every institution, I think is important.

Dr. Madhu Mona Soni:

Yes. And I'm glad that's a frame of reference. It's something that we need to periodically look at as well as we think about healthcare disparities, as we think about interprofessional teams and healthcare systems, making sure that that is an aspect that's being included as well. We all know that resources may be limited based on which institution you're at, how long the course might be, but this is meant to be sort of a template to make sure that we're covering the basics so that our future MDs are competent in the basic skills.

Dr. Rachel Salas:

Yeah. And for the audience, I want to highlight that Dr. Soni here is obviously a neuromuscular neurologist and doing clinical work in an academic setting now, but previously had worked in the private practice setting. But the different roles and hats you can wear as a neurologist, right. So she's doing that clinical practice. And now is teaching medical students, house staff, and then sponsoring, being a mentor and a leader nationally and globally. But then also, contributing and leading educational scholarship, like publications and things like that, to actually set standards and encourage new opportunities in areas that we can develop the future, not just physicians and neurologists, but future healthcare professionals. And so, I don't know how involved you are Mona, with curricular content for, for instance, nurse practitioners and there are a lot of other important healthcare professionals that you talked about in your own clinical practice, that I know that we are working together to try to spread the knowledge of taking care of patients with neurological disease. Do you want to comment on just expanding that net of reaching out to other healthcare providers and professionals to better treat our patients with neurological disorders?

Dr. Madhu Mona Soni:

Sure. So, one aspect is that those who are still in training, and we certainly have physician assistants and nurses, nurse practitioner programs, where there are interests in collaborating with the neurology department for them learning the clinical aspects. And so we don't have them necessarily in all areas, but they are participating in some and throughout other departments in medical school. We also have to be mindful of course, about the medical students. And when we think about accreditation, ensuring that our medical students are getting the attention that they need as well. So I do think that there's more room for that.

For those who are currently in practice and specifically in terms of our multidisciplinary clinics, one of the things that I put together in the ALS clinic, was something called Lunch and Learn. So our half day clinic, when we started, we would start typically at one o'clock, but we would gather around 12:00, 12:15. And basically I had asked all of our providers to present an educational session, specifically on their role and their aspect of dealing with or managing patients with ALS in this particular setting. So it was an opportunity for everyone to be an educator and for all of us to learn from them and for them to learn from us, about our specific roles in the patients with ALS. And so I actually put an abstract together as well. And it was interesting because we did an evaluation and both sort of a pre- and a post-quiz to see where the knowledge gap was. And there were a couple of areas, including, for example, respiratory testing and care, where we could certainly highlight more and educate our teams about that aspect. So, that is one example of how we try to also educate our interprofessional colleagues.

Dr. Rachel Salas:

So, that's all great. And I mean, I think that just shows how interprofessional the field of neurology really is, like many others. I'm curious, Mona, for all the expertise and the work that you've done in training students and house staff and peers and other healthcare professionals, but what do you think the future holds? Like, kind of casting the net, looking further out, even 5, 10 years from now. I mean, do you think medical education's going to be the way it is now? Or what do you foresee? What are some big changes you see coming?

Dr. Madhu Mona Soni:

I think that the pandemic has taught us a lot. We, as you know, we had to, without much time or notice, really change our curriculum. And there was the accelerated implementation of the virtual platforms. The silver lining is, is that some of that has stayed, because it really has provided convenience for both students who are at different sites, for faculty depending on their location. So I do think that virtual learning and the hybrid model is here to stay.

In terms of going forward, healthcare professionals and systems kind of working together, shared curriculum in certain settings may also be part of what we're going to be looking for. How does artificial intelligence play a role also in education and streamlining some things? There's also discussion about, should we be moving towards more competency-based education and do away with the tiered grading system and make it pass/fail, and only when the training meets that competency, do they then get that MD degree. Whether that's four years or it's five years or whatever it is that they need. And I think that, that's a service and a social responsibility that we have and where some of the discussions are going to be taking place. We've recently heard also about the UME to GME transition, which is our medical students transitioning into the internship and the residency roles, and how do we ensure that transition is a smooth one and that they do have those skills of independent practice when they start their internship. So these are, I think, some of the ongoing discussions that we're going to be seeing down the road.

Dr. Rachel Salas:

Yeah. And I'm glad you brought this up because I think it's important for our colleagues that are in private practice to see, there are big changes coming in terms of the way, not only medical students and house staff, but all healthcare professionals are being trained. And I do echo everything that you just said. We are having discussions even at Hopkins about our grading system and is the tiered traditional system still what we need to be doing? And there has been quite a big discussion on competency-based approaches. And prior to the pandemic, we were actually in our clerkship about to roll out a different type of compensatory grading system, and then that got placed on hold because we went from tiered to pass/fail, like most medical schools during the pandemic. And we're still in it as we speak. So I agree with you, the pandemic not only allowed us to do a virtual kind of get familiar with that, but then it also like caused us to rethink the way we're grading and assessing our learners. So I think for all of you listening out there, there's going to be some interesting changes. And I think that things are going to be, maybe not vastly different, but pretty different in 10 years from now. That's the prediction, right?

Dr. Madhu Mona Soni:

That's right. And I also think we can't get away from the fact that the bedside learning is still such a crucial component. We certainly don't want to see that decreasing in any way or doing away with that, of course, with all the simulation that we do have available. And I think from a professionalism standpoint, that's the other aspect I want to make sure is continued to be emphasized on, as at the end of the day we're professionals and making sure that those skills, the communication skills, the interprofessional ones, the resiliency, along with wellness, are all parts of our graduates as they deal with the challenges going forward, in medical care and then both personally and professionally.

Dr. Rachel Salas:

Yeah. I'm really glad you said that, because I couldn't agree with you more. And speaking as a neurologist, just generally the loss of that bedside teaching and that human connection with the touch and the neurological exam, which is obviously very hands on, is so important. And I really think that that should be the main focus of medical school. I would envision coming together, not just nationally, but globally with formalizing a very standardized curriculum that all learners across everywhere could have that in that first or second year. But then you go to medical school to learn how to be that physician or nurse or whatever and then it's all that bedside teaching, that clinical, it's that connection with other human beings as patients and team members.

Dr. Madhu Mona Soni:

Right. And if we think globally about the best clinicians, when I was a resident, I actually did a week in India and I was on the neurology ward with them. And when we think about like limited resources that other countries may have, but yet their clinicians are such experts because what do they rely on? They rely on their history taking and their physical exam skills to know what's going on with the patient.

Dr. Rachel Salas:

Yeah. It goes back to some of the things I've been talking about with other educators is like, maybe our focus in the early years of medical school really should be teaching our learners how to learn and how to be adaptive, right? And kind of predicting on where things are going and also rolling up their sleeves like health system science, which is now the third pillar of medical education. And then you have the health humanities, but health system science is all about, what I see, is like rolling up your sleeves when you see things that need to change or need to be done, not to wait or complain about it, but actually to do something about it, right?

Dr. Madhu Mona Soni:

Right. And actually, the objectives changed into roles, so that not only are we teaching practitioners, but it's going to be advocates and it's scholars and it's the collaborators and the communicators to, I think, embody just what you mentioned.

Dr. Rachel Salas:

Yeah, no, that's great. And so this is a nice segue to your work in wellness and wellbeing. I always used to say like, "Oh, like work-life balance. What the heck is that?" But now, thinking about it in terms of work-life integration, right. And so, you kind of harped on this a little bit ago when you said, the pandemic helped making things a little bit more convenient and the hybrid model and virtual model have really had some positives. I mean, they've had some negatives, but there's been a lot of positives, so let's transition into your work with wellbeing.

Dr. Madhu Mona Soni:

Sure. So I also was the director for our departmental mentoring program and one aspect of it was a professional interest area for wellness. And so it came about particularly during the pandemic, and we also were in the process of some interval leadership within the department. So, many changes happening at around the same time. The thought was, well everybody is experiencing certain challenges here. And so we brought together not only the faculty and the residents, but we really brought together as many people within the department. So we have a wellness collaboration group, which actually has representatives, not only from, as I mentioned, the physicians and the trainees, but also the medical assistants, the nurses, and the research department, to basically come together, and we have monthly meetings now, where we basically talk about what are things that we can do to enhance the wellness of our colleagues within the department?

So we created a survey, sent that out, based on that, have certain action items. We're currently working on trying to develop a space within the department where people can go just for quiet time. We're thinking about perhaps offering chair massages and then smaller, lower hanging fruit in terms of just posting locations as to for our center of wellness within the institution where people can reach out for help. So if they don't feel comfortable talking to somebody within their own area, that the institution does have wellness. So making sure that's visible in many locations. We're incorporating this into the huddle areas as well. We have a monthly newsletter. It was on pause for a little bit, but in the newsletter, it's really just highlighting different aspects. Hydrate more, whether it's exercise. Our upcoming one's going to be on laughter. We actually did chair yoga poses. So we actually had photos of each of the wellness collaboration team members in different chair yoga poses to share just simple things that you could do to promote wellness and making sure that we share that that is really an important part of what we're focusing on in addition to the daily work.

Dr. Rachel Salas:

Yeah, that's great. I really love those photos of the chair yoga poses, that's amazing. I'll have to use that at some point. So speaking of that, what I've heard and actually what I've experienced and I love the idea, like several of our meetings, not just in the department, but institutional, have been virtual, which for me is huge and really has contributed to my wellbeing. Not having to get up as early. I can take my kids to school. I'm a little concerned or worried that once we go back to whatever our new normal is, that there's going to be this kind of push to be like everything has to go back in person. And so I kind of worry a little bit about that in terms of having a little bit of a backlash in terms of wellbeing, what are your thoughts on the virtual pros that we've all experienced and how are those going to be integrated in the work you're doing with wellness?

Dr. Madhu Mona Soni:

So, I actually think that because of the recognition of not only how convenient this is for people to connect wherever they are, but also the space limitations that we have. Trying to find a conference room or a meeting place. I think our administrators have recognized that as well. And so I've actually seen more of a interest in maintaining these virtual meetings for certain sessions. There are of course meetings where you do want to convene from time-to-time. So what I foresee is that there may be periodic, whether it's quarterly or less often, where people may meet in person, but the other meetings will continue to be in a virtual setting for all of the conveniences we've mentioned. Not having to commute to some place is just a huge aspect of preventing fatigue as well as, now with the gas prices going up, why have to commute when you can do the same and save that energy to where you really want to put it to use.

Dr. Rachel Salas:

And it's better for our carbon footprint, right? Things are better for the environment. So it's greener.

Dr. Madhu Mona Soni:

There you go.

Dr. Rachel Salas:

Yeah. So I'm glad to hear you say that, especially as a leader in this domain. I think it's important for institutional and departmental leaders to hear that. And not really going 100% back to full in person. While many people might want that, not everybody does. And I don't know if everybody's willing to stick their head out and say, "No, I prefer to be virtual." So I'm hoping that the leaders out there are hearing that. And if anything, either do what you had said, or finding a way to meet in the middle with a hybrid approach, so you can show up however you want. Meeting people where they are.

Dr. Madhu Mona Soni:

Yeah. And I think that the flexibility that it offers. So we also, from a clinical standpoint, do have some people who are still doing interim tele visits. And so I do that currently still, one session a month. It was weekly for a period of time. It was the majority for a period. But knowing that, and then if you have a meeting, it just makes so much more sense. And now we're also expanding to different sites. So, from that practicality, and we know that clinics can sometimes go over. So, it's impractical then to expect somebody to get into a car and then go meet at a place for maybe, an hour session or something that. So our teaching sessions, although we've gone back to some in person because of the sites and where the students and the faculty are, I think I mentioned earlier, we're still doing some of the teaching sessions through Zoom.

Dr. Rachel Salas:

Yeah. And in the last podcast we did with Dr. Marie Eugene, we talked a little bit more about telemedicine and my practice is still completely telesleep. And I'm actually probably going to continue that. And our center has even broaden our--I have now my Texas license, Texas is my home state. And so I got my license there and now I'm seeing patients for not kind of bread and butter stuff, but more complex patient presentations within insomnia and restless leg syndrome. So it's forever changed my practice. I was very comfortable with telemedicine even before coming to Hopkins as a med student and as a resident. At University of Texas Medical Branch, telemedicine was part of our curriculum. And so it's really a natural fit. And so for me, I've really seen a lot more of the pros of remote and virtual. And I think has been a very big positive for sleep, because we are now having insights to the patient's environment, many times their sleep environment. So it's actually more beneficial for us. And I can see how neuromuscular, or our colleagues in movement, obviously an in-person is at least at some point, right, are very crucial, but there are some specialties, not just in neuro, but in other fields of medicine that have probably thrived in telehealth.

Dr. Madhu Mona Soni:

Yeah. And just the access to care that you're mentioning, the outreach now that we have. And the ability to connect with patients through Telehealth really allowed us during the pandemic to continue our multidisciplinary clinics virtually. So you could imagine patients who already have respiratory compromise, we were not about to have them travel during the pandemic to come to the institution. And I want to echo what you just said, it's so meaningful for me to see a patient in their home environment. It just gives you a different perspective of them as a person holistically. And when they then share with you things, when they do come into the office, you have that background as well. So I think it's definitely opened up lots of doors.

We are, again, continuing that option. And right now, as needed sort of ad hoc, I'm adding on patients through telehealth, if I have to talk to them about test results, or they've got an interim symptom. We still encourage--Idon't do new patient visits through telehealth, but for my follow up ones. And I was pleasantly surprised when I started doing video visits, how much you actually can glean from just the observation of their speech. If they take a sip of water and they're not coughing on it, and then facial expression and then other targeted things. There's limitations, but I think that for our follow-up patients, there's definitely a lot that we can still assess through video.

Dr. Rachel Salas:

Yeah. And I think the added bonus is, never before, could you have family members or other important support that now could actually, even if they live in a different state or city or they're at work, they could call in. I've had many times where the patient's family member, who I'd never seen before, even their spouse at times have joined the visit. And it's just, again, just really in many ways has been really helpful. And for us to provide better care from that aspect.

Dr. Madhu Mona Soni:

Right. Or even seeing their pets they bring to our appointments.

Dr. Rachel Salas:

Even seeing their pets. Yeah. Right. Yeah. So great. So Mona, we're at the end now and I always kind of want to... Because part of these podcasts are really not necessarily just what you do, but who you are. And so I think one of the best ways to get to know a little bit more about us as humans and beyond the neurology and the neuromuscular and the educator, is what do you do for fun? What it could be like, what are your hobbies? Or what's the most fabulous thing you like to do, but what brings you back? When you're not in the office when you're not teaching, when you're not doing all the fabulous things you're doing, what are you doing for you?

Dr. Madhu Mona Soni:

So I, and my family can attest to this, I enjoy capturing things through photos, particularly nature's beauty, whether it's landscapes or flowers or sunset skies, I just really enjoy that. And then really special moments with family and friends. I recently was reading something and then also just reflecting on conversations with old friends that you never know when the last moment is going to be for something. So, really capturing that. Sometimes it feels annoying to family members when it's like, "Oh no, not another picture." But then later to be able to share that during special occasions, I think, is appreciated. I also really love gardens and gardening. So, that brings me comfort. I'm like a kid in a candy store if I'm in a garden. I also like to actually explore bike trails and travel. And then just reflecting on looking at pictures of previous trips, it dawned on me how we can never take our freedom to travel for granted again.

Dr. Rachel Salas:

No, that was great. I really resonated with everything you just said. That last moment, and then being grateful for all the things that we were able to do that sometimes we get so busy in our work and everything that we have going on and all the craziness happening in the world these last couple years or three years now almost. And so thank you. I mean, I have much more gratitude for what you just said and for my life even, and having to know you too. So you've been a great colleague, mentor, and a neurologist and educator, and it's been so fabulous to have you on and just to kind of hear your perspective and all the amazing things that you're doing. So I just want to thank you and we'll catch up pretty soon.

Dr. Madhu Mona Soni:

Thank you, Rachel, and thanks for the opportunity and all the fabulous things back to you as well. So thank you for all that you're doing.

Dr. Rachel Salas:

All right. There you have it, Dr. Soni doing amazing things and we'll catch you all next time with our next neurologist. Thank you.