Fellowship Experience Q&A
Current fellow Greg Goldstein, MD, speaks with our Division's science writer Laura Hedli about his time at Stanford
Laura Hedli [LH]: When did you know you wanted to focus in neonatology and what led you to make that choice?
Gregory Goldstein [GG]: I knew going into pediatric residency that I wanted to subspecialize. When I considered the variety of sub-specialties within pediatrics, neonatology fit my personality and long-term career goals best. I like that a neonatologist frequently encounters high stakes situations, where you must act quickly and correctly to avoid devastating consequences to the baby. Having difficult conversations with parents and helping them through challenging situations is such a privilege. Furthermore, the amount of uncertainty in medical decision making in the NICU is staggering. I really enjoy synthesizing the vast array of research and applying that to an individual patient’s situation, especially given that I’m becoming more skilled in clinical research and recognizing the knowledge gaps in the neonatology literature. Finally, I like how there is a lot of time available for non-clinical work, such as research. A full-time neonatologist works on average every other week.
LH: Why Stanford?
GG: The resources for research are unparalleled. I knew coming to Stanford that I would have the opportunity to work with leading research mentors aligned with my own topics of interest. I’ve been amazed by how generous my PIs are with their time to mentor me. The culture from both my research mentors and the fellowship leadership is that they want fellows to develop their own academic passions; no one is going to tell you what those are or keep track of how exactly you spend your non-clinical time, but they will support you in every way they can. I’ve had the opportunity to work closely with wonderful PIs such as Gary Shaw, Henry Lee, Karl Sylvester, Suzan Carmichael, Valerie Chock, Jochen Profit, along with several post-docs and biostatisticians who have all invested significant effort in working with me. I’ve obtained internal grant funding for my research and a master’s degree. The fellowship program encourages us to participate in national conferences and I have had the opportunity to attend meetings organized by PAS [Pediatric Academic Societies], CAN [California Association of Neonatologists], WSPR [Western Society for Pediatric Research], the national NEC [Necrotizing Enterocolitis] Symposium, and the AAP [American Academy of Pediatrics] NICU Fellows conference.
LH: What should applicants and incoming fellows know about the clinical aspects of fellowship?
GG: I’m very happy with the clinical experience. The pathology we see in the Stanford NICU is diverse and the acuity is high. I was concerned before my fellowship interview that there wouldn’t be enough patients here because I saw that there are only 40 beds, relatively fewer than other big academic centers. However, our NICU is just as big and busy as other major centers. We have an intermediate care nursery that acts as a step-down unit, and oftentimes there are about 30 patients in that unit. Thus, most of our NICU patients are active, and we are constantly getting new transfers. Patients come from all around the San Francisco Bay Area. We get to see a mix of everything and are involved in the care of every sick patient. We have lots of extremely preterm infants, substantial neonatal ECMO experience, infants with CDH, severe hyperammonemia that requires dialysis, etc.
In terms of our role in the NICU, we get an appropriate amount of autonomy. On the night shift, the fellow is the leader of the team that includes nurse practitioners, pediatric residents, and an attending that supports us based on our need. We all work together as a team. In the delivery room, the fellow is the team leader for all complex deliveries. The fellow coordinates the personnel set-up for the delivery and directs the resuscitation. In the NICU, we help with medical decisions, procedures, and communication with families.
Furthermore, I feel grateful to be able to work with so many truly exceptional neonatologists that have contributed enormously to the field of neonatology. The wisdom I learn from them in everyday interactions at the bedside and in conferences makes me a better clinician. The faculty take pride in and really care about the education of the fellows. They consistently go above and beyond to strengthen our experience.
LH: Do you feel as though there is a good blend of leadership opportunities and also opportunities for collaboration?
GG: Absolutely. There are numerous leadership opportunities besides your role in patient care. For example, I have been involved in several NICU division task forces, such as with the roll-out of new ventilator guidelines, bubble CPAP, and nursing-led rounds. Within our fellow group, we divide up leadership responsibilities. I was on the pediatric fellowship council for two years as the neonatology representative. I currently create the schedule for the fellows and I helped organize the new fellow orientation this past July.
LH: How did you decide on your research projects?
GG: Choosing a research project is an important and daunting task for a first-year fellow. My research mentors told me that my first project neither had to define my fellowship research, nor the exact direction of my future research career. I think the most important decision you make is choosing your research mentors who help you discover your passions and provide you with the tools and resources to execute your goals.
LH: You have three mentors. That’s fairly unique.
GG: The key there is that I have one primary research mentor and two other close mentors. Gary [Shaw] is my primary mentor, but Henry [Lee] and Karl [Sylvester] have also been very helpful as co-mentors. Their combined expertise and support have really helped accelerate my research.
LH: What have you learned from each of your mentors?
GG: Gary has taught me so many pearls along the way. He’s emphasized that if you dedicate time to research you need to enjoy it and be passionate about it, otherwise you’ll be unhappy and unproductive. He says that finishing a project is critical, and many trainees don’t succeed at this. Gary has good tips for time-management. Working efficiently is key to being happy and successful in academia.
Karl has showed me how you can be both a highly successful researcher and a clinician. He’s taught me that it’s important to think about the biology when discussing research ideas and questions.
Henry is remarkably productive. He’s involved in so many different academic activities, yet he always seems available to support me. He’s a great role model for what I want my job to look like in the future. Henry has good advice for science writing. He’s taught me to write more succinctly and not extrapolate in papers unnecessarily.
LH: How did you become interested in studying NEC? Why did you choose to focus on it for your fellowship research?
GG: Necrotizing enterocolitis is such a serious problem with our preterm infants. About 5 percent of the very low birth weight infants get NEC. Of those, about 25 percent die, and for those that survive, they may have lifelong neurodevelopmental disability. We don’t have a good way to diagnose NEC early, nor do we have good treatment. It is a disease that desperately needs innovative research. I was very excited to work with Karl, who is a highly accomplished NEC researcher.
Now that I’ve worked on multiple research projects on NEC and attended the NEC Symposium, I understand why we don’t already have answers to these problems. NEC biology is complicated and difficult to untangle.
I’m broadening my research focus a bit. My current research interest is in the epidemiology of periviable infants, which includes the complications of extreme prematurity, such as NEC and ROP. Some of our 22-25 weekers have good outcomes, but many don’t. I’m certain we can do better.
LH: What are you hoping to learn?
GG: To put it broadly, I want to understand why there is such variability in the outcomes of these periviable infants across centers and apply this to improving clinical management.
LH: You received funding from Stanford’s Maternal & Child Health Research Institute (MCHRI), both a Clinical Trainee Award and Master’s Tuition Support. How do you think that funding has impacted your fellowship training?
GG: The rigorous educational experience from the master’s program in epidemiology and clinical research has been invaluable. It was a useful exercise to go through the process of submitting an NIH-style grant for the first time. I now know how to write a biosketch, a specific aims page, and a career development section. Stanford’s MCHRI awarded me $15,000 for my research. Part of the money will go to the CPQCC for access to data and some of it will help support a biostatistician that I work with.
LH: You’re halfway through your master’s program. How has it been managing your fellowship training with getting your master’s?
GG: Very challenging, but doable. I schedule most of my daytime clinical time when classes are not in session, such as in the summer and between quarters. I inevitably have some night shifts before and after days with classes.
LH: Was obtaining a master’s in epidemiology something you knew you wanted to pursue when you came to Stanford?
GG: Yes, it’s one of the reasons I chose this program. I had two research mentors prior to medical school who were both physicians and epidemiologists. They both suggested that I wait to do a master’s program until later in my career when it would have the most impact on my research development. I really appreciate that advice.
LH: Now that you’re a third-year fellow, what other research training opportunities have you found most impactful during your fellowship experience?
GG: The Department of Pediatrics hosts a grant writing club. This course gave me a good foundation for grant writing and helped me write a successful MCHRI application. Now, as I prepare to apply for my first NIH training grant, I feel more confident that I’m on the right track. Additionally, I enjoy learning from the faculty and the discussions at our division’s monthly research and journal clubs. Our division hosts a separate weekly lab meeting on prematurity research, which I also try to attend when possible.
LH: You did med school and residency on the east coast and then came out here. How are you finding Bay Area living?
GG: It’s a wonderful place to live. There’s a really nice balance of good weather, access to a big city, and ability to travel to the mountains for hiking and skiing. I enjoy running and playing tennis outside year-round. I currently live on the west coast of the Bay Area Peninsula, which reminds me of the east coast with how it looks. The mountains abutting the ocean are gorgeous.
LH: I think your commute is probably a little more than most. Why did you choose to live in Pacifica rather than closer?
GG: I live that far away out of necessity. My wife works on the west side of San Francisco, by Golden Gate Park. Pacifica is equidistant from both our jobs, and the location is beautiful. My commute is 35 minutes on a good day, which is less than ideal, but both my wife and I are very happy with our jobs.
LH: How do you think as a person you’ve grown during your fellowship experience?
GG: I think I’ve become more professional at work, such as with how I present myself to others. Fellowship is different than residency and medical school in that you get out of it what effort you put in. In our program, your non-clinical time is up to you in terms of how you want to schedule it. Since I have so many activities that I work on simultaneously, I’ve become better at prioritizing certain aspects of my life and job.
LH: In terms of your fellowship class, how would you describe your relationship with the other fellows who are here?
GG: You get to know your co-fellows really well. You feel a shared bond, especially with the fellows in your year. You’re going through the same challenges as them. You can talk with them about aspects of your job that no one else understands. You learn from fellows in the years before you, and you help mentor the fellows in the classes after you.
LH: What’s next for you?
GG: That’s the question I’ve been thinking about a lot lately. I’m actively working on getting a post-fellowship job. The biggest challenge is to secure a position that fits my goals but is also in a good location for my wife’s career. We both want to stay in academia. It’s difficult to time and plan, but I’m confident we’ll make it work.
LH: Is there anything else you think prospective fellows should know about Stanford?
GG: I think our program leadership has demonstrated that they really care about improving the quality of education for the fellows, specifically the fellowship directors, division chief, and the program administrators, Meghan and Weichen. They listen to fellows’ feedback and are constantly improving our program.
Though the cost of living is extremely high in the Bay Area, it roughly evens out since our fellowship salary is relatively high. Just don’t expect to buy a home in the Bay Area unless, for example, you have a partner with a high-paying job.
Finally, the quality of clinical expertise never ceases to amaze me. We have faculty expertise in neonatal ECMO, neonatal neurology, sepsis and PDA management, jaundice, resuscitation, fetal center, neonatal cardiology, neonatal epidemiology, state and national-level QI, biodesign, and the list goes on. I am incredibly happy that I chose to train at Stanford.