Melanie Cole, MS: Welcome to Bettered a Northwestern Medicine Podcast for physicians. I'm Melanie Cole, and we have an exciting thought leader panel for you today, celebrating 125 years of urology at Northwestern Medicine. Joining me is Dr. Edward Schafer. He's the chair of the Department of Urology and the Harold Stein, professor of Urology at Northwestern Medicine, and Dr. Schafer will be moderating today's episode.

Joining Dr. Schafer is Dr. Richard Matlovich. He's a urologic surgeon at Memorial Sloan Kettering and Dr. Nima Nvi. He's a professor and chair in the Department of Urology at the University of Texas, MD Anderson Cancer Center. Dr. Schafer, I turn it over to you.

Edward Schaeffer, MD, PhD: Thank you and, rich and Nema. I just wanna first thank you guys for. Participating in this, video podcast as you are both well aware, Northwestern Medicine Urology turns 125 years this year. And when we were reflecting on the department, one of the key, attributes and key strengths is, the individuals that we train in our residency program here, and frankly, the individuals who train.

And are influenced to go into urology during their time at Feinberg School of Medicine as medical students. So, with that in mind, we thought it would be really nice to hear from our alumni. so many of our alumni are incredibly successful in their individual specialties and professions, but we certainly thought that you really were two of our, the star alumni of the program in the recent past.

And when reflecting on this, it's actually a nice. in the sense that you are one generation apart in training. Nema, you finished in 2010. I, believe, and, and Rich, you finished in 2018. And so with that, introduction, I would just wanted to get your thoughts first on, what attracted you to consider and then subsequently elect to train at Northwestern for your residency program.

Maybe we'll start with you, Nima, since you are a little bit senior rich.

Neema Navai, MD: yeah. Thanks Ted. It's, wonderful to be invited. I'm really a testament to the legacy of Northwestern that I even, stand in the shoes, you know, that I, get to stand in today as a, a chair in a department as, prolific as the Andersons Cancer Center. Urology department. my story, with Northwestern, goes back quite a ways.

I was a medical student there, and that was my first foray into urology. I got the chance to see some other, amazing talents in urology well, ahead of me. namely, people like Scott Ner and many others, but there were, esteemed faculty, including your father who was chair at the time, Jack Gray Hack, who was actually still seeing patients in clinic when I was a medical student.

And I got to spend some time seeing patients in clinic with him. that introduced me to the legacy of the field, but also the wonderful richness, that urology offers both clinically and from a research standpoint. I got to spend time with Joe Wang, who is a PhD researcher, in prostate cancer at the time, at Northwestern.

And that really stimulated for me, in intellectual curiosity. But, more deeply than that, I found alignment both in the people, the culture, and hopefully what I could do impactfully for a field. that really got me started, and got the juices cooking. it was later that I got to work with some of the faculty within the department at that time that were really influential to me.

and that included people like, Kevin McVerry, Chris Gonzalez, norm Smith, your father, bill Catona, and many others. So, that was my introduction urology. That was my introduction to the department, and the institution. I was really pleased when I finally got to train there as a resident after graduating from my medical student years.

And it's one of those things where I look back with such fondness that when I got invited for this opportunity, I can't tell you how heartwarming it was and how honored I was to be, asked to contribute to something this's meaningful.

Edward Schaeffer, MD, PhD: thank you for those thoughts. We always pitch to all of our resident applicants that our goal is to really train the complete resident, in the six years, of time here Northwestern. But, some of our alumni choose to go off and do fellowships, and so we chose to do a fellowship at MD Anderson and then subsequently.

Have had your entire career there. And, in contradistinction to that, rich, who finished, you know, kind of one generation after you, although he too, was a complete resident when he was finished, elected to do a fellowship at Memorial Sloan Kettering. So thankfully this podcast is not in person or there could be some fisticuffs, but maybe Rich, do you wanna, do you wanna reflect on the process when you were.

Applying, you know, NEMA was a medical student in Northwestern, so he had a little bit of a different perspective and you were more of an outsider really surveying the whole landscape of urology programs and, any thoughts about what were key factors in the training program that were really important for you?

Richard S. Matulewicz, MD: Yeah, I mean the first time I visited Northwestern was also the first time I stepped foot in Chicago, so I was a Northeastern boy. grew up in New York. Went to school in Boston for nine years after that. And then when I was, looking at programs, the minute I showed up at Northwestern, you know, I called my folks after the interview day finished, and I said, this is the place I wanna be.

the immediate gravitas of being on that campus, the history, the program. immediately seeing people that I truly wanted to be when I grew up, was enough to draw me to the program, take the leap of faith, move to the Midwest for six years, and, really kind of, test my boundaries and do something new.

And it was really because of the program. And the program and the people, from the, minute you step foot on the campus, you understand, the shoes you're gonna walk in when you train in the program. And I think a lot of the, trainees and, what drew me to the program especially were, the people and, the mentors, the role models, the folks I knew that.

wanted to be, in the future. And, that was really the crux of, of why I knew I wanted to train at Northwestern and, and kind of start my career there.

Edward Schaeffer, MD, PhD: was there anything that you, you know, key tenants, that you Developed or picked up here that you still kind of carry with you today in your, you have a very robust practice in the surgical management and management of individual with testicular cancer, but also have a strong research program in, urothelial carcinomas.

is there any kind of key tenant or two that you still carry with you, bearing in mind that you may be doing something completely different now in your practice?

Richard S. Matulewicz, MD: Yeah, absolutely. I mean, I knew from early on that wanted to be an oncologist, but I thought that the benefit of the training. Program was really developing me as a urologist first and all the things that I, learned even outside of oncology and the program, having this incredible resource with male infertility, andrology, stone disease, female public medicine, just being able to experience a.

All of this to really become a complete urologist before I moved on to really hyper specialize. these are things that I, still borrow from today. You know, having good experience in, pelvic surgery, despite being primarily a retroperitoneal surgeon will, always be helpful. And just learning the different techniques, really getting a, a broad and.

Really wide, breadth of exposure to endoscopic surgery, robotic surgery, laparoscopic surgery, open surgery, really everything, just from the clinical training perspective, you know, being able to finish the program and, and really feel comfortable doing pretty much anything, I thought was in incredibly impactful. And then the research experience goes without saying, you know, the ability to have a dedicated research year, truly a protected research year with.

a number of different mentors within, the department, outside of the department, really set me up for how I kind of approach research questions, problems, you know, really respecting and understanding the process, being thoughtful about how you approach, a clinical question or translational research question. That all started, at Northwestern with the training, with the, real true protected time to think about questions, to develop your own thoughts, your own approach, you know, honing your grantsmanship and the way you, you really wanna prepare to be a surgeon scientist in the future.

very much owe it to the program and, and all the mentors, at Northwestern that kind of put me in this position.

Edward Schaeffer, MD, PhD: Nema, you hold the position as chair at MD Anderson, which is, one of the top two cancer, centers, in the country along with Memorial. As you guys both know, we really, think so highly of each of your programs. you know, you have the ability to kind of craft and shape, notable and historic institution in its own right.

What is the most kind of purple component of the MD Anderson program that, you picked up in medical school or in, in our residency training, that you have secretly inserted into the culture in ethos that is MD Anderson.

Neema Navai, MD: it's a great question and, thanks Ted. you know, they're both as you noted, esteem programs that I have a ton of respect for. I think that's where it starts. Um, one of the things I recognized through the thoughtful leaders at Northwestern in my experience there was, paying deference to the legacy of the institution and recognizing just how much, gravitational pull it has.

likewise when I came to MD Anderson for my fellowship training, stayed on, for my faculty career through mid and, now my late career, and given the opportunity to lead it. I think about that a lot, what the legacy of the program is and paying deference to it and, and trying to do my best to live up to it.

I, carry that from my experience at Northwestern. There were a couple of other factors. I think Northwestern had, almost a singular focus, although it was such a comprehensive and, thoughtfully executed program. But it cared so deeply about its trainees and it cared so deeply that the training program was exceptional.

Not just good, but exceptional and beyond. essentially reproach in every way. That is a huge value to a program, is to have, a training program that's exemplary because. Exemplary trainees magnify the influence across all the other aspects, of a program. It strengthens the research. It strengthens the clinical care and the quality.

It strengthens the culture and it, creates a culture of excellence that otherwise can be, I think, particularly challenging. So I've tried very hard. To maintain that same focus at MD Anderson to make sure that we lean in heavily to our training program and, ensure that it's the, best fellowship program in oncology.

bar none. And that's something that we invest in very heavily. And there's another aspect which is, this deference to a, communal good or communal goal, that you don't want individual contributors for individual. outcomes you want individual excellence feeding into collective, benefit. And that's something that I have worked very hard to model the way at MD Anderson and, also, work very steadfastly to create as a culture, as now the leader of the program.

and that's something that I learned from Northwestern. I think you felt it, at Northwestern, that everybody was really working towards something far greater than themselves, but they expected individual excellence was the mechanism to get them there. And that's something that I hope to. to create in, a little way here at MD Anderson.

Edward Schaeffer, MD, PhD: Yeah, it's exciting. You know, I, think that, I'm not really sure what the secret sauce is. it's obviously reflected in the success that each of you have had, but, I remember when I was interviewing for this job, so I'll tell you a little anecdote, Nima, I got to interview with the, residents who are currently in the program.

And there was a young, junior resident in the room and, we sat in this round table and I asked them what they thought. the best part of the program was. And I thought they'd say, you know, the legacy of Jack Ray hack, or Sarky Optical Cater research, or Josh Meekus, technical skills, et cetera.

And this young, trainee. Rich Matt Levivitch leaned forward and he said, the residents are the stars of this program. And I gotta be honest, I was taken aback by that, when I reflected on it, and then I was obviously, honored to be able to come here as chair, I realized that that's totally true.

And, and when you know, the group is always very tight. They're super duper motivated, and they really push you as a faculty to kind of be better. To be, aspire to greater things. and I'm not, you know, we've been very successful in attracting those trainees long before my tenure here, but certainly proud, to have done that, for our current trainees.

And I, think it's, hard to kind of pinpoint that when you're, talking to prospective resident candidates, but certainly. I always tell them, like, meet the people that you're with now, but just look at the track record for people and what they've done when they've completed the residency program here.

because that should act as an an in inspiration, for sure. when you guys, reflect on, the future, of urology, what things do you see, You know, as next steps where residency training programs are really gonna be integral in that there's a evolution in healthcare. things are always changing, but I feel like that's never more so than the present.

what are the cores of a training program that are, gonna be must haves, when you think about the future, next steps. Rich. any thoughts?

Richard S. Matulewicz, MD: Yeah, I think, the important approach just given how everything is evolving and constantly changing. I mean, even from the start of my residency training into now, the operative approach, the use of robotic, minimally invasive surgery, additional technologies, all these things are, are changing. All of the time. And I think the thing that I took away was, not necessarily knowing, what to think, really, how to think, you know, how to approach the surgical patient, how to approach the urology patient, when to use certain modalities and approaches.

Not to beholden to one specific approach, but really to understand, beyond just c tumor, cut tumor out. how to manage this person from start to finish. You integrate multimodality care, work with your colleagues, kind of talk with people, understand and most of all take good care of patients as the kind of guiding light for what we do every day.

And I think that. when you know how to approach something, you can be very nimble and, be very adaptive and you can allow yourself and your patient care to evolve as healthcare evolves. So, rather than just, you know, learning. You from A to B2C, how to do an operation.

Really understanding how to get from point A to point C with all the tools at your disposal. All the approaches, all the tricks, you know, all the things get from start to finish, to take care of someone. I think, that's really the, the way to, train somebody in the way to make someone into a surgeon, urologist, that's gonna be able to, continue to evolve with the field.

Edward Schaeffer, MD, PhD: Any other thoughts? Nima?

Neema Navai, MD: I think as you said, it, everybody experiences change throughout their career and, I'm sure in the moment everyone has felt like the change that they were, set to face was the most challenging in history. I think we are right to think that though. I don't envy the people entering medicine today.

I think they're entering, a field that is far more in flux than it has ever been. I think the external challenges, being imposed are just wholly unique. I think, although there's a lot of sort of overblown expectations of artificial intelligence, I think there are very real substantive expectations that it will transform medicine, clinical care, and crucially the cognitive components of our care models.

I think that these trainees that are coming in, today are going to have autopilot like surgical tools in the operating room with them, and that is something that none of us have experienced before. We've been able to, I think, adapt. when I started training, da Vinci Robot didn't exist.

I was a third year resident when, Northwestern got their first robot, and now I'm an obligate robotic surgeon, is what I like to say. That's the only thing I do. even though barely trained on it. short of, a year at MD Anderson, a couple years in Northwestern. but it became everything I do.

And I think that what, Northwestern did fundamentally very well was create resilient, and dynamic trainees. so that when you left, as you, I think said it earlier the complete urologist, it wasn't just in your education. It was also in your resilience, your fortitude and your ability to, coach yourself and train additionally and adapt.

I think that's gonna be the vector of success for training programs moving forward. I think the ones that succeed in creating the thought leaders of tomorrow are gonna be the ones that really focus on adaptation and resilience. I don't know if this has ever been studied. It would be a great study for someone at Northwestern to do.

I have a feeling that. Some of the most resilient urologists in the country are those that trained at Northwestern, and I bet you the burnout levels are the lowest, because of it. and I think if they keep that legacy, they'll continue to create, really the people that are paradigm shifting for our field.

Edward Schaeffer, MD, PhD: I think it's an, true honor for me to, Maintain and hopefully, enhance the legacy and the, prowess of the training program here. it is true what a young, rich, Matt Levi said, the residents are the stars of our program, and they really are the inspiration for all of us as faculty.

So, in reflecting on, now my 10 years here as chair. And thinking about what that impact will mean in the whole history of the department. It's really, it's cool. So, with that, I, certainly appreciate, your time today and your thoughts and, it's always great to bump into members of the Northwestern Medicine family as we're out and about in academia and, throughout the country.

So, good to see you virtually. Hopefully I'll see you guys in person soon. rich and Nima, be well and, uh, thanks for your time today.

Neema Navai, MD: Yeah. Thank you for the opportunity.

Richard S. Matulewicz, MD: Yeah, thanks.

Edward Schaeffer, MD, PhD: Thanks guys.

Melanie Cole, MS: What a great discussion and such an exciting time in your fields. I wanna thank you all for joining us today to celebrate 125 years of urology at Northwestern Medicine. Thank you very much again for joining us and to refer your patient or for more information, head on over to our website at Breakthroughs for Physicians.

Dot nm.org/urology to get connected with one of our providers. That concludes today's episode of Bettered a Northwestern Medicine Podcast for physicians. I'm Melanie Cole.