This week’s faculty spotlight shines on Kevin Watt, MD, associate professor of pediatrics in the Division of Critical Care Medicine. Watt talks to us about how he decided to dedicate himself to medicine as a result of reflections during a research fellowship in rural Nepal and his overarching, long-term career goals to optimize drug therapy and outcomes in critically ill children and train the future generation of health care scientists. He also shares his reflections on his most significant mentor, Daniel Benjamin, MD, PhD, and offers some insights into three of his current research projects.
How long have you been at Duke? How did you decide to come here?
I came to Duke 13 years ago as a pediatric resident. I was attracted to Duke because of the people, and I stayed at Duke because of the people. I love working with my colleagues, and I learn something new every day.
What are your responsibilities within the Division of Critical Care Medicine? What does a typical day for you look like?
Depends on the day! I split my time between research and service in the Pediatric ICU. If I am on service, I deal with everything from respiratory failure to shock to children who have just had major surgery. On the research side, I am primarily in the office designing and managing trials, analyzing results from the trials, writing grants, etc. It’s nerdy, but the really fun days are when I can block off several hours to develop pharmacokinetic models to predict how drugs will behave in children.
How did you first get interested in medicine? What made you decide to pursue pediatric critical care medicine in particular?
I was lying on the dirt floor of a house in Nepal, wracked with pain and fever, and wondering what the heck I was doing there. I spent a year in rural Nepal on a research fellowship in my first year out of college. I was a natural resources major in college, and my year in Nepal was spent looking at the interaction between agriculture and mountain ecology. I had a lot of time for reflection during that year to think about what drives me and where I want to dedicate my life, and what came out of it was medicine.
Pediatric critical care was simply the right fit. In many ways it was a natural extension of my interest in ecology and the complex interactions that drive an ecosystem. The human body is just another ecosystem, and in the PICU, we get to focus on the complex interactions between child, disease, and treatment. I also love the teaching that takes place at the bedside, helping parents through this challenging time, and that feeling of calm and focus that I get when taking care of a really sick child.
What’s one thing you wished more of your patients knew about pediatric critical care or medicine in general?
Most kids get better. I always get a lot of sympathy from people when I tell them I work in the PICU. While the PICU can be a challenging place to work at times, children are resilient and the vast majority do well.
What are your specific interests in the field of pediatric critical care medicine?
My overarching, long-term career goals are to optimize drug therapy and outcomes in critically ill children and train the future generation of health care scientists. I am especially interested in how the altered physiology we see in critical illness affects drug exposure and dosing in the body. Most people are not aware of how little we know about drugs in children. If your child goes to the pediatrician and is prescribed a drug, there is about a 25% chance that drug is not approved by the FDA for use in children. If they are admitted to the hospital that number jumps to 50%, and if they come into the ICU it is over 70%. Which is not to say that we do not have any experience with these drugs, but it does say that no one has done the rigorous studies required by FDA for labeling. Our group, led by Danny Benjamin, is working to address this gap through the Pediatric Trials Network.
Can you tell us about some of your current research?
I am a clinical researcher and working on three exciting projects right now. We just received funding to evaluate the impact of extracorporeal life support (ECMO and dialysis) on drug exposure and determine optimal dosing in these vulnerable children. I am also leading two trials through the Pediatric Trials Network, one focused on the long term safety of antipsychotics in children and the other a study to determine how much drug passes into breastmilk for a number of commonly used drugs.
Who was your most significant mentor and what knowledge did you gain through this collaboration?
Danny Benjamin. I first met Danny at the beginning of fellowship to discuss whether my proposed ECMO research project was a good fit for the departmental T32. After pointing out all of the many flaws in my proposal (it was a terrible project) and the low likelihood of its success, we discussed what a career path in clinical research would look like and how to design a project that would succeed. That straightforward and frank discussion was just what I was looking for and has continued to be a hallmark of our relationship. The three things he provides as a mentor are: 1) well-developed training/research infrastructure, 2) funding, and 3) and team mentorship model. I have been involved with a number of physician-scientist training programs, talked a lot about mentorship with both senior and junior researchers, and I have not come across a more effective mentorship approach.
Since your completed your pediatric internship and residency as well as a pediatric critical care fellowship here at Duke, do you have any advice for trainees?
Take advantage of the opportunities you have while training. Yes, it’s hard. It’s meant to be hard. It’s also one of the few times in your career where you really get to try out different things--take the new car out for a spin, kick the tires, see if you like it. At the start of residency, I imagined myself as primarily a clinician. But at the end of residency and then to a much greater extent in fellowship, I gave research a try and loved it. So much so that I went on to get a PhD and now spend 75% of my time doing clinical research.
What passions or hobbies do you have outside of work?
Just about anything outdoors with my family. I have two children, and my wife is a professor of global health at Duke. I had a prior career as an Outward Bound instructor so love backpacking, climbing, and paddling. Since moving to this area, I have focused on cycling--mainly mountain biking and cyclocross. We spend a lot of time camping as a family, and every summer we make a road trip to Colorado.