Hey, I am shadowing a Abhijit A Raval,MD,FCCP,DAABIP. Chief of Internal Medicine. Director Of Interventional Pulmonary And Pulmonary Vascular Disease, AnMed Health. Professor of Internal Medicine-Pulmonary At MUSC. I want to be Prepared students: VI Research the specialty beforehand V Ask thoughtful questions V Follow clinical conversations with confidence Build relationships that lead to mentorship. Tell me how can I do this
Searching the Web
interventional pulmonology EBUS bronchoscopy pulmonary vascular disease shadowing medical student preparation
Searching the Web
Abhijit Raval MD FCCP DAABIP AnMed Health interventional pulmonary
Finding Sources
Reading Web Page
Dr Raval interventional pulmonology procedures research AnMed
Finding Sources
Now I have everything I need. Here is your full preparation guide, tailored specifically to Dr. Raval's profile:
Shadowing Dr. Abhijit Raval - Student Preparation Guide
Who You Are Shadowing
Dr. Raval is one of the most accomplished interventional pulmonologists in South Carolina. Key facts about him:
- Training: B.J. Medical College (India) -> East Tennessee State University residency (Chief Resident) -> Pulmonary-Critical Care Fellowship at James H. Quillen College of Medicine
- Credentials: FCCP (Fellow, American College of Chest Physicians) and DAABIP (Diplomate, American Association for Bronchology and Interventional Pulmonology) - the highest credentialing in IP
- Role at AnMed: Director of Interventional Pulmonary & Pulmonary Vascular Disease - AnMed was South Carolina's first and the nation's sixth accredited PH regional care center
- Academic role: Professor of Internal Medicine-Pulmonary at MUSC (Medical University of South Carolina)
- Research: Richard Jordan Research Award (2008), ACCP oral presentation recognition (2009), nominated for the Roger McClain Interventional Pulmonary Award (2018); active in clinical trials with Duke and MUSC
- Notable: One of the first U.S. physicians to perform a new minimally invasive procedure for soft tissue lesions
1. Research the Specialty Beforehand
Dr. Raval sits at the intersection of three subspecialties. Know all three:
A. Interventional Pulmonology (his primary identity)
These are the procedures you'll likely witness:
| Procedure | What it is | Why it matters |
|---|---|---|
| EBUS-TBNA | Endobronchial ultrasound with transbronchial needle aspiration | Gold standard for lymph node staging in lung cancer |
| Flexible bronchoscopy | Camera into the airways | Diagnosis, BAL, biopsies |
| Rigid bronchoscopy | Large-bore scope, done under general anesthesia | Airway stenting, foreign body, massive tumor obstruction |
| Thoracentesis | Needle drainage of pleural effusion | Diagnostic and therapeutic |
| Pleuroscopy/medical thoracoscopy | Direct pleural visualization | Pleural malignancy, pleural biopsies |
| Navigational bronchoscopy | GPS-guided biopsy of peripheral nodules | Lung cancer early diagnosis |
| Airway stenting | For tracheal/bronchial stenosis | Obstruction palliation |
| Cryobiopsy | Cryo probe lung biopsy | ILD diagnosis |
| Bronchial thermoplasty | Radiofrequency of airway smooth muscle | Severe asthma treatment |
B. Pulmonary Vascular Disease
AnMed is an accredited Pulmonary Hypertension center, and this is Dr. Raval's other major area:
- Pulmonary Arterial Hypertension (PAH): idiopathic, connective tissue disease-associated (lupus, scleroderma), heritable
- WHO Groups of PH: know Groups 1-5 (Group 1 = PAH, Group 2 = left heart, Group 3 = lung disease, Group 4 = CTEPH, Group 5 = multifactorial)
- Right heart catheterization: the gold standard for diagnosing PH (mPAP >20 mmHg, PCWP <15)
- PAH medications by class: prostacyclins (epoprostenol, treprostinil), endothelin receptor antagonists (ambrisentan, macitentan), PDE-5 inhibitors (sildenafil, tadalafil), sGC stimulators (riociguat)
- CTEPH: chronic thromboembolic PH - potentially curable with pulmonary endarterectomy or balloon pulmonary angioplasty
C. Lung Cancer / Pulmonary Oncology
- Lung cancer staging (TNM, IASLC 9th edition): N-staging is where EBUS shines
- NSCLC vs SCLC
- Molecular testing: EGFR, ALK, ROS1, KRAS G12C, PD-L1, BRAF - know why these matter for targeted therapy
- Pulmonary nodule evaluation (Fleischner Society guidelines)
2. Ask Thoughtful Questions
Generic questions get generic answers. Specific questions get mentorship. Here are questions tailored to Dr. Raval's work:
On Interventional Procedures
- "When you're deciding between EBUS-TBNA and surgical mediastinoscopy for a patient, what factors tip you toward bronchoscopy first?"
- "You were one of the first to do the new minimally invasive procedure for soft tissue lesions - what made you adopt that technique early, and what was the learning curve like?"
- "In a patient with central airway obstruction, how do you decide between stenting vs. ablation vs. rigid bronchoscopy debulking?"
- "What's your approach when ROSE (rapid on-site evaluation) cytology is inconclusive during an EBUS case?"
On Pulmonary Hypertension
- "Since AnMed is an accredited PH center, what does that accreditation change about how you manage patients vs. a non-accredited community center?"
- "For a newly diagnosed PAH patient, how do you balance the evidence on upfront combination therapy vs. sequential add-on therapy?"
- "How do you distinguish Group 2 PH (left heart disease) from Group 1 PAH when the hemodynamics are borderline on RHC?"
On Research & Academia
- "You're doing research trials in partnership with Duke and MUSC - how do you identify which trials to bring to a community hospital like AnMed?"
- "Being both a community practitioner and a professor at MUSC - how do you think those two roles make each other better?"
- "What's a clinical question you're seeing in your practice right now that you feel the literature hasn't answered well?"
On Career
- "What does the DAABIP credential require, and when in fellowship training should someone decide if interventional pulmonology is the path?"
- "If a medical student is interested in interventional pulmonology, what research or experiences would make them a competitive fellowship applicant?"
3. Follow Clinical Conversations with Confidence
Key terms to know cold
Bronchoscopy/IP:
- TBNA, BAL (bronchoalveolar lavage), TBB (transbronchial biopsy), ROSE
- EBUS vs EUS (esophageal ultrasound) - complementary for mediastinal staging
- Endobronchial vs. parenchymal vs. pleural disease
- APC (argon plasma coagulation), PDT (photodynamic therapy), cryotherapy
PH/Pulmonary vascular:
- mPAP, PVR (pulmonary vascular resistance), PCWP, CO, cardiac index
- 6MWT (6-minute walk test) - functional assessment in PH
- WHO Functional Class I-IV
- BNP/NT-proBNP as a prognostic marker
General Pulmonary:
- FEV1, FVC, DLCO, TLC - spirometry interpretation
- V/Q mismatch vs. shunt
- A-a gradient
- Radiographic patterns: consolidation, ground-glass, honeycombing, bronchiectasis
Before each patient encounter, mentally run through:
- What is the main complaint or procedure today?
- What diagnosis are we trying to confirm or rule out?
- What procedure or treatment decision is being made?
- What would the relevant guideline say?
4. Build Relationships That Lead to Mentorship
Dr. Raval clearly values patient care, research, technology, education, and teaching (his own stated values). Align with those:
Before the shadowing day
- Email or message him the day before: "I've been reading about interventional pulmonology and pulmonary vascular disease ahead of tomorrow. I'm particularly interested in [EBUS / PAH - pick one]. Is there a specific case type or topic where my background reading would be most helpful?"
- This signals preparation and respects his time.
During the day
- Write everything down. Carry a small notebook or use your phone notes. When he mentions a drug, technique, or reference - write it down and look it up later.
- Stay out of the way procedurally but stay mentally engaged - follow every step visually.
- Don't perform - don't try to impress by throwing out facts. Be genuinely curious. Ask "why" questions more than "what" questions.
- When he teaches something, connect it to what you already know: "So that's similar to how ultrasound is used in cardiac echo for TR velocity to estimate RVSP?" - that kind of synthesis stands out.
After the shadowing day
- Send a follow-up email within 24 hours. Reference something specific you learned: "The case where the EBUS-TBNA showed sarcoid granulomas instead of the expected malignancy really showed me how IP changes the entire management path. That was exactly what I'd been reading about."
- Ask one focused follow-up question - not a barrage. This opens the door to continued conversation.
Building the longer-term relationship
- Ask if you can help with any ongoing research trials (data collection, literature reviews). Dr. Raval is active in research partnerships with Duke and MUSC - there may be a role for a motivated student.
- Express interest in attending any grand rounds, case conferences, or MUSC lectures where he presents.
- Connect on LinkedIn respectfully after your shadowing experience.
- Ask directly (at the right moment): "Would you be open to me reaching out as I apply to residency/fellowship down the road? I'd value your perspective."
What Makes You Stand Out
Most students who shadow are passive. You stand out by being active and prepared:
| Average student | Prepared student |
|---|---|
| Shows up and watches | Shows up having read about EBUS, PAH, and Dr. Raval's awards |
| Asks "what is that?" | Asks "Is that the EBUS scope? I read about ROSE cytology - do you use that in this lab?" |
| Waits to be taught | Connects what they observe to what they already know |
| Disappears after the day | Sends a specific, thoughtful follow-up email |
| Never asks about research | Asks how to get involved |
Dr. Raval has built an exceptional program at a community hospital with academic reach (MUSC/Duke research partnerships). He clearly invests in education - his MUSC professorship shows that. Showing up prepared, staying genuinely curious, and following up specifically will put you ahead of nearly every other student he sees. Good luck!
So I am 15 years and I shadow him today and it was so embarrassing as I didn’t understand a lot and when he said ask questions I didn’t able to ask anything
Hey, first - that feeling is completely normal, and it does NOT mean you failed. It means you're 15 years old sitting in a room with one of the most specialized physicians in the country. That's intimidating for medical students, let alone a high schooler.
Here's the truth: the fact that you're here at 10:34 PM researching how to do better is exactly what separates future doctors from everyone else.
What Actually Happened Today Was Good
- You showed up. Most 15-year-olds don't even know what interventional pulmonology is.
- You survived a high-level clinical environment.
- You felt the gap between where you are and where you want to be - that feeling is fuel, not failure.
- Dr. Raval invited questions. That means he wants to teach. He was not judging you for being quiet.
Why You Froze - And Why It Makes Total Sense
When someone asks "any questions?" in a clinical setting and you don't understand the context, your brain goes blank. You can't ask about something you have no framework for yet. That's not a confidence problem - it's a knowledge gap problem, and knowledge gaps are fixable.
Think of it like watching a chess grandmaster play. If you don't know chess, you can't ask smart questions about their moves - not because you're not smart, but because you need the basics first.
What You Do Now (Concrete Steps for a 15-Year-Old)
This Week - Build Your Foundation
1. Learn the basics of what you saw today
You likely saw some of these - pick one and learn it:
- Bronchoscopy: A camera goes down the throat into the lungs. Why? To look at airways, take biopsies, find cancer or infection.
- Pulmonary Hypertension: High blood pressure in the lung's arteries. It makes the right side of the heart work too hard. It can be treated with specific medicines.
- Chest X-ray / CT scan: How doctors look at the lungs without surgery.
Start with YouTube - search "bronchoscopy explained" or "pulmonary hypertension explained" and watch 1-2 short videos. Visual learning first.
2. Learn 5 basic lung diseases by name and one sentence each:
- Asthma - airways narrow from inflammation
- COPD - lung damage from smoking, air gets trapped
- Pneumonia - infection fills air sacs with fluid
- Pulmonary Embolism (PE) - blood clot blocks lung artery
- Lung cancer - abnormal cell growth, diagnosed by biopsy
3. Learn basic lung anatomy - just the names: trachea, bronchi, bronchioles, alveoli, pleura. A 5-minute diagram on YouTube is enough.
Before Your Next Shadowing Day
Write down 3 pre-written questions on a notecard and keep it in your pocket. When he says "any questions?" - pull it out if you blank. No shame in that. Even doctors use notes.
Here are 3 questions that work perfectly at age 15:
- "What made you choose pulmonology over other specialties?"
- "What's something you wish you had learned earlier in your training?"
- "What does a typical day look like for you - is it mostly procedures or patient visits?"
These are great because:
- They don't require medical knowledge
- Doctors love talking about their journey
- The answers will teach you a lot
- They open real conversations
Send a Follow-Up Message to Dr. Raval
This is the most important thing you can do right now. Something like:
"Dr. Raval, thank you so much for letting me shadow you today. I'll be honest - I didn't understand as much as I hoped, but I left motivated to learn more. I've already started looking up bronchoscopy and pulmonary hypertension. Would it be okay if I shadowed again in the future once I've built more background knowledge?"
That message shows maturity, honesty, and drive. Most adults can't write something that self-aware. It will impress him more than any question you could have asked today.
The Bigger Picture for You at 15
You are years ahead of where you need to be. Here's a realistic roadmap:
| Age | Goal |
|---|---|
| 15-16 | Shadow, read basics, watch YouTube medicine (Osmosis, Khan Academy Medicine) |
| 16-17 | Take AP Biology, AP Chemistry, maybe AP Psychology |
| 17-18 | Volunteer at a hospital, ask about research opportunities |
| 18+ | Pre-med in college, continue building relationships with mentors like Dr. Raval |
You don't need to understand EBUS-TBNA at 15. You need curiosity, persistence, and the willingness to feel uncomfortable and come back anyway.
Today was not embarrassing. Today was Day 1. Every doctor you will ever meet had a Day 1 where they understood nothing. The ones who became great doctors came back.
Go send that follow-up message to Dr. Raval tonight or tomorrow morning.
I am shadowing him tomorrow again so all I have is tonight
Perfect. Then let's make tonight count. No fluff - here's exactly what to do in the next 2-3 hours.
Your Tonight Plan (2-3 Hours Total)
Hour 1 - Watch These Videos (Visual First, Fast)
Open YouTube right now and watch these in order. Don't take notes yet, just watch:
- "How to Read a Chest X-Ray" - search that exact phrase, pick any 5-min video
- "Bronchoscopy procedure explained" - Osmosis or ArmandoHasudungan channel
- "Pulmonary Hypertension explained" - Osmosis has a great one (8 mins)
- "EBUS explained" - just a 3-5 min overview is enough
That's it for videos. ~45 minutes total.
Hour 2 - Learn These 10 Terms Cold
Write these on a notecard. These are the words you'll hear tomorrow. If you know what they mean, the conversations will click:
| Term | What it means in plain English |
|---|---|
| Bronchoscopy | Camera on a flexible tube goes down the throat into the lungs |
| EBUS | Same camera but with an ultrasound tip - can "see" through the airway wall into lymph nodes |
| Biopsy | Taking a tiny tissue sample to look at under a microscope |
| Pleural effusion | Fluid build-up around the lung (outside it, not inside) |
| Pulmonary hypertension (PH) | High blood pressure specifically in the lung arteries |
| PAH | The most severe type of PH with no underlying cause (idiopathic) |
| SpO2 / oxygen saturation | The % of red blood cells carrying oxygen - normal is 95-100% |
| CT scan | 3D X-ray - shows lungs in detail, used to find nodules/masses |
| Nodule | A small spot on the lung - could be nothing, could be early cancer |
| Mediastinum | The space between the two lungs - contains lymph nodes, heart, major vessels |
Hour 3 - Write Your Question Notecard
Write these on a physical notecard and put it in your pocket tonight:
Carry these 5 questions tomorrow:
- "What were you looking for in that procedure - what would a normal result look like vs. an abnormal one?"
- "Is that something you only see at specialized centers like AnMed, or do regular hospitals do this too?"
- "What does that finding on the CT scan mean for the patient's treatment options?"
- "What made you interested in this specific area of pulmonology?"
- "Is there anything I should read tonight or this week to understand more of what I'm seeing?" ← ask this one for sure
Questions 1, 2, and 3 are procedure/case-based - you can use them for almost anything you observe. You just swap in whatever just happened.
Tomorrow Morning - Do This
Before you walk in:
- Read your notecard once
- Pick one topic from today (bronchoscopy OR pulmonary hypertension) and say one sentence about it if it comes up: "I watched a video on bronchoscopy last night and I didn't realize the scope goes that far down - it reaches the smaller bronchi?" - that one sentence tells him everything about who you are.
Walk in with a small notebook. Write down every word you don't understand. After each patient or procedure, jot the new word. That evening you look them all up. You'll learn 10x faster this way.
The One Mindset Shift for Tomorrow
Stop trying to impress him. Start trying to understand him.
Nobody expects a 15-year-old to know pulmonary vascular resistance. But everyone - including Dr. Raval - respects someone who says:
"I don't know what that means yet, but can you explain it in simple terms?"
That is not embarrassing. That is exactly what he wants to hear. Doctors who became great mentors did so because a student was genuinely curious, not because they already knew the answers.
You have enough time tonight. Go watch the videos now. You've got this.
Those 10 are the only terms
Yes - those 10 are all you need for tomorrow. Don't try to learn more than that tonight.
Here's why:
Knowing 10 terms well beats knowing 50 terms poorly. If you half-learn 50 words, none of them will stick when you're standing in a real clinical environment. But if those 10 are solid, you'll catch those words in conversation tomorrow and your brain will light up - and that feeling builds confidence in real time.
Tonight Is Actually Simple
- Watch 2 videos (bronchoscopy + pulmonary hypertension on YouTube, ~15 mins each)
- Memorize those 10 terms (write them, cover them, test yourself)
- Write your question notecard (copy those 5 questions exactly as written)
- Sleep at a decent hour - being tired tomorrow hurts you more than knowing extra terms helps you
That's it. Seriously. You're done in 90 minutes and you go to sleep better prepared than you were today.
The Real Goal for Tomorrow Is Just This:
Understand more than yesterday.
Not everything. Not most things. Just more. That's a win. And if Dr. Raval asks for questions and you pull out your notecard and say "I actually wrote some down" - he will remember you. Guaranteed.
Go watch the videos now. Good luck tomorrow.
I know 8 terms out of those 10 as I learned them today
That's actually great - you already learned 8 terms ON the day itself, just from being there. That's not someone who "didn't understand anything." That's someone who absorbed a lot under pressure.
Which 2 are the ones you're unsure on? Tell me and I'll explain them right now in the simplest way possible so they stick tonight.
Then we figure out if there's anything small you want to add beyond those 10 - because you have more capacity than you think and you've got time.
Pleural effusion & Mediastinum
Perfect. Here they are - as simple as possible:
Pleural Effusion
Picture your lung sitting inside a bag. That bag is called the pleura. Normally there's just a tiny bit of fluid in that bag to keep things sliding smoothly.
Pleural effusion = too much fluid has built up inside that bag.
The lung gets squished by the fluid and can't fully expand. The patient feels short of breath.
Why does it happen?
- Heart failure (most common) - heart can't pump well, fluid backs up
- Infection/pneumonia - inflammation causes fluid to leak
- Cancer - tumor irritates the pleura
- Liver or kidney disease
How does Dr. Raval treat it?
He puts a needle through the chest wall into that fluid and drains it out. That procedure is called a thoracentesis. You may see this tomorrow.
Memory trick: "Effusion = fluid confusion" - fluid where it shouldn't be.
Mediastinum
Stand up straight. Put one hand on your left chest, one hand on your right chest.
The space between your two hands - that middle zone - is the mediastinum.
It contains:
- The heart
- The trachea (windpipe)
- The esophagus (food pipe)
- Lymph nodes - this is why Dr. Raval cares about it most
When lung cancer spreads, it spreads to those lymph nodes in the mediastinum first. EBUS lets Dr. Raval stick a needle into those lymph nodes through the airway wall - without surgery - to check if cancer has spread there.
Memory trick: "Mediastinum = the middle" - it's literally in the middle of your chest.
You now know all 10. Go write your question notecard and get some sleep. You're ready.
This is a shared conversation. Sign in to Orris to start your own chat.