The Importance of Being Earnest.

Attempting to effect change in modern medicine, particularly as trainees or junior faculty, is often an overwhelming undertaking. While early-career physicians are in close contact with patients, they often lack the credibility or access to resources that are necessary to implement new ideas at large institutions. Although there may be scientific evidence to support new models of care, existing cultural patterns of practice can foster resistance to these interventions. The authors describe their own experience as residents reforming the management of endocarditis patients at an academic medical center, emphasizing the important role that residents can play in changing medical practice. Starting with a devastating patient case, the authors share their story of creating a multidisciplinary endocarditis team while navigating the many obstacles, some unseen, that can derail innovative ideas. Ultimately, through a combination of new perspectives, data-driven analysis, determination, and-most importantly-hope, the authors were able to dramatically improve outcomes for patients. Moving forward, their experience can serve as a model for young physicians and inspire them to effect change in their own institutions.