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Mitch: The Scope is here at the AAMC Learn Serve Lead 2022 conference, and we are having conversations about how we can build from the ground up when it comes to medicine, medical care, and academics when it comes to health.

And so, in the effort to continue these types of conversations that we are loving having here at the floor, we're joined by Dr. Jose Rodriguez. He's the Associate Vice President for Equity, Diversity, and Inclusion for University of Utah Health, and a tenured professor for the Department of Family and Preventative Medicine.

As well as a second-year medical student from U of U Health, Moroni Lopez, who is one of two student representatives here at AAMC.

So when it comes to medical education, like how we're training our future doctors, we have a student here. You're in your second year. You're going to be deciding residency sooner than you'll realize, right?

Moroni: Yep.

Mitch: What are some of the ways that we can start to approach this differently, that we can start to change the way we do things?

Dr. Rodriguez: When we think about change, we've got to think a little bit about where we've been. And Moroni here is part of one of the most diverse classes in the history of University of Utah School of Medicine.

Mitch: Wow.

Dr. Rodriguez: And the class that's behind him is actually more diverse than the class that he's in.

Mitch: Oh, wow.

Dr. Rodriguez: And we're making strides in this area in a way that hasn't been seen before. Now, as a diversity officer, I would say that the strides are wonderful, but that we cannot rest on our laurels. Moroni, why don't you tell us a little bit about how you see the diversity of your class and how you see it helping your education.

Moroni: Yeah, I think as the curriculum's been moving along, a lot of the education that is designed for us in our preclinical years is meant to be a lot of team-based learning, a lot of problem-based learning, a lot of collaborating. And I think being able to make sure that within each one of these teams we have diverse thought, we have diverse viewpoints, it' crucial.

I think even when we go through and talk about a patient case, there are some things that I might pick up on, whether the patient is mentioned as being an immigrant, things that have to do with their social determinants of health that I might pick up on because of my experiences, or that my other classmates might have picked up on because of their diverse experiences, that the other members of the team just might not have thought of.

And I think being able to do that and integrate that into every part of our core curriculum as we move forward in our medical education is important so that every one of these future doctors can not just think, "Okay, there's a case. This is what the presentation of a disease looks like," but they can expand it to a more comprehensive and holistic view of a patient and how to best help them.

Dr. Rodriguez: You're talking about how people see each other, right? And I think that's an important part, and I think that's really what makes the diversity of medical school classes important.

Because as you get through this . . . I don't want to call it a traumatic experience, but it certainly is difficult. And for a lot of people, it's the hardest thing that you've ever done in your lives. As you go through this, you bond to your classmates in a different way than you would've bonded to your classmates in, say, undergrad or in high school.

And the way you see your classmates is how you'll end up seeing your patients. And so the more diversity that there is that's visible in your class, the better it's going to be for all of the participants.

We're here at AAMC, and yesterday we heard from Professor Cornel West, who I thought was magnificent in his delivery of the messages. And one of the things that he said that'll always stick with me is he said, "I've got to learn how to love your crooked self with my crooked heart." And I think that's a beautiful quote, because what it recognizes is that in all of our difference, we have some things that make us exactly the same.

And another AAMC lesson that I've learned recently is . . . Last year they had the author of the book "The Sum of Us." That's professor McGhee. And that book talks about how anti-black racism is bad for everybody, including those of us who do not identify as black.

I read that book after she came, and I have to tell you that it struck me how they talked about some of the betrayals that have happened in places that are considered to be very religious.

And one of the things that happened many, many years ago that nobody has the blame for is that we have dismissed a biblical teaching. Now, I know this isn’t a religious space, but I want to say this because it's so important.

Lots of Christian churches were complicit in things like racism, slavery, the Holocaust, Jim Crow laws, all of these things, and the reason was because of a fundamental disconnect. And the disconnect was that they took what is a fundamental and founding principle of their religion and ignored it, and that is the image of God, that all of us as humans are in the image of God.

I think, "My goodness, that seems so religious." But what it says to me in a non-religious sense is that we are all part of the same family, and until we can figure out how to live together as a family, we're not going to get better at eliminating health disparities. We're not going to get better at making education accessible to all.

And so I think about my career and I think about what you're going to do. Why don't you share with us, Moroni, some of the things that you're planning on doing with your career?

Moroni: Yeah. So right now what I'm planning on is I want to become a family medicine doctor, and I want to work in a clinic that predominantly has a lot of underrepresented populations within it.

I grew up myself as an immigrant here in Salt Lake Valley, and my family didn't have access to health care for the longest time just because we couldn't afford it. And so I think for me to be able to turn around and provide a lot of this access to a lot of the families that are where my family was many years ago is very crucial to my personal mission and to a lot of what I stand for when I think of moving forward as a physician.

Dr. Rodriguez: That, my friend, is music to my ears. As a family physician, that makes me so happy. And that is actually one of the things that I've found most fulfilling in my job, is that I still can see patients at Redwood Health Center where I'm an Associate Medical Director, but I also work with a lot of new American populations.

So, as you can imagine, the largest population that I see is the Latino population, and I don't really have to speak English ever at work because my MAs, my front desk, the other providers I work with are all bilingual in Spanish. So it creates community, and it creates a space where our patients feel welcome. And I think we need to figure out how we can get you to be at Redwood for your longitudinal integrated curriculum.

Moroni: That's the key.

Mitch: Well, I had a question, I guess. When I hear you two talking about this idea of community, of seeing one another as human beings, etc., how does representation play into that? Why is it so important that we have those different types of ideas when it comes to providing better care, when it comes to providing better education? How does representation get involved into the community of medicine as a larger goal?

Moroni: For me, I think bringing it back to this conference, our leadership speaker for today, he was talking to us about you can only be what you can see. And for me, that's been playing very true.

I don't know where I got the idea . . . well, I do . . . of becoming a doctor because nobody in my family is a physician. But I knew that I wanted to serve my community and I wanted to really do things that would change the future of my community. And I was very passionate about health care and I couldn't see Latino physicians in my community, right?

And I think to that point of the representation, I remember when I got accepted to the University of Utah, seeing Dr. Rodriguez for the first time on a Zoom call, because it was COVID still. I saw Rodriguez and I thought, "There is a Latino physician in my health system? This is amazing." And I've been trying to catch up with him ever since because I now see what I can be.

And I'm not saying he's the one that's telling me to become a family medicine physician, but it definitely helps to see someone who's taken those exact steps, who understands a lot of my background because he's been where I've been, but also he can show me how I can be a really good version of what I want to be.

Dr. Rodriguez: Well, thank you, Moroni. That's a nice thing to say.

I will tell you that you're absolutely right about you have to see it to be it. My parents are both Puerto Rican. They emigrated from the island just a few months, really, before I was born, and we went to this place in Upstate New York. But my mother and my father were adamant about making sure that we saw Latino physicians. So we didn't see one in our community. We had to drive a half an hour, 45 minutes to the only Cuban doctor around. So it was never a question of if I could do it because my providers were Latino.

And this is an important point because I think that's why even in administrative work and even in academic medicine, those of us who identify as underrepresented or as historically excluded, we feel obligated to be in the community, to be those beacons so that people can come. So thank you for sharing that.

The other reason why diversity matters is when I think about what skill set you need to graduate from medicine in, you need to have the skill set to be able to see lots and lots of different patients.

Mitch: Oh, sure. Yeah.

Dr. Rodriguez: And I have to tell you that we understood that the population was changing before Moroni was born. All right? We knew this.

Moroni: You anticipated me.

Mitch: Yeah, you're quite young.

Dr. Rodriguez: For a long, long time. And the way we were going to do it is we were just going to teach the existing physicians to be culturally competent. But unfortunately, cultural competence has made us nicer doctors, but it has not done anything to address deficiencies, disparities, and inequities in health care.

But what does work and what there's evidence for is racial concordance, guys. When your physician, your provider looks like you, you are more likely to do what the provider says and to get the preventative services that you need. And that's huge, right?

So this is about making things fair. And so, as we move on, we're going to see lots of changes in the Supreme Court decisions. We're going to see lots of decisions on race and ethnicity and including it in admissions. The bottom line is that the value of having a diverse class doesn't change because of a Supreme Court decision, and we have an obligation as physicians and as leaders to work towards the elimination of inequities.

Moroni: Yeah. I think one more point, and it goes back to the Redwood Clinic, right? The physician is the leader of this health team, but when you have every single member of that health team also being able to identify and to connect with all your patients, you can actually streamline a lot of that as well, right? Because it's not the physician that's working with that patient 100% of the time. You're dealing with the entire health team.

And I think for me, it's . . . I mean, also seeing my mother who at 50 years old went back, got her nursing degree, and now she's working in that setting, right? In all of the layers of that health team, to be able to know that there are bilingual and multicultural people, and diverse thoughts within an entire health team helps both provide that security, I think, for the patients, for those families, and it provides that extra foresight sometimes as to how to really help and work with a patient that might be culturally different from what we're used to, from what we're taught maybe in the books of medicine, and things like that.

Dr. Rodriguez: I couldn't agree with you more. I'm very much excited about what the future can bring for us. Utah is changing and it's changing quickly, and the University of Utah has seen it and we're changing as well. And I think what we'll see in the future is we'll see more diversity of our physician providers, but we will also see it in other specialties.

As you know, in our School of Medicine, we have the number two public program for physician assistants in the country. What you might not know is that it is by far the most diverse class of physician assistants outside of a historically black school.

Mitch: Oh, wow.

Dr. Rodriguez: And so you've got to think about that out loud. We're in Utah, we're not known for our diversity, yet this is what's happening. And at a time when physician assistant education is becoming actually less diverse as far as students, our program is changing, and that's in the School of Medicine. And because they work so closely with our MD program, that's changing as well. So it's an exciting time to be here. And being here with students like Moroni makes me happy.

Mitch: I couldn't agree more, having had these amazing conversations with the people who've come.

Moroni, I'm so excited to hear the kinds of things that you're saying and to hear how . . . I'm looking forward to seeing how you can help change medicine.

Moroni, Dr. Rodriguez, thank you so much for joining us here.

Again, this is The Scope at the AAMC 2022 Learn Serve Lead conference, and we are having discussions about how to improve medicine from the ground up. If you would like to hear more of our conversations, you can visit the website, uofuhealth.org/aamc22, or visit thescoperadio.com. Thank you guys.

Dr. Rodriguez: Thank you.

Moroni: Thank you.

Dr. Chan: How do you strategize to apply and get into medical school? What activities help prepare you for medical school? How should you consider the financial implications when applying to medical school and residency programs? And why are couples slow to announce that they're dating while in medical school? Today on "Talking Admissions and Med Student Life," I interview a couple, Nisha and Milo, both former fourth-year medical students who recently graduated from the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah, School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Okay. Well, welcome to another edition of "Talking Admissions and Med Student Life." I got two great guests on today, Milo and Nisha. How are you guys doing?

Milo: Doing well.

Nisha: Yeah. Doing well.

Dr. Chan: Fourth-year students about to graduate in a few days, I think, right?

Milo: Yeah, Wednesday.

Dr. Chan: Wednesday . . .

Milo: Friday. Friday.

Nisha: Friday.

Dr. Chan: Friday. Friday, but it feels like tomorrow. Yes.

Milo: Yes, yes.

Dr. Chan: All right.

Milo: Yeah. There was the quarantine.

Nisha: Yeah.

Dr. Chan: Yeah. Yeah. And we'll talk about that. Yeah. So I want to start . . . I love the story. I love hearing people's stories. So let's go back to the beginning, and Nisha, let's start with you. So when did you first want to go to med school? When did that enter your consciousness, and was it like one moment that stood out, or is it a series of moments that led you to become a doctor? Curious to hear when that started for you.

Nisha: You know, when I was very young, I wanted to be a doctor, but that changed as I got older until I went to college and I realized, you know, I really loved biology, especially human biology and at the same time, I was also an English major and I did a lot of work in research with human rights types of issues. And I realized that medicine was a really good combination of the two where, you know, there's a lot of science and stuff like that, but you also can make a really big impact on people's lives and the health of communities. And so that was when I realized that that's what I wanted to do for sure.

Dr. Chan: And then Milo, how about you? When did you come to the decision?

Milo: Yeah. I've always had an interest and aptitude for science. Initially, I thought I was going to get into research. Cancer has kind of run in my family, and growing up, I would always tell people, "Hey, I'm going to go cure cancer." And I didn't really realize how difficult that would be and what would actually be involved even in cancer research until I got into college and started doing some research and realized that full-time research was probably not for me, although I did enjoy the research. I still had a love for science and got introduced into medicine with the research I did but really wanted to work more hands-on with people and have research be part of what I did, but not entirely what I did. So I was talking to my uncle who was actually in maternal and fetal medicine and he said, "Well, come shadow me. It sounds like what you're looking for may actually be a career in medicine." I went and shadowed him, and he was right. I think it just combined the problem solving, the science, working with people. It just combined everything into a package that fit really well for me.

Dr. Chan: And where did both of you grow up? And, like, where did you end up going to undergrad?

Nisha: So I grew up in Emmett, Idaho, which is a pretty little rural town close to Boise. And I did my undergrad at the College of Idaho, which is in Caldwell, about 45 minutes from Emmett where I grew up. And I double majored in English and biology there.

Milo: I grew up all over the West. I was born in Phoenix, Arizona, and then for my dad's work in construction, we moved really pretty much every year or two. We bounced between Utah, Idaho, and Arizona mostly, ended up back in Arizona when I finished high school, and went to University of Arizona for the in-state tuition.

Dr. Chan: Finances do come into play with these things. So I totally get it. I totally get it. And then while you were in undergrad, for both of you, like, what kind of activities did you do that prepared you for med school? What kind of groups or organizations were you part of?

Nisha: I worked at the women's and men's center at the College of Idaho, where we worked with students that had experienced relationship violence in particular, but were also struggling with other mental health issues. And that, you know, had a big impact or prepared me to, you know, talk to people about issues that were difficult and find ways to help them and connect them with resources. And then I also did some shadowing and with the Idaho program involved in shadowing, and then I did research with the Idaho INBRE Program, which is for undergraduate researchers and we did a biochemical and microbiology research, which also really helped prepare me for medical school and helped prepare me for the kind of critical thinking in particular that you need in medicine.

Milo: And I did quite a bit of volunteering in hospice through a hospice facility in Tucson. I founded a chapter of the Medical Reserve Corps at University of Arizona, which focused on getting communities involved in emergency preparedness and how to respond as a community member if they were to be the first person on the scene of an emergency. And then I got involved in research in speech and language and ended up long-term with an MRI lab looking at language learning and language pathology.

Dr. Chan: And what were . . . how did you, like, what was your process like when you started looking at medical schools? I mean, did both of you look at, like, spreadsheets, or did you go by word of mouth? Like, how did you start coming up with a strategy when you looked at medical schools to apply to?

Nisha: So there's a lot of, you know, pieces that you need to apply to medical school. And I actually found that the University of Utah's website and their requirements were pretty in depth and in detail. So those were the guidelines that I used to make sure I had all the boxes checked off for medical school. And then for me, what was important or one of the things that was important was finances. So, you know, I looked into the schools that had, you know, either scholarship opportunities or that would allow me to have in-state tuition, and Idaho works with the University of Washington and the University of Utah. So that had a, you know, pretty big influence on my decision about, you know, where to apply and for medical school.

Milo: For me, I mostly wanted to stay West. It was where I was familiar with, and my family was planning on staying in either Arizona or Utah. So I applied mostly to Western medical schools, which narrowed the list down pretty significantly. And then finances were also something I had to consider. So I picked public universities that typically had better tuition.

Dr. Chan: And then I don't know if we're going to talk about it, but did both of you get in the first time, or what was that process like or, like, talk about that. Like, if there's any bumps in the journey, like, how did that go?

Nisha: So I applied technically twice. The first time I applied, I had some family issues. Right before the secondary applications were due, my grandfather got diagnosed with cancer and ended up dying pretty shortly afterwards. And so I decided that I wasn't ready to start medical school at that time. And so I didn't finish completing the application cycle. I did apply the following year, and that year, I got in off of the waitlist for the University of Utah.

Dr. Chan: And Nisha, was it like an immediate yes in your mind, or were you kind of fielding other offers? I mean, like help me understand what you're going through right then.

Nisha: When I got accepted to the University of Utah?

Dr. Chan: Yeah.

Nisha: So I had actually taken what, you know, probably a pretty big risk, but I had only applied to the University of Utah and the University of Washington that year. And I really loved the University of Utah on my interview day. And when I got accepted off of the waitlist, it was an immediate yes and that's where I wanted to be.

Dr. Chan: I find, I mean, that's great, Nisha. I love that. And it's interesting, because like I've worked in Idaho for many years and I feel that, like, University of Washington, they definitely have like a bigger brand name in Idaho and I just see purple everywhere that I go. And so, yeah, I'm just curious, like with you being in right, I would argue kind of right in the middle of Idaho, kind of in between Utah and Washington. Yeah. Like, yeah. So I'm happy that it sounds like our website and our interview day really helped sell you on the program.

Nisha: Yeah. You know, I really, you know, I liked the people that I met, and I liked the idea of being in one place for all four years of medical school. And, you know, I really liked the campus, and it seemed like, you know, the opportunity to work out in multiple different hospitals in the area was also really appealing to me.

Dr. Chan: How about you, Milo? How was your journey?

Milo: It was on the longer side. It took me three application cycles to get in.

Dr. Chan: So you hated me, but then liked me at the end, right?

Milo: Well, I didn't apply. So the first application cycle, I put in primaries, but I was actually doing some shadowing with the neurosurgeons at U of A, at that point. And there were some things that came up in the shadowing that made me kind of pump the brakes on going all in on medical school right away. I knew that with the debt you accrue in medical school, once I got in, I was kind of locked in. You really want to come out the other side a doctor, or you get into some financial issues. So, you know, I saw some issues with the insurance companies and just some of the policy that I saw in shadowing. There were neurosurgeons there who were working, kind of fibbing their hours so they could work over the 80-hour limit. And they spent a lot of time just arguing with insurance companies over what they thought was necessary and what would get paid for. And I really had to think if that was worth, you know, because if it was just patient care, I knew that that's what I wanted to do, but there were just some things that I thought detracted from that and I had to consider if that was worth it. So I actually didn't finish the secondaries the first year I applied.

And the second year, I think I applied to I think 8 or 10 schools. I got an interview only with University of Arizona and got waitlisted and didn't end up making it in that year. Then actually, I moved out to Utah because my family was out there and wanted to establish residency in case I got into medical school there. I got a job at a lab that I really loved doing neuroimaging and only applied to Utah that third year because I was with my family doing some research that I really loved. And I figured if I get into Utah, that's really where I'm targeting and that would be great, and if not, then I'm in a good situation anyway, but I did get in that year.

Dr. Chan: So both of you, I mean, this kind of flies in conventional advice I give to people, but both of you essentially kind of suicided applied to like one, maybe two programs. Usually, I tell people like, "Oh, 10 to 15," but it sounds like you both felt fairly confident in what you were doing. Is that accurate, would you say?

Nisha: Yeah. And, you know, I think for me, just looking at the numbers as someone from Idaho, I think statistically I was most likely to get into the two schools that I applied for. It was also cheaper for me to just apply to two schools, and the in-state tuition was also very appealing. So those were kind of what led my decision to just apply to those two schools. My plan was that if it didn't work that year and I hadn't got in, then I would extend my application further and, you know, improve my application as necessary, but I was, you know, willing to apply to more programs the following year if I didn't get in.

Milo: Yeah. You said I had a lot of confidence and I don't know if I had a lot of confidence, but I was in a situation that I was happy with, and if I didn't get in that year, I figured I'd get there eventually. And I was enjoying what I was doing at the time. So it wouldn't have been a disaster if I didn't get in that year.

Dr. Chan: And I can tell you from my end, now I can say that since we're having this conversation four years later, I remember talking to you Milo on the phone and you were so excited. I remember like I thought, "Oh, you're definitely coming." And then Nisha, when I talked to you, you were pretty cool, and I think you're holding your cards close to your chest. I don't know. Maybe you were stunned, but I came away from that phone conversation with you going, "I don't know if she'll come here," because you were pretty cool on the phone. So I don't know if you remember that phone call that many years ago, but that's kind of how I remember it.

Nisha: Yeah. I think I was pretty stunned actually. Because I had been waitlisted, I didn't have a lot of hope of getting into the University of Utah. And so I had really mentally prepared myself to do another application cycle. And so, when I got the call, I think I was pretty shocked at first, but also, you know, so that was kind of my initial reaction. But, you know, obviously, I did decide to go here, and I have loved all of it.

Dr. Chan: Do you remember being excited, Milo?

Milo: Yeah. Yeah. I actually woke up to your phone call, and it was earlier than I expected to hear back. But when I saw the number, like it kind of clicked and I picked up the phone kind of thinking that I was going to be on the phone with you. And I was super excited. Like I said, I only applied to Utah because I figured, you know, that's really where I wanted to be and just getting to stay here, stay with my family, go to a really great school, it checked all the boxes for me. So I was very excited.

Dr. Chan: Great. And then I want to jump . . . okay. I love asking this question, especially couples. So what is your first memory of each other? Was it during second look day? Was it during orientation week? Was it . . . were you anatomy lab partners? Like, how did you guys meet initially?

Nisha: So we met and we were in the same clinical skills group actually, which was the first time that I remember meeting Milo. And then we did a lot of studying together that first year. Me and Milo and another one of our friends were kind of in a study group, and we spent, you know, lots and lots of time going through all of the material and writing stuff on the whiteboards. So that's kind of some of my first memories.

Milo: Yeah. Definitely, where we met was the learning communities, like within the first week of medical school. And then I think walking back from classes to our cars, I ran into Nisha and we had like this really nice, in-depth discussion about, like, the world and politics. And it was just such a change from all of the preliminary conversations you have with everyone else kind of like, "Hey, where are you from? Do you know what specialty do you want to do?" Just really kind of superficial small talk and I'm really bad at that. And it was just such a striking change that that really stuck out in my head.

Dr. Chan: Nisha, do you remember this or do you not remember this?

Nisha: Yeah, I definitely remember that and for the same reason because it had been, you know, a lot of just the small talk conversations, which, you know, are obviously important, but were pretty tiring for me. So it was nice to have a conversation about things that I was, you know, that I was interested in and passionate about, and it was just really nice to connect with someone that wasn't the small talk superficial level.

Dr. Chan: And who is your . . . what was the name of your CMC group, and who was your instructor?

Milo: We were Powder Mountain. We started out with Dr. Barrett, who was fantastic, but he had a great job opportunity that he left for. And then we got hooked up with Dr. Glasgow and Dr. English.

Dr. Chan: Okay. I love it. And so it sounds like CMC really brought you together. And then, you know, again, like I've done other podcasts with other couples who ended up doing the couples match. Were you . . . how do you feel about becoming a couple? I mean, I know there's some, sort of . . . sometimes I talk to the med students and there's like this weird code, where they're like, "Okay, we're not going to date each other, but maybe we will." You know, and then, so I've noticed couples are very slow to kind of like announce that they're a couple. I mean, did you guys grapple with that at all, or were you pretty much like, you know, once you guys were together, you're together and you didn't care about like any sort of silly codes like that? Do you understand what I'm saying?

Milo: Yeah. I think it took us a while to get to the point where we were together because yeah, there's complications with dating a classmate who you're going to be in a program with for four years. But I think once we got to that point, I wouldn't say we overtly announced it, but we probably didn't try to hide it either.

Nisha: Yeah. We were really good friends for about two years before we started dating. So it was right before we went into the third year that we were really officially dating. And so we also didn't see a lot of our classmates around that time, which I think kind of made it a little bit easier, at least from the kind of announcing standpoint. And because we had been good friends for so long, at least for me, that made me a less worried about moving forward and becoming a couple and, you know, also with the knowledge that the match was going to come up in two years and so if we were going to stay together, that would probably mean doing couples match together. And so I think, yeah, just . . .

Dr. Chan: I love it. It sounds like it came together quite nicely on a kind of good schedule.

Nisha: Yeah.

Milo: Yeah, it definitely did.

Dr. Chan: And speaking of the first two years, how was that jump from undergrad to med school? Was it relatively easy? Was it kind of like the fire hose analogy? Did you have to redo your entire study kind of skills? Like, how was that jump from undergrad to med school for you?

Milo: Yeah. So I actually took five years between undergrad and med school. So I actually think it was . . . I felt recharged and like ready to go back into the classroom. It was kind of like a fire hose. I forget who told it to me, but when I was a first-year medical student, someone told me the first two years of medical school, like going from undergrad to first year is like going from zero miles per hour to 40 miles per hour. And you just have a lot of adaptation that you need to do. It feels like it's moving really fast, even though the material isn't quite as hard. And it just feels like a really big jump.

And I think I agree with that. I definitely. Maybe it was relearning study strategies after having been out of it for five years, but I felt like it was a pretty big jump and took a lot of adaptation. And then from first to second year is like going from 40 miles per hour to 60 miles per hour where it, you know, it's harder stuff, but you've got a lot of your habits formed at that point, and you just kind of have to lean on them a little bit harder and work a little bit harder for the material.

Nisha: Yeah. I agree with that. I think I had to learn how to process material in a different way. When I was in my undergrad, I took extensive handwritten notes on everything, which was really one of the ways that I learned well, and that was not really possible in medical school or it was at least quite a bit more difficult. So I had to, you know, learn some other strategies besides that. And I had also never really done any group study in undergrad, but I found that in medical school, group study was actually one of the things that worked best for me.

One of the other challenges that I had was going into medical school, I knew that taking multiple-choice tests was not my forte and it was something, you know, that I had not done as well with. In the undergrad, I did not do very many of them. So one of the things I really had to focus on was how to take multiple-choice tests, how to think about those types of questions. And I was actually really lucky because Milo is very good at them, and he was willing to spend a lot of time talking through strategies with me and helping me, you know, focus on the material, learning the material in a way that would kind of let me showcase that knowledge in a different way.

Dr. Chan: Great. It sounds like you guys were like, to you use a business term, a lot of synergy, you know, coming together. It sounds like you were able to kind of really develop some great skills, study skills, academic skills that really paid off.

Milo: Yes, absolutely.

Dr. Chan: And Milo, you alluded to it like a little bit. So if I had a time machine and I went back four years ago and I asked you what specialty you would go into, what would have you said, and then, how did third year either help or not help that decision? So I'm just curious. Yeah. I mean like, what would you have gone into, and then how did third-year kind of play into it?

Milo: Yeah. Mine's pretty easy. I thought I was going to do neurology, and I'm doing neurology. So, yeah. A lot of that was that's the research that really ended up pulling me in towards the end of college, and the five years I took between undergrad and medical school were a lot of neurology research. So I came in with a strong basis in it, knew that I really enjoyed it. Tried to keep an open mind through the first three years of medical school. I gave pathology a good look actually and internal medicine a pretty good look as well. And in the end, it actually came down to internal medicine and neurology, and they're really similar. I think people go into them for a lot of the same reasons, but I've always really liked learning about the brain and the nerves and, you know, they both had similar aspects and I picked the organ system that I liked the most, and that was neurology.

Nisha: For me, I went into medical school thinking I was going to do surgery, either general surgery or urology. And part of that was because I had shadowed a urologist and I got to watch some surgery and I just thought it was like the coolest thing ever. So, you know, I thought that that was going to end up being what I wanted to do. And in third year, my very first rotation was internal medicine, and I really enjoyed it. I think it was, you know, some of the longest hours in third year, but I was always excited to be there the next day and checking on my patients.

And after that rotation, which I enjoyed so much, the rest of the rotations were not as enjoyable as that was for me. Although, for some reason, I was so convinced that I was going to be a surgeon and I was kind of still thinking in my mind that that was the direction I was going to go. And it was Milo who actually said to me, he was like, "It's your life and you can do whatever you want, but you've been kind of miserable since your internal medicine rotation. So I don't really know why you're still going the surgical route." And that made me stop and think and realize, you know, what I really realized that that was what I had enjoyed doing the most. And when I made that decision, it was something that I was really happy with and really excited to do.

Dr. Chan: So a lot of people have told me like it was like finding your people. And it sounds like neurology, internal medicine, you found your people. Would you agree with that?

Milo: Yeah, absolutely. One word that got thrown around about neurologists on the interview trail at least was quirky. And definitely, I'm a little bit quirky. And I just felt like I fit in really well with the neurology crowd.

Nisha: Yeah. You know, I really like, you know, puzzles and problem solving, and that's a lot of what internal medicine is, is you get, you know, someone that comes in with non-specific symptoms and you have to figure out what's going on. And that's something that I really enjoy. And it also made sense because before medical school, I did quite a bit of research in a lab. And one of the things I loved about that was, you know, experiment didn't go the quite the way that we were expecting is, you know, a lot of troubleshooting and trying to figure out what was going on. And, you know, that was an aspect that really carries over into internal medicine, which I enjoy. It's a lot of kind of sitting and thinking. And, you know, one of the things I really love about hospital medicine, in particular, is that you get the answers, you know, you can see improvements and you get, you know, order labs and you can get them back pretty quickly. So there's kind of this real-time feedback on what's going on, which I also really enjoyed.

Dr. Chan: And then going into fourth year, did you, like so, when did, like, the discussion start kind of coalescing around the couples match, and when . . . like, because I know sometimes, students do away rotations. Like how did that kind of factor into, like, as you transitioned to fourth-years?

Milo: Yeah. Neither of us did an away rotation, but I think we had been together and felt like we fit together for a good year and a half previously. And so we just kind of . . . I don't know. We didn't have too big a discussion about it. It was just kind of, "Hey, you want to do this?" "Yeah." "Okay." And we did.

Nisha: Yeah. I agree with that. And neither of us did an away rotation, and for a large part, at least for me, that was just due to some of the advice that I got, which was in internal medicine, it wasn't really necessary unless there was somewhere in particular that you really, really wanted to go. And we didn't feel that strongly about any particular place.

Dr. Chan: So, yeah, I guess that segues to my next question, Nisha and Milo, like, what was your strategy for the couples match? Like, how many programs did you apply to? Did you try to identify like a certain geographical area of the country? Or did you just check all the boxes and just took the money and threw it through the window? Like what did you do? What was your strategy?

Milo: Well, at risk of sounding a little bit snooty, I guess, we just took the NIH, like, top 100, I guess top 50, like, funded schools and just went through those, cut a few of them and applied to most of the top 50. Well, no, about half of the top 50. I think most of the top 30. We ended up applying to like 20 . . .

Nisha: Twenty-two programs I think.

Milo: Twenty-two. And that was kind of our initial cut was the NIH list.

Nisha: Yeah. And I think we were really lucky too that our scores throughout medical school were very, very similar, and neurology and internal medicine are pretty comparable in terms of, you know, a program that was good at neurology was also usually pretty good at internal medicine and vice versa. And, you know, and we were very similar in competitiveness, both in terms of the specialties and in numbers, as I said before. So I think that made it a lot easier for us. I think it would have been more challenging if one of us was going into, you know, a very, very competitive specialty, and we might have had to make more sacrifices if that had been the case. But I think that was something that made it quite a bit easier to couples match, and, you know, we got interviews to pretty much all of the same places, and, you know, they were pretty close together in time as well. So that was nice.

Dr. Chan: I love it. I'd never heard of this NIH method. Are both of you thinking of, like, doing research during your residency careers, or what was kind of the logic behind using the NIH?

Nisha: So I actually had met with one of the internal medicine advisors, Dr. Lappe. And I was trying to sort out, you know, because you're supposed to apply to, like, some reach schools and some safety schools and then, you know, kind of schools that are in your range. And I was trying to figure out like, how do I know the competitiveness of schools? And she just, like, Googled the NIH internal medicine funding list, and that's what came up. And she looked at the list and she was like, "This is . . . the order that these are in is pretty consistent with the competitiveness of the schools." And so, you know, and she said like, "These are the schools that I think are, you know, within your grasp. These are the ones that I think are reach programs." And so that was why we used that list.

Milo: Yeah. I think moral of the story is have a good mentor and speak with them regularly, because Dr. Lappe was just invaluable, honestly, to both of us. And she spoke mostly to Nisha, but she gave advice to both of us and we both told her like, "These are our scores, these are our thoughts." And she was fantastic.

Dr. Chan: And I think, so it sounded like 22. So you each applied to approximately 20 some odd programs?

Nisha: Yeah.

Milo: Mm-hmm.

Dr. Chan: And then the interview offers sounded like coming in. Did you have to make hard decisions about turning down some interview offers, or did you just go out and do them all? Like, how did you approach that?

Milo: Yeah. We had to cut some of them. I think we got the majority of the ones we applied to, and we cut down to, I think, 12 or 13.

Nisha: Yeah.

Milo: So we ended up cutting about 10 each. And again, having a good mentor for that Dr. Lappe and on the neurology side, Dr. Wold and Dr. de Havenon spent a lot of time talking with us about which to keep and which could probably go.

Nisha: Yeah. And, you know, at that point, we started looking a little bit more into, you know, how much does it cost to live in that area, you know, some of, like, the benefits offered by the different schools and kind of some of the lifestyle around the schools, which we had looked into initially, but not quite as hard as when we actually got the interview offers and realized we needed to cut down to fewer programs than we had interviews for. So we used that to make some of our decisions as well.

Dr. Chan: And did you, I mean, like, and again, kind of like back to when you were applying to med school, would you, like, call each other or text each other at night and kind of give like each other's opinions, or was there some sort of Google master document spreadsheet where you would kind of, you know, pros and cons? Like, how did you kind of synthesize all this information you were getting as you both hit the interview trail?

Nisha: So we called each other usually after the resident dinner, the night before the interview, and then usually, like, on the way to the airport or at the airport the day after the interview was over and just kind of talked over our initial thoughts. And, you know, we typed some of the stuff that we really liked or, you know, or were more concerned about in a Google Doc. But in the end, it kind of came down to, I think, the feeling that we got at the different interviews and the places that we just enjoyed being the most or felt like we fit in the best.

Milo: Yeah. While I was at the airport, I would write down like in-depth the handwritten notes in a notebook about each program. And actually, when it came time to make the decision, I don't think I even went and looked at those outside of the top maybe two or three programs that we were thinking of. In the end, I agree it just came down to feel, how well you thought the program would take care of you and how well you thought you would meld into the program.

Dr. Chan: And did you send, like, you know, because like in the world of medical education, we call them love letters, like when you start corresponding with these different programs or love emails as it were, did you feel you had to do that, and what was your, like, who would do the writing? Or was there a place that like interviewed one of you and the other place was like not as quickly sending out interview offers, and did you have to kind of use some love letter-ish maneuvers with them? Like, how did you do that? Nisha: So, in terms of the actual interviews, there was one place where he got an interview that I was waitlisted. And then after his interview, I got an interview there. And then there was a couple of interviews that I went on, but they made sure to ask me if my partner had gotten an interview yet and said that they would, you know, press the other program. But for the most part, we got interviews to the same places. And then at the very end, we sent a love letter to our number one program, individually to our respective programs and said, you know, both that this is our number one program and our partner is also going to be ranking this program number one. But, you know, even in terms of that letter, we weren't really sure as to whether or not we needed to send it or not, but decided that it probably wouldn't hurt us to do that, especially because we said very specifically this is our number one program, and we only sent it to one place.

Milo: Yeah. I think on my end, I thought it was important to send that kind of final you're my top school love letter. Towards the beginning of the interview trail, I did send schools kind of thank you letters detailing some of the things that stuck out to me about their school and some of the things that I liked about their program. That kind of fell off around the middle of the interview trail. And actually, a number of schools just outright said like, "Don't do it. It fills our inboxes. We probably won't read them. Save everyone some time."

Dr. Chan: Unless you have a really catchy header line, we're not going to open this.

Milo: Yeah. That said, there were some that . . . I think there was one that actually it sounded like they really wanted us to send a thank you letter on the neurology side. So I definitely sent emails for those.

Nisha: Yeah. And I think almost all of the internal medicine programs on the day said, "You don't need to send thank you cards to your interviews or to the main program. We're happy that you're here. We know that you're happy that you're here. Please don't send us anything," which I think is different as compared to some other specialties. So that was probably pretty specialty-specific.

Dr. Chan: And when you started looking at your list and you started finalizing it's, like, was the number one choice for both of you pretty crystal clear, or is there some horse-trading negotiation? How did you work that out as a couple, because, like, I get the sense from both of you, your applications were very similar and very competitive, but again, my experience with couples match, you know, it's like all things as you navigate in life, there's trade-offs and there's accommodations and there's and yeah. So a lot of people kind of try to figure out . . . like compromise. The word I'm trying to use is compromise. So, yeah, how did you guys do that? Or was that even an issue for both of you?

Milo: It was an issue. There were some trade-offs for sure. So, actually, I had wanted to just stay at Utah. My family is actually right in Holladay. And I really hadn't seen them. They moved after I graduated from high school, and I hadn't really had a chance outside of med school to, like, be near them and close to them. And so I figured like Utah's a great school, I know the neurology faculty, and I love working with them and my family's here. So I had actually wanted to just stay in Utah. And Nisha said, you know, like, "Let's be a little adventurous. This is our one chance to, like, go out, gain other skills and then maybe come back here after that." And so our compromise ended up being we would each choose our top non-Utah school, put those at one and two, and then put Utah third. And that's what we ended up doing. There was a little bit . . . and then we both got kind of our choice in the top three.

Nisha: Yeah. And I was, you know, really appreciative of Milo's willingness to compromise on this one. And, you know, I think we were also lucky though that our top programs, the ones that we had liked the most were similar. So, but I will say even within that, I mean, there were several programs that we both really, really liked, and there wasn't like a clear number one for us. And I think when we were getting ready for interview season, a lot of people made it sound like, oh, they went to this one program, and they just loved it and they knew it was the program for them and it stood out above all the rest. And we had a lot of programs that we really liked. And so we also did do some, a lot of talking and kind of compromising on how we were going to order those as well. And geography did play some of a role in that, but then so did cost of living and other things that were kind of our future goals.

Milo: Yeah. I think Nisha brought up a really good point. Other students, I heard say like, "I went to this place and it was the one for me." And actually, at the resident dinners, that was an answer a lot of the residents gave us too when you ask them like, "Hey, what made you choose here?" They said like, "I just knew it was the one." And I don't think either of us had that feeling about any one school.

Nisha: Yeah. There's a lot of good programs.

Dr. Chan: There's a lot of excellent programs. And now, I'm going to kind of turn to something before you tell us where you matched because it's kind of pertinent to what's going on. Like, what rotations were you on when, like, when COVID started happening, and how was that communicated to you and kind of like the emotions of, you know, I graduate soon, match is supposed to happen. Like, what were you doing at that time and how was that?

Milo: Yeah. I had just finished my core sub-I on cardiology, and I had a planned two-week break to go be at my brother's wedding and he just snuck it in actually. We got back from the wedding, and like three days later everything shut down, and we were told the classes wouldn't happen and no more, no more clinical clerkships or anything. So I just remember . . . I actually did not think it was going to be that big of a deal to be honest. And my brother-in-law, he's a surgeon, and I saw him at the wedding and we were talking about it and we're both kind of like, "Yeah, you know, it's concerning and definitely something to keep an eye on, but in terms of, like, large-scale impact, maybe not." And then like half a week later, I talked to him again, and we were both like, "Wow, we got that wrong." And it was just weird. It's surreal. And honestly, it's still a little bit surreal. Having gone from a really busy sub-I being in the hospital to just being at home and trying to stay away from everyone and figure out what to do with my time, it's a big change. And the whole experience has just been surreal.

Nisha: Yeah. I was on radiology, and it was kind of confusing for a couple of days in terms of what was actually going to happen because we were about halfway done with the rotation. So, you know, we weren't sure if we were going to have to come into the hospital because we weren't seeing patients, or whether it was going to transition to online. But I thought the school handled it very well, and we were, you know, given updates really regularly. So, you know, that helped eliminate some of those questions.

One of the things that I think was harder was that Milo and I had both planned for our advanced internal medicine rotation to be our very last rotation, because we wanted that to help us get prepared for intern year, and that was done mostly online, which was still a good experience and we still learned a lot, but that also kind of shifted some of the plans that we had or in terms of getting ready for internship.

Dr. Chan: How did it feel, Nisha and Milo, to have, you know, the realization that Match Day because like Match Day is traditionally like, I call it the Super Bowl. Like, you've worked so hard for so long to get to this point, and it's you bring together your loved ones, your family members, and it's a huge celebration and, you know, I know the Dean's office, we mourned that we couldn't offer that to you. What was your feeling? Like, did you go through, like, the five stages of like anger, grief? Like, how did . . . when you realized that you would not have a "normal Match Day" or it was it not that big deal to you? I mean, I'm just curious.

Nisha: I wasn't that . . . I mean, I was excited for Match Day, but I had never been to a previous Match Day before. So I also think because some of my friends who had been to the previous Match Days were a lot more upset about it than I was. I was actually really, really sad about graduation. That was the thing I was looking forward to the most. And I think, in my mind, I was kind of hoping like, "Hey, if we do really good quarantine and, you know, maybe we miss Match Day, but maybe this will be over by graduation," which, obviously, was very wishful thinking on my part. But yeah, for me, Match Day was not as bad as missing graduation was.

Milo: Nisha and I were flip-flopped there. I was really looking forward to Match Day and, you know, graduation as well I think maybe to a lesser extent. I really wanted to be with friends and family and open the letter and see where I was going, and just have it be a big thing with everyone around, and I thought that would be a lot of fun. And obviously, you know, it's sad that it's not happening, but luckily, we've still been able to have contact with family, and all the Zoom meetings and virtual meetings have made it still possible to see friends and peers. And so there's alternatives even if they're not quite as good.

Nisha: And I think some of the, you know, Zoom alternatives that we've figured out how to do with family and friends has actually been a really good experience, because when we leave for our residency, we kind of already have some things in place about how to keep in touch with our family that I think had this not happened, would have been, you know, more difficult to implement.

Milo: That's definitely true.

Dr. Chan: And so how did you celebrate Match Day virtually with the med school or with your families? Or how did you do that, and where did you end up matching to?

Milo: Yeah. So Match Day, we spent with our aforementioned best friend that we studied with. We went over and had brunch with her and her partner, and we all opened our match emails together and then kind of video conferenced with our families all at the same time.

Nisha: Yeah. Our program, and I'll just say we both matched to the Yale. Our program had, I think, sent out, like, an automated email saying, you know, "Oh, this is like your new Yale email," about an hour before the official match results came out.

Dr. Chan: Uh-oh, it sounds like a violation. No, I'm kidding.

Nisha: So we knew kind of where we were going. At that point, we weren't sure if it was real or not real, or if it was like a spam or something. But yeah, that ended up being where we matched at. So that was kind of a spoiler for us, but it was also kind of fun because we asked, you know, our family where they thought that we would match on our list. So that was kind of cool.

Dr. Chan: So where did you match to?

Nisha: Yale.

Dr. Chan: Where? One more time.

Nisha: Yale.

Milo: Yale.

Dr. Chan: You got to say, you got to love it. Ivy League. Whoo. So sell me about Yale. What was great about Yale's program?

Milo: Yeah. So I really loved the people there. I met with the . . . so the program director there was just fantastic. By the time I got around to Yale, it was kind of further in the interview season, and the one-hour program director meetings at the beginning, I just felt like they never really said much, but his was fantastic. He just had such a good grasp on what was important to residents and what people had on their mind in terms of choosing where to go. And he had this really cerebral way of talking about that and then provided very concrete ways of like, "Here's what we're doing or have already done in order to address these issues." So it was very clear that he had his finger very well on the pulse of the residents there and their concerns. And he was just a very thoughtful person.

And then there was a doctor that I interviewed with who was doing almost exactly the same stuff that I foresee myself doing, a lot of medical education, ended up getting his masters after residency during his fellowship. And he kind of said, "Hey, I actually requested to interview you because it seems like we had a lot of the same interests and I would love to mentor you." And he just really pulled me in. And actually, come to find out he is the nephew of Nisha's parents' next-door neighbor and they live in, like, a small Idaho town. So just crazy coincidence.

Dr. Chan: Wow.

Milo: But both him and the program director were just so accessible and eager to jump in and help, and they had some really good medical education opportunities as well.

Nisha: Yeah. You know, I felt like the people there were, you know, very nice and very friendly and very passionate about the things that they were doing, which came out a lot in the interviews. And I, you know, really wanted to go somewhere where people were really excited about the work that they were doing and were willing to involve residents in that work. And, you know, one of the things that really stood out to me was that the program director talked to all of the applicants individually, and he, you know, he knew, like, all of our names and he knew facts about us from our applications, which for as many applicants as he sees I'm sure in a week was really, it stood out to me in terms of, like, how much they care about the people that are coming to their program and are interested in knowing them as individuals.

And, you know, they also had a lot of focus on resident wellness, which I appreciated, and their noon conference education just really kind of blew me away in terms of the way that they talked about the cases that they were looking at and, you know, how they approach testing and diagnosis and how they use the cases, like this is how we've changed our policies because of this. Then, you know, really tried to focus on how to, you know, do medicine in a more efficient, evidence-based way. And I really appreciated that as well. So it was somewhere I knew the people were awesome, and I would also get, you know, a really good education and things that were important to me.

Dr. Chan: Nisha, wow, this has been great. And I guess this last question, and it's more kind of a personal question in just what you're going through, but, you know, from our standpoint, from the Dean's office, this class is very unique for many ways because, you know, you're kind of more or less the COVID generation, and you're about to start your medical careers and to be quite honestly, in an area of the country where there's a lot of COVID cases. And I'm just curious like, how are you feeling internally, like how's Yale kind of like, you know, the onboarding? I'm sure that you've gotten a bajillion emails about this, and in the midst of this, all you're supposed to be doing all the normal residency stuff and finding a place to live and all that. Like, what does this mean to you? Like, how does it feel to just know that you're uniquely positioned to start your residency program in the Northeast, right in the middle of a COVID pandemic?

Milo: Well, there's a lot of emotions. I will say that I am actually kind of itching to get back into the hospital. I think having been taken away from it since mid-March, I'm pretty eager to go back and get back to what I signed up for and what I really want to do. But there are a lot of concerns surrounding COVID. And like you said, Yale borders New York pretty closely. It's just a few hours away. So they're kind of right in the epicenter. All of the messages we've got from them are encouraging in terms of they have protective equipment. They've been incredibly supportive and very accessible in terms of asking or answering questions we have. But yeah, there's a lot going on. It's a big transition to go across the country. It's a big transition just to start up internship in general and trying to find housing and get all the paperwork done for a new program. It's a lot going on, but I think we're trying to take, take it as it comes. And I think once I get out there, I'm excited to dig in and get started.

Nisha: Yeah. I'm also excited to get back into the hospital and back into seeing patients. And the program has been really good about, you know, keeping us aware of what's going on and what things are going to be like when we get there. And a lot of, you know, they send a lot of emails that are like have positive quotes or say, you know, like good things that are happening in the hospital. And it's clear that they're really trying to, you know, keep residents as well as possible, and, you know, focus on taking care of each other as well as taking care of patients. And I think that has alleviated some of my concerns as well about that we're going into an environment that is very, very stressful, but to a program in a place that is trying to make it, you know, as safe and as well as possible for the residents.

Dr. Chan: Well, I'm just really proud of both you, and you're just a great example and I'm excited for you and kind of anxious for you too, but I think that's normal.

Milo: Yeah.

Dr. Chan: As you kind of launch into this new part of your career and journey to becoming full-fledged attendings, you're going to be MDs very soon, which is kind of crazy when you think about, you know, you're going to have doctor, MD as the new name, but, you know, I just want to thank you for coming on the podcast and just kind of talking about what you've gone through. I think it's important to kind of explore it, and like I know there are people out there that are listening that will really benefit from it.

Milo: It was a pleasure, Dr. Chan. Thank you so much for having us.

Nisha: Yeah. Thank you. We're really excited as well.

Dr. Chan: All right. Well, you guys take care and maybe we'll catch up in a couple of years and maybe have you come back on the pod and hear how it's going out in Yale. Being a Yalie, is that the right term? Do you automatically now just hate Harvard, and, you know, you officially kind of adopted the blue, but become a bulldog as it were? I don't know. Yeah. So we'll have to have you come back on the pod in a couple of years. All right?

Milo: That sounds fantastic.

Nisha: All right. That's awesome. Thank you.

Milo: Thank you.

Dr. Chan: All right. Take care, Nisha. Take care, Milo. Bye-bye.

Nisha: And you too.

Milo: You too. Bye.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Chan: What do you do when you find yourself trying to figure out your next move in life? How does a trek through the jungle in Vietnam prompt you to pursue a career in medicine? Why is it important to have a strategy that works best for you when applying to medical school? What's it like to do a couple's match into the same residency program?

Today, on "Talking Admissions and Med Student Life," I interview a couple, Rudi and Quinn, both former fourth-year medical students who recently graduated from here, the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life," with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Rudi: All right.

Quinn: Here we go.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." I've got two great guests today, Rudi and Quinn. How are you guys doing?

Quinn: Doing well. You know, COVID life, doing what we can.

Dr. Chan: Yeah. Fourth-year med students, who recently matched, and don't say where you matched just yet. We're going to do a reveal at the end, all right? But I want to go back to the beginning, and let's start with Rudi. So, Rudi, when did you decide to become a doctor? Was it one moment, was it a string of moments, and how old were you and what did that look like?

Rudi: I am a person who has many ideas going at once. Actually, graduating high school, I was like, "Oh man, what should I do? What should I do in life?" And I was able to shadow a general surgeon during my last year of high school, and I was like, "Oh, this is really neat, but I don't know. Do I want to be a teacher? Do I want to be a lawyer? Do I want to be a chemist?" Because I really liked my chemistry classes.

So my first year of undergrad at the University of Utah, I took this careers exploration class that pretty much you could try out all these different careers from bankers, lawyers, business people. I was able to also shadow another physician in a primary care specialty. And I just noticed that every time I was in a medical setting, I was interested. There were fun stories to listen to. I really didn't know what was going on, so that was also something that was particularly interesting for me.

It spoke to me more than most of the other careers, so I was like, "I think I should embark on this mission to become a physician and go to medical school." But I also knew that I had a lot of other interests. So, in undergrad, I think I did a million different clubs, tried many different coats on, and ultimately, I just really enjoyed the medical field.

I was able to volunteer at Primary Children's, both as a music volunteer as well as interacting with children. And that reinforced that I just really enjoyed the patient contact, a bit different from bench work that was in my chemistry undergrad.

So it was pretty immediate. I had thankfully early insight into what I wanted to do. Yeah, I don't really have an interesting of "I did this and this and this," but I just tried a whole bunch of different coats on and the physician cap worked the best for me.

Dr. Chan: That's great, Rudi. How about you, Quinn? How did you come to decide to become a doctor?

Quinn: I was a career changer.

Dr. Chan: Yeah. I'm pretty sure you have a different path than Rudi. I'm nearly positive about that.

Quinn: A little bit. Yeah, where do we start? I didn't know what I wanted to do. I found out that my high school German credits were going to count for a lot of saved time and money, so why not? So I studied German.

Well, that same mentality kind of led to actually a bachelor's degree. But I found myself kind of in the same boat. I didn't know what I wanted to do. So I worked a little bit, retail and then management for . . . well, actually, I guess I should pause there. I ended up going around the world for a bit. I lived in Thailand for four years, and that led to an MBA.

Dr. Chan: What were you doing in Thailand? You just kind of brushed through that. What was it . . . four years in Thailand is a lot.

Quinn: So it was four years. I like to divide it into . . . there's a first year of just exploration and travel throughout Southeast Asia, and then the second year was an MBA because, honestly, I started to feel the pressure from family and kind of like, "All right. Great. What are you doing over there? Hey?" And obviously, I liked school a lot, so I was kind of missing that learning environment.

So I entered into a Thai MBA program, but then finished it as a Thai exchange student back here at Duke. So it was kind of fun, flying incognito. I fell in love with finance. I loved it a lot. I took every finance class my university offered and completed the MBA and then went back to Thailand for that fourth year, where a lot of my friends were getting married. There was just a lot that I had on my bucket list to do. One was Vietnam, for example, Myanmar, that kind of thing.

So that sort of ties into the aha moment because right about then, I had been sending out applications for management consulting positions, and I had a job offer out of Kuala Lumpur. And I was all set up to do it. I was pretty stoked. Wasn't really sold on it though. I guess you could say my heart wasn't into it. This was something that all my peers were doing. They're going to Microsoft, Google, like all the big names.

I solidified this position, and I was traveling in Vietnam, and I had this . . . traveling leads to some unique experiences. And I had this guide, who we're going through the jungles of Vietnam, and she basically . . . she hurt her toe essentially is what happened. We had bonded, so she knew my life story, and she knew I had all this education. And then at that point, she thought, "Well, okay, if someone can help me, it's going to be this guy who went to school for so long."

And so she came up to me and said, "Hey, Quinn, I really need your help with this. What do you think is wrong? What can I do?" And that's sort of when I had the . . . I guess you call it an aha moment. Yes, I love business. Yes, I love finance. I love numbers. I love math, but kind of the impression I wanted to leave was more of a direct personal, more of a one-on-one helping the environment, instead of a really laid back, balancing spreadsheets, and PowerPoint presentations, and things.

So that's where I kind of had the, "Oh my gosh. Wow. I don't regret anything that I did, but this is, I realize now, only a very small piece of the puzzle that I'm putting together."

Dr. Chan: Wow. So much more circuitous route through the jungles of Vietnam and Thailand. I can't get the sense . . . did you own a factory over there? I don't know how this business part . . . like, were you an entrepreneur or what did you exactly do? Quinn, were you CIA? Were you a secret government infiltration kind of thing?

Quinn: I can't really comment on that. I did make multiple trips to the U.S. Embassy. We can say that.

Dr. Chan: All right. That starts to clear it up some more.

Quinn: Right. I know it's murky. It's intentionally murky. I'm sorry. Yeah, my superiors don't allow me to elucidate that anymore.

Dr. Chan: This explains a lot, Quinn. All right. So jumping forward in time, when you both started applying to med school, what was your strategy? How many schools did you apply to? Where did you look at? What was your strategy going into the med school application process?

Rudi: For me, the med school application process is actually something that was a bit undefined and defined itself as I went. I knew you had to take the MCAT and I was like, "Oh, man, I hate taking tests." And so I got that over with. And then I actually looked at the application, and I'm like, "Oh, wow. This is a lot more than the MCAT."

So, for places to apply, I really wanted to stay close to my family. My parents are in North Ogden, Utah, so Utah was one of my first choices, but I wanted to also just apply broadly to places that I thought were within my benchmark. So I think I ended up applying to 10 to 15 schools. Not as many as most people.

And then in terms of the application, I heard just through the grapevine that you should present yourself as best you can with as diverse of experience as you could. I thankfully had a passion for doing multiple things, from volunteer work to leadership. And so I dug through my resume and was like, "Okay, these are fitting within the app."

And then for the personal statement, I actually recited it to my friend, and she wrote it down because I noticed that when I spoke, it was a lot easier for me than writing things down to get the thoughts I wanted out.

Dr. Chan: Rudi, what kinds of activities were you doing that were kind of unique and different?

Rudi: One, I was on the MUSS board leadership, which is the Mighty Utah Student Section for sports, because I loved sports.

Another thing, we have a wonderful thing at the University of Utah called the Bennion Center, and I absolutely love that center. It's involved with multiple volunteer opportunities. And one you can do is you can start up a volunteer sustainable project, and mine was with an elementary school in West Valley that was focused at maintaining childhood fitness and getting kind of the lower socioeconomic status schools involved in a sustainable way that they can stay fit and healthy in an after-school program. Because many of them there, they sit at school for like a couple hours while their parents finish up work, and I thought that was a wonderful opportunity to kind of get people involved.

Another is . . . there were just a bunch of random things. I really liked University Housing. I was involved as an RA, as a programming assistant working at alternative solutions to alcohol-related activities, more of safe activities to prevent binge drinking, and just anything on campus. I think I signed up for pretty much anything.

Dr. Chan: That's awesome, Rudi. That's awesome. Quinn, how about you? What was your strategy in the application process? What did you do?

Quinn: So it all started . . . taking it back to Vietnam, I ran into a U.S. physician there, and this was just after I'd had this aha moment. And he said, "Oh, interesting. You're thinking about it?" I said, "Yeah. What do I have to do?" He's like, "Oh, well, you have to take this test." "What's that called?" "It's called the MCAT." "Oh, is it hard?" "Oh, just study for it. It's [inaudible 00:11:57]"

Dr. Chan: "Is it hard?"

Quinn: He's like, "No. I mean, this is one you need to study for, but no. Your pre-med classes prepare you well." "Oh, okay."

So fast forward, came to Utah. I took the old MCAT actually, and then wasn't quite satisfied with my score so I wanted to retake it. But that was when we shifted to the new version of the MCAT. So I actually studied for both and took both. That was not fun. That was a really bad time.

But what I did after that, so as far as schools I applied to, for me money was a little bit of a problem. As you can imagine, life in Thailand for four years leads to . . . it doesn't build the bank account so much. So I was really balancing my own little formula, kind of similar to residency choices actually. So cost of living, first of all, of course, and then a name. Nothing ridiculous, but I wanted to be able to have options moving forward, so trying to balance name with cost of living, and then, of course, what can I do outside of med school.

And I happened to have some friends who lived here in Salt Lake, so that was a huge in as far as cost and who I could live with. I had a small friends network here already, so I actually live with three guys I already knew.

So once I sort of ran that formula, Utah came out on top really as far as all the pros. I mean, it maybe didn't knock out any one category, but when you combine them all, it was sort of the clear choice.

But then as far as activities, everything I did was guided by Mayumi in the pre-med advising office. It was fantastic. So I went into her. When I first got here, I went into her and said, "Mayumi, hi, I'm Quinn. Nice to meet you. I'm going to apply to med school in one year." And she said, "Hi, I'm Mayumi. No you're not."

Dr. Chan: That sounds like Mayumi.

Quinn: So I kind of had my eyes opened. She's like, "I'll show you why and you'll understand." And she was right. That is absolutely not what I did at all. I took the other route. I went most thorough. So I ended up doing a second bachelor's because I was really close to a B.S. in Biology by the end of it. So I just went really thorough with my pre-meds. I didn't want to get to med school and not have seen anything that wasn't specifically, like, medical curriculum. And that really helped. I mean, I had immunology. I had the upper-level genetics. I had all that stuff, so it did definitely help.

And then as far as activities go, I don't know why, I always was drawn to the ED. So I had heard, just through the grapevine at The U, the pre-med kind of culture, that the ED was a fun place to volunteer. So I decided to jump on that. Everyone loves the kids' activities. To be honest, I'm an only child. I don't have a lot of exposure there, so I knew I'd be a little more uncomfortable in that environment, and I wanted to do something I enjoyed.

So I was able to get into the ED, and yeah, I loved it. I thought it was great because you have . . . well, first of all, you can see everything that's going on. So you can see the level one traumas come in. You can see how physicians interact with patients. You can see how residents interact. You can see how physicians interact with residents.

You get the chance to actually talk to families, and it's not just talking to them. And this isn't coming up for diabetes checkup. This is the ED. So obviously, they're not happy to be here. They're really stressed out. They're really worried about it. So it was a really, really fun, high energy, in a way demanding . . . I mean, it ebbs and flows, but when it's busy, it's really busy. And I really enjoyed that environment.

So that was my primary volunteering, but then shadowing . . . I had no idea what I wanted to do, so I tried to be as [inaudible 00:16:20], but just due to some family circumstances, oncology had kind of a . . . I don't know, I would say it was close to my heart, but it's not. My mom passed from a cancer diagnosis. So I think it was familiar. I had dealt with oncologists before, and I had been the person receiving the bad news and not having an optimistic outlook, and that was actually really, in a strange way, familiar territory for me.

So I shadowed a bunch at the Huntsman Cancer Center, and that was really rewarding. I stuck with one physician, I didn't want to bounce around, and it was great.

Kind of like you learn in med school, when you work with one preceptor or one attending, it's excellent because their teaching can build on itself. They already know what they taught you. They already know where you stand. They know your history. I definitely support the diverse approach. I definitely think that's recommended. But what I really did was just kind of went wild with this one physician, put a bunch of hours in.

Dr. Chan: Quinn, that's great. Does Rudi know the Pep Boys story? Are we ready to talk about that now, Quinn, four years later?

Quinn: Yeah. We can definitely talk about that. I was so shocked. I had absolutely no idea what was going on.

Dr. Chan: Let me go first. Let me tell my perspective, all right? So people might not know this, but I actually don't live in my office. I go out in the community because I have a life. I had some issue with my car, and I remember I had to go to Pep Boys, the auto parts store. I think it was a battery issue or something.

I remember standing in line, and all these other people around, and then all I hear is like, "Dr. Chan," and I'm going, "Oh, boy." Then I see the Quinn right there, and you just start talking to me, and I was just . . . I think I remembered your name. I can't remember how it went. But I think I just mentioned Duke or something. I think it blew your brain that I remembered a detail about you.

I don't know if you had been accepted at that point. I felt it was a really strange interaction. And I just remember I walked away going, "That was like the most memorable Pep Boys visit I've ever had."

Quinn, what was your perspective? How do you remember that story? I always associate you with Pep Boys. Every time I drive by that place, I just think of you hanging out there.

Quinn: Well, actually, it's interesting because I also associate you with Pep Boys.

Dr. Chan: Oh, boy. Yeah.

Quinn: You're right. It blew my mind. I mean, you were a little humble. So I also had car issues. Like I said, saving money, so Pep Boys knew me pretty well. I happened to live not too far from there, by Nibley golf course. Yeah, I was a frequenter of Pep Boys, but I have not seen Dr. Chan there too often.

So I was doing my thing. I was in line. And you're right, I had not been accepted yet. This was kind of post-interview, that awkward time where you really don't get a lot of feedback, but you're crossing your fingers. You're not sure what's going to happen.

Then all of a sudden, I saw Dr. Chan. So like you said, "Hey, Dr. Chan. Hi." And you did not remember one detail. You remembered basically my whole file, which was wild. So you kind of said, "Oh, yeah. Quinn from Green Bay. Yeah, time in Thailand. Oh, Duke, MBA." I was like, "Oh my gosh. I don't want to read into anything."

Dr. Chan: I was your handler. I was your intelligence officer who just knew your file.

Quinn: And that's what you said later. You said, "Well, actually, in the meeting, we had just reviewed you relatively recently, which is why I knew," but of course, I had no idea that any of that was going on. I was just absolutely mind blown. All I wanted was a sign, just a small sign, like maybe someone from the admissions committee could give me a wink in the hallway or something. And then I had "the" Dr. Chan telling me the whole thing. I was like, "Oh my gosh. This is so . . ."

Dr. Chan: Quinn, are you ready to know the truth right now?

Quinn: Yeah.

Dr. Chan: Rudi was also in that store that night and watched us and that planted the seed.

Quinn: No. No way.

Dr. Chan: Yeah, I know. It's just . . .

Quinn: [inaudible 00:20:41].

Dr. Chan: I know. She was near the back, kind of . . . yeah. She was just watching this unfold.

Quinn: Oh my gosh. This is absolutely crazy.

Dr. Chan: I know. The truth comes out. So in all seriousness, I want to hear the story. How'd you guys meet? Was it orientation week? Was it anatomy lab around the table kind of thing? Let's hear it. Let's have Rudi go first. I want to hear the different perspectives because it rarely matches up. I want to hear Rudi's version.

Rudi: We actually owe it to our classmate, Scott. So I had received that wonderful phone call from you in the beginning of January of . . . oh, what year was that? 2016. Scott was also applying and he had not heard yet. So it was kind of this awkward tension. And he was like, "Oh, one of my buddies also got in. I should introduce you. Oh, actually, you'll get along really well because you both have Wisconsin background. So, yeah, I should introduce you sometime." Well, we walked out of the mutual class we had and little did I know, Quinn was outside. They had an anatomy test that day.

Quinn: There was light streaming down. Her hair was blowing in the wind. It was really nice.

Dr. Chan: Wait, so you guys met before med school? I thought I was somehow more involved in this matchmaking thing.

Rudi: I thought he was extremely stressed and not a person I would like hanging around because I think he looked at me maybe for, like, a second and then started talking to Scott about the anatomy test that was coming up. I was like, "Oh, boy, this is what my class is going to be like? What did I get myself into?" And that was the uneventful first meeting.

Quinn: [inaudible 00:22:29]?

Rudi: Well, that was second look day.

Quinn: Oh, wow. Well, Dr. Chan, we should amend your question then.

Rudi: So that was the first meeting, but I think the first conversation we had was actually at second look day.

Dr. Chan: I like this. I like this more. Keep on going.

Rudi: Yeah, so there was a group of us University of Utah students who kind of grouped together because you look for people who have commonalities. So it was Scott, the friend who introduced us, and then it was also Snehal, another one of our classmates, and we were eating our CafÈ Rio lunch in a very talkative room and it was just us four eating.

I have a Green Bay Packer phone case because I just love and bleed the Green Bay Packers. So I set it on the table and I saw Quinn laugh. I was like, "What's he laughing at my phone case?" And Scott was like, "Oh, yeah. Rudi, did you know Quinn's from Wisconsin?" I was like, "I think you had mentioned it, but not . . . oh, where are you from?" And Quinn's like, "Well, actually, I'm from Green Bay." I'm like, "Oh my gosh, do you love the Green Bay Packers?" And he's like, "They're okay." Oh, my goodness. I was like, "How are you from Green Bay and you don't love the Green Bay Packers?" So he impressed me twice on meeting.

Dr. Chan: All right. So it sounds like this doesn't have a good trajectory at the beginning. Quinn, do you want to defend yourself? Do you remember any of this?

Quinn: I'd like to start with the end and then work towards the beginning.

Dr. Chan: Sure, you can be a surgeon. Go for it.

Quinn: I think, as you know, Dr. Chan, a lot of it was tone and inflection. There can be the same words said but a very different meaning portrayed depending on how you say them.

Dr. Chan: Very poetic of you. Go on.

Quinn: I think that more along the lines of what I said about the Packers was, "Yeah, they're okay." And it was an optimistic, high inflection on the end, like, "Yeah, let's talk about this more." I mean, even my delivery right there, I think, was a little subpar. Bu I don't think it was as bad as she lets on.

So I was saying, "Yeah, yeah, yeah." The reason is because if you are from Green Bay, Wisconsin, you have the most . . . I mean, they're probably diagnosable. I don't even know. This is not my realm any longer. But wild, wild, wild fans. I mean, absolutely . . .

Dr. Chan: Yeah, cheese heads, the cheese curds, kind of some unhealthy living stuff going on there. Yeah.

Quinn: Absolutely. We're talking middle of winter and you might just have some Packers boxers on with a bunch of body paint, and this is Wisconsin winter keep in mind. So, to me, saying, "Yeah, they're okay," I guess in perspective relative here, I'm a raging fan to every other team. But for the Green Bay Packers, I'm pretty mild I think. So I just had to defend myself due to my roots.

But going back, she was absolutely right. I was in advanced anatomy. I was with Scott. Scott's the boy savant genius man, who could just look at a chart and be like, "Oh, yeah, dude, no worries. Yeah, it's totally these 10 nerves that I've never heard before, but now I can correctly identify and trace them through the human body." He's one of the most frustrating men to study with that I've ever encountered.

So I was with Scott. Scott was basically my advanced anatomy tutor throughout the course, although we were taking it together. Yeah, we did have an exam coming up and I was very stressed for exams. Unfortunately, that hasn't changed. That still happens.

Dr. Chan: It only gets better.

Quinn: Right. Exactly.

Dr. Chan: It just costs a lot more money. Yeah.

Quinn: They do. Oh my gosh, you have to pay for them. And that's when I met Rudi. So admittedly, I probably wasn't performing the best or focusing my attention where it should have been. But yeah, for the most part, given the Packers story and then . . . the first look was better. I don't think I had an exam coming up because I actually remember socializing and remember talking . . . wait.

Rudi: Second look.

Quinn: Did I say first look?

Rudi: Yeah.

Quinn: Oh, I guess that's the application process. First look would be the application process.

Dr. Chan: Very Freudian. All right. So did you to start dating before med school even started? I mean, when did you get together exactly?

Rudi: No. The summer before med school started, I actually was in Italy being a nanny and I kind of cut off contact from the U.S. So I think our relationship bloomed in the middle of Foundations.

Quinn: As I was sinking.

Rudi: So Quinn was always a class goer. I'm a class goer. So a plug out there: Go to class. You'll meet wonderful people that you might end up dating. But he became more and more stressed as the semester went on and his hair became more frazzled, and there was a day where . . . he always wears button-ups and his button-up was off by one button, so the collar was uneven and the buttons were all off. And Scott, our friend, again was like, "Rudi, you've got to help him out." I was like, "Why do I have to help him out?"

Dr. Chan: So I didn't realize Scott was such a key figure in this saga. So was Scott really trying to get you two together?

Rudi: I should ask him.

Dr. Chan: Or is he just really worried about Quinn's hygiene, or what was going on?

Rudi: He was worried about Quinn's mental status.

Quinn: Yeah, I think he was worried because he saw me in advanced anatomy and he was like, "Oh, you'll pull through this," and then he probably saw me in med school and said, "Wow, his buttons have never been off like this."

I was bad. Apparently, I was starting conversations and walking away and not completing them. This was dark times. That's when you need friends to rely on, and I think Scott wanted to make sure I was okay and thought this was a great opportunity for Rudi and I to get to know each other better.

Rudi: Yeah. So Scott and I sat next to him during one lecture. Usually, he's in the front row, and I was never a front-row sitter. So I was like, "Oh, man, this is really uncomfortable." So I looked over at Quinn, and he was scribbling every word that was on the PowerPoints. Mind you, we get the PowerPoints. You don't actually have to write them all out again. But Quinn decided he was. I was like, "Man, that looks really stressful."

And then he looked over at me and saw I was making flashcards because that is the save-all grace in medical school. And he was like, "What are you doing? How are you doing that?" I think after the lecture we started studying together, and I showed him that flashcards are a great tool and that maybe copying all the lecture slides may have worked in undergrad, but we are drinking from a fire hose.

Quinn: Yeah. We did a little show and tell basically, like, "I'll show you how I study and then you show me how you study." And unequivocally, she had the superior method of study.

Dr. Chan: That's a good cost-benefit analysis, Quinn. The MBA paid off right there in that moment.

So I know when I've talked to other students, there seems to be this weird coda or weird kind of feeling that if people date each other in the class, you kind of keep it on the down low for as long as you can. Were you pretty open, or how did that kind of . . . or because Scott was just kind of silently engineering all this, it was kind of well-known? When did you guys become public and when did your classmates know?

Rudi: So I absolutely [inaudible 00:30:46] don't let your classmates know mainly because I was like, "That would be weird if my friends all of a sudden started dating." So I don't think we ever went public. I think we just randomly started telling people. I think it was even second year. We started dating a week before our Foundations exam, which ended up being the most memorable exam of my lifetime.

Quinn: The final exam.

Rudi: We had just started dating. You're assigned seats for the final exam, and we were put right next to each other.

Quinn: Like, across the aisle. It was awful. I was totally aware of every move she was making while I'm trying not to fail out of Foundations.

Rudi: Yeah, with the nerves of the exam.

Dr. Chan: But you were worried because you weren't sure if this relationship was . . . you're kind of in that iffy stage, or why were you so concerned about sitting next to each other?

Rudi: I think I . . .

Quinn: I don't think I was concerned. I was actually probably thrilled.

Rudi: Yeah, I think we were both excited.

Quinn: It was just . . .

Dr. Chan: Oh, okay.

Quinn: . . . like a distraction I wasn't able to overcome, if you know what I mean.

Dr. Chan: Oh, okay. So you're in that exciting stage of your relationship.

Quinn: Yeah. Exactly.

Dr. Chan: You're three feet from them and you're just like staring at them and . . .

Rudi: Yeah. Exactly.

Quinn: Yeah.

Dr. Chan: Okay. All right.

Rudi: There are hearts hovering above them and . . .

Dr. Chan: I hear you. I get you. All right. I love it. So jumping forward, to kind of focus back on more med school, Rudi, what were you thinking of becoming before med school started, and then how did third-year impact your decision, and what did you end up choosing?

Rudi: Oh my god. This is like the most beautiful question ever. So I went into medical school because I wanted to be a general surgeon. I thought that was my destiny mainly because the mentor when I was a pre-med was a general surgeon. He was just one of the most wonderful individual I had met. He said, basically, if you love what you do, you shouldn't have to work a day in your life. And he gauged that on how many times you look at the clock. So he said, "If you're always looking at the clock, that's probably not what you want to go into." And whenever I would shadow him, I'm like, "I never looked at the clock, so obviously I want to be a general surgeon."

And then third year hit. Up to general surgery, I loved every rotation. I started with OB/GYN. I was like, "Man, maybe I should do OB/GYN." I did peds. I'm not a kid person, and I absolutely loved peds. And then I did some electives that I also loved. And then I hit general surgery and it was such a letdown for me, Dr. Chan. I wanted . . .

Dr. Chan: What happened?

Rudi: I noticed that I hated how the patient was under for so long. I wanted to hear their story. I was like, "Why do they have that tattoo? What is their life story? Why are they actually here? I mean, I know we're taking out a part of their colon, but what was it that led to that?" And it went extremely slow. The OR, it's a beautiful place, but I was like, "We have been preparing to cut this person for the past two hours. When does the preparing end?" So it did not fit the Rudi mold.

And another thing, they say, "Find your people," and I just . . . the friends who were going to general surgery, I absolutely love them, but I don't think these are people who I want to work beside my entire life.

So I left general surgery borderline depressed. I didn't know what I was doing. I was like, "Why am I in medical school? I was supposed to be a surgeon and now I'm not."

And then I went to the wonderful rotation of psychiatry, where you talk a lot about what your purpose is, or how you're feeling, and how the rotation is going. And I think it was a great time to have some self-reflection on "What do I actually want to do? Where are my people? What are the people I want to serve? What is the patient population that I really want to work with?"

So I made a mini career exploration for myself and would shadow different specialties. And the one that I kind of did towards the end was emergency medicine. I remember going in there. I went in to shadow a physician at 8:00 a.m., and I didn't leave I don't think until 8:00 p.m. I just loved it so much. And that was the time that the clock did not matter. I got to see patients from people who were disadvantaged in life to people who had advantages, and they were all there for acute immediate problems that they did not know how to solve.

I just loved the jellybean bag, if you will, that there were all these different flavors. And I personally loved that I could not turn anybody away. You come to emergency room, you will be seen. And that just really spoke to even what I was doing an undergrad where I just really loved working with every patient population.

So that's really where . . . third year is so wonderful because it's like, "Oh, what do I want to do?" But when you find it, it's this beautiful aha moment, and that was what the emergency room was for me.

Dr. Chan: I love it. Yeah, you didn't look at the clock. I remember . . . so I did a psychiatry residency, but as part of my psyche residency, your intern year, I did a rotation in emergency medicine. Yeah, you go in and then I just remember a few hours later, like, "Oh, yeah, I need to eat and actually use the restroom." You had to find time to just do those basic because you just . . . literally, there are 20 rooms and there are all these people, nurses trying to track you down. Time goes by very, very quickly I remember. So I like what you said. It's about not noticing that the clock is there.

Quinn, how about you? What's your path? What were you thinking about before school started, and when did you end up deciding because of third year?

Quinn: So going into it, I didn't really have an idea. By going in, I mean med school. So I wasn't really sure. I don't know. I kind of had a . . . it was like a quest to prove myself and to choose something prestigious and kind of colloquially understood as difficult. I wasn't entirely sure. I thought general surgery.

So I started med school, started studying, decided to button my shirt differently, that kind of thing. As that progressed. I thought, "You know what? This surgery thing could work." But I was cautious because I worked in the OB/GYN department for a year before med school, and one of my mentors there, my boss/mentor, she would almost yell at me if I ever tried to figure out what specialty I was. She'd be like, "No. Absolutely not. I don't want to hear you talk like that. You'll figure it out third year. This is not something for you to stress about."

And generally, I think that could work, but for me not thinking about is actually more stressful. So this is something I was just always chewing on, wasn't really sure, probably general surgery. It's what I was thinking about, but I kind of had this cognitive dissonance. It just didn't fit right. I wanted that prestige in saying, "Oh, I'm a surgeon." But I already knew that's not the lifestyle I wanted.

So, in my head, it was kind of almost like a sad road of reckoning of, "Okay. Well, I guess I'll just work 80 hours a week for the rest of my life." It wasn't really a happy thought, like, "Yes, that's what I want to be, but no, that's not at all the lifestyle I want whatsoever. But that's okay because, ultimately, this is what I want to be."

So fast-forward to third year. I started with OB/GYN and the GYN part wasn't too interesting to me, which is more OR-oriented, but OB was so fun. I absolutely loved it. It was a party. I love the experience of being there with the parents in that moment. Like I said, no siblings, so this was all new to me. I mean, OB, I looked forward to those shifts. Got destroyed on rounds, but that's fine. It was really, really a fun time, positive energy. I was considering OB for a while, but then the GYN part, the OR part.

I moved on to family med, which was great, but then I found . . . we had one urgent care day a week, and I found myself looking forward to the urgent care day more than just the regular kind of day in, day out family medicine rotation. So I kind of liked OB/GYN, I kind of liked family med, but only aspects of both of them.

And then I hit psych and, oh my goodness, that was the hard part. For months, I thought I was going to do psych. I absolutely loved it. I loved going there. I guess Rudi can tell you. She's never seen me so engaged in my patients. I'd be looking them up when I got home. Overnight, I'd be looking them up before I even went in just to see what happened. Like, "Oh my gosh, someone threw a tray at a nurse. That's not good. I'm going to have to go ask them about that tomorrow. Wow. Okay. Yeah," and, "Hey, what happened about that tray?" "Oh, yeah, you saw the note, huh?" So it was really fun. Really, really, really tough.

And then I hit general surgery. And the first day, "What are you going to be?" "I'm going to be a general surgeon." "Okay, great." And pretty much by the end of the first day, I knew that was no longer what I wanted to be.

Dr. Chan: It sounds like a Rudi experience.

Rudi: Yeah.

Quinn: Yeah. I mean, it's so hard because I'm trying to . . . I really don't mean to sound like I'm not grateful for the training because of course I am. And I'm definitely grateful for opening my eyes and pointing me to the direction I ultimately went on. But it was a cataclysmic just horrible experience everywhere. It just was not for me at all. It was a terrible fit. The learning style didn't fit.

Rudi: Pace.

Quinn: Right. The pace didn't fit. I'm in the OR, and I really quickly found out . . . for a whole procedure, I had the best experience down in St. George. It was fantastic. The two weeks were amazing. The autonomy there . . . there were no residents at the time, so it was just me basically as first assist to an attending with an incredibly capable PA, and that's it. That's your team.

And I found out, even in that best-case scenario, I really was only interested when things were going wrong. For example, all of a sudden I got splattered by blood. Like, "Wow, that's interesting. What's going on? You have my attention." But even then, as soon as that was managed, I just very quickly lost interest and it just wasn't a good fit, like I said, overall.

So, kind of like Rudi, I didn't really know what I wanted to do. Continued third year and just sort of went through the . . . I don't know. Went through the rotations and nothing was really working. There were aspects of everything.

Going into med school, because I volunteered in the ED, I had a little bit of exposure to emergency med, and I just said, "The one thing I don't want to do really here is emergency med. I don't want to have my schedule messed up. I don't want to not have a 9-to-5. I'd like some normalcy in my life." And near that end of third year, that kind of changed.

I took a little time for Step 1, which meant that I actually had to kick my peds rotation to fourth year. And then I took my typically four-year sub-i third year. So at the end of my third year, I was in my emergency med sub-i because basically I had deduced that there's nothing else.

I had exposure, my Vietnam connection, and then going forward, my volunteering. And I actually had CMC. That's our clinical skills course where we learn basically . . . I mean, initially we're pretending to be doctors, but we learn the physical exam skills. My preceptor was an emergency med physician. So looking back, I actually had quite a bit of exposure to emergency medicine, and it felt right.

The only thing that wasn't settling for me was the schedule. Everything else was great. So I decided, "Let's just do this sub-i. It is what I'm most interested in now. This is kind of where I think I'm going." And a lot of it came from my mentor, my CMC preceptor, of just seeing his lifestyle, asking him what he is. He's in academics, but he's not in the ED all of his shifts. He has multiple hats. That's definitely what I want to do, different degrees. So this was what I could see myself doing the most

Did the sub-i, and kind of the opposite of surgery. From day one, I knew I loved it. I love the high . . . I am pretty easily . . . I wouldn't say distracted, but I'm very easily bored. I lose interest in something very quickly. And EM absolutely held that interest. I mean, I don't think I've ever been bored in the ED.

I just love kind of the wild aspects I sort of hinted on with the volunteering experiences. You don't know when a level one trauma is going to be called in. You don't know what's coming through the door, and that's what was so fun.

And through volunteering, I learned that you can have an incredibly meaningful connection with a patient in a very short amount of time. So oftentimes it's said you don't get to know your patients longitudinally, and I feel that's completely false. Yeah, it's not longitudinal, sure, but you can have such a rich connection with your patients because you're seeing them in such a time of crisis. So I absolutely love that.

I love the fact that I'm not turning anyone away. I love the fact that I'm not getting flack for sending a test because I'm genuinely concerned about something. Really, I love all those components to it. And ultimately, it fit with my lifestyle. I mean, I love traveling. I want to be able to do that. I love being able to manipulate my schedule.

And then actually, to come full circle, one of my favorite things about EM now is the spontaneous aspect of the schedule. I love so much literally not knowing when I work the next time I work. It just helps me not be bored. Like, "Oh, wow. Okay, I go in at 6:00 p.m. Interesting. Well, I better prepare for that."

Dr. Chan: So both of you chose, kind of for similar reasons but different reasons too, emergency medicine.

Quinn: That's correct.

Rudi: Yes.

Dr. Chan: So I guess the last part, let's talk about the match. What was your strategy as a couple's match going into the same field? I mean, what did that look like? Was one of you in charge of the notes, the database, or was it more a gut feeling? Would you try to do combined interviews, or were you up front with people and say, "Hey, that person over there, we're together"? How did you navigate that trying to go into the same program?

Rudi: So when we first decided that we both wanted the same specialty, I was like, "Oh, I haven't heard of many people doing this."

Dr. Chan: You got it, Rudi. Correct. Honors for you. This is great. Yeah.

Rudi: What I do is when I don't know something, I am one who searches the internet in every corner to look for solutions. So I was able to find some people who did internal medicine/internal medicine, and then I was also able to find family medicine/family medicine. But I actually couldn't find any stories online about emergency medicine/emergency medicine.

So we both had the same mentor, Dr. Fix. She was extremely helpful. And she was like, "Okay, this is going a bit shooting from the hip, but we're going to have to apply broadly," meaning many programs across many states. And then in emergency medicine, you do away rotations, so she's like, "Those are going to have to be also casted broadly across the geography of United States." And so we're like, "Okay, we can do that."

So I did two away rotations, one at University of Wisconsin Madison and the other one at Maryland. And then Quinn did one at Pittsburgh. We also had to do one at Utah, so we thought that was more of the western region. And then we had the Midwest with Wisconsin, and then more of the Northeast with Pittsburgh, and then more of the East with Maryland. Neither of us really wanted the South, so we were like, "We're okay not doing a rotation there."

But we did our aways broadly. And then when we applied, we looked at the list of places to go and said, "We'd like to go here. We wouldn't like to go here." And we did that based off some reputation, some off of where family is. We're very familiar with the Midwest. And then some off of just word of mouth of like, "Oh, we heard this program is great," or, "This one is super hard to get into. It'd be shooting for you."

Dr. Chan: So a couple of questions pop into my mind. First, I know there are some four-year programs, but most ER programs are now three. And I assume you guys targeted the three-year programs, correct?

Rudi: Yes.

Quinn: A couple of four years snuck in there, but for the most part, that's absolutely correct.

Rudi: Both of us really want to continue our education and go on to a fellowship. And it was hard for us to deal with training for five years versus four years with a fellowship included, and both of us both felt that three years is kind of where we fit. That felt most comfortable to us. So, yeah, we were like, "Let's look for three years," and then my excitement ran away with me and some four years snuck in there.

Dr. Chan: And the hard part about the couple's match from what I can tell, I did not go through the couple's match myself, is that inevitably your application to residency is tied or yoked to another person's.

Rudi: Yes.

Dr. Chan: And it is rare in the world of med school, and admissions, and everything else that two applications are exactly the same. So there's usually one application, for better or for worse, that's a little stronger than the other person, and sometimes you can start seeing the interview offers kind of go more towards one person or the other. Did that start happening with you guys, and how did you navigate that as a couple?

Quinn: Rudi, she was the one with all the interview offers. So it was tough. I mean, honestly, psychologically, it was a little hard on me, until I started looking at how many interviews I had relative to other EM applicants, and then I felt good about myself.

She definitely had more. A great example is University of Washington. I really wanted to go to Seattle, and that was one where I didn't even get an offer. I didn't get an interview invite at all and she absolutely did. So that's when it came up that not only is it a good school, not only is it a location that we both like, but it just wasn't on the table only strictly because I was in the equation.

Rudi: I think both of us had to swallow some humble pie and be like, "We're in this together. It's not just one person. It's two people." And we had to also look at, "What do you want to gain out of residency? What do you want to gain out of essentially life? Where would you feel comfortable the most?" And both of us . . .

Just medical school is difficult. Sometimes you feel very alone, even though you have a very, very big peer support group, and what we were looking for the most was a residency family. So we always had to be like, "Does this have a residency family feel to it?" "No." And if they didn't want to have both of us interview, that's obviously not the program for us. We want to be part of a residency family.

Quinn: So we've kind of learned through medical school Rudi does better with large amounts of data, hence the fire hose. Rudi is really good at that initial filtering. So that [inaudible 00:51:49]. We had a mutual Google Docs spreadsheet that we were both adding to, both editing, both organizing. And what we did there, of course, is you do the reach, and then the probably solid programs that you have a good shot at, and then the safety. We did that. I don't remember what our . . . Seventy?

Rudi: Somewhere around 70, yeah.

Quinn: Seventy programs. I think 20% were reach, and something like 60% were actual "you're a good fit for this program," and the remainder would be safety. So we did that. Once we had that, then I could kind of step in. I do a lot better with decision-making, so that's when we started to look at, "These are these programs." We sent out the applications. We started to get feedback. It's coming in slowly.

One thing we can kind of . . . a little pro tip here. If you do do a couple's match, you absolutely unequivocally have to contact the program when one person does not get an interview. It was amazing.

Rudi: Communication was huge.

Quinn: It was amazingly successful at calling or emailing both multiple times, "Hey, I'm in this together. I'd love to go here. He would love to go here. Can we get an interview? I'm going to be traveling in the area." I was shocked. That was very, very successful and led me to having much more than the average EM applicant.

Dr. Chan: Interesting.

Quinn: And then Rudi, I mean, she had almost double me.

Rudi: We had a really good line of communication open. If I got an email, I'd be like, "Quinn, did you get this interview?" And he would either say yes or no. And if he said no, I would immediately email the program coordinator because they're the ones that have the most communication with the applicants. And then usually, about 10 minutes later, he'd have an interview offer. So communication was absolutely key with obtaining the interviews we wanted.

Quinn: Really, though, I think a big thing was . . . initially, it was a difficult decision because we didn't really know what we wanted. We knew we wanted a fellowship. So again, that sort of name is unfortunately an aspect of it. I mean, we needed to go to a place that people recognize. We needed to go to a place that produces fellows.

And they'll widely tell you this on the interview trail, that you can call, you can ask residents, but it's really easy to figure out how many fellows the program produces per year. And that was something that we really wanted to focus on because, like we said, we're definitely headed to fellowship.

So that was one important aspect. The other was just "Do we want to live there? Could we be happy there?"

Dr. Chan: With both of you going to undergrad here and then med school here, did you have this feeling that you wanted to leave Utah for your . . . because I call it the triptych, the triple undergrad, med school, and residency. For a lot of people, they love that because they have a lot of family here or culturally just they feel very . . . they just like being in Utah. But for other people, like, "I might practice in Utah one day and my residency program, that's the last hurrah to live somewhere else in the country." How did you guys feel about staying in Utah for residency? Did that come up in your discussions?

Rudi: That came up quite often actually. Quinn's story, as you've heard, he doesn't stay in one spot very well. So eight years in Utah was like, "Okay, I'm ready to move on."

Quinn: I mean, people would ask me this when I'm on my aways, "Hey, why aren't you focusing on Utah? It looks like a great program." And my answer just every single time was, "Guys, it would probably be top of my list had I not done undergrad and med school there." Really. Why not?

But yeah, I get antsy. I had to move. I was telling everyone else, "Yeah, you should rank this. I mean, top three for sure, if not number one, just from what you're telling me you're interested in. But for me, it's just not a good fit right now."

Rudi: And then, for me, it was a bittersweet tough decision just because I am pretty close with my family. My sister lives in Salt Lake. My parents are close. And we're pretty tight. We run every Saturday morning together and get lunch, so we're close.

And so that was kind of a tough pill to swallow because I do want to see other patient populations and I do want to have a different exposure. I think that would, for me, benefit in the long run. But it was definitely a bittersweet pill to swallow. And put aside COVID, travel is absolutely an option. You will still be able to see your family. So we had a . . .

Quinn: The airport, that's right. We wanted to be close to a major airport as well. That was actually kind of a major decision.

Dr. Chan: And then with your rank list, did you feel good about it? Did you go back and change it a bunch of times? How did that play out between you two?

Rudi: So I was a little contentious at first because we both had different wants. We were going to rank 15 programs, and so we split it into, "These are the top five we love, these are the five that we're good with, and then these are the five that are . . . we don't want to go there, but we want to go to residency so these will be okay."

Quinn: We didn't really know how to tackle it, and we were pretty overwhelmed. And we were starting to train for a marathon, so we just went for a run and by the end of the run, we were able to divide it basically into those three groups of five and then had a rough idea of our first rank list, the inaugural ranking.

Rudi: Yeah. We changed it a bit going from there, but I don't think it was anything that stressed the other person out or was something that the other person didn't agree with. It was like, "Oh, I was thinking that program, not really for me," or, "I really love this program," or, "Let's talk about this program." And so it started to evolve. I think a week before, we were like, "This is it. This is a good list."

Dr. Chan: And so you felt good about it between the month that you submitted it and the time you found out?

Rudi: Yeah.

Quinn: We submitted like nine days or two days or something before.

Rudi: Six.

Quinn: Six days. Yeah, right between. Six days before, so we were tweaking it. There were a couple schools, not naming names, Ohio State, that were basically top of our list on interview day, like absolutely blown away. And then the more we learned about what they didn't tell us on interview day, it kept falling, like a rank every two days, essentially. And then it ended up being lower on the list. So things like that were happening. But for example, Madison, Wisconsin, was always top five, and if not always top three.

Rudi: It was Duke. We had ones that we're like, "That was such a good fit. That was a program that we would excel at." And so it didn't shift too much. And once we submitted it, I don't think we ever talked about it again, other than, "We're excited to figure it out."

Quinn: Yeah, there was no like, "Oh, shoot, we really should have manipulated that." No. I mean, once we sat down and actually figured it out . . . because it's difficult with the couple's match because it's not quite a factorial calculation, but you need to . . .

Ideally, you all want to be together. So your first 15 are all both of you in the same city, but then you need to figure out, "Well, if we can't be together, what's the next most important? Does someone really want this state school, but they'd be separated geographically farther away from their partner just to be at that school?"

So you have to really get creative with that list. Someone might want the next five permutations, for example, me at Pittsburgh, her at Wisconsin, and then the next one would be me at Pittsburgh and then her at Maryland, me at Pittsburgh and then her at another school. So that led us to have, I think, almost 260 permutations.

Rudi: Our list is very long.

Quinn: Yeah. So we didn't max it out. We didn't do the 300, but we did fill about 260 rows in the actual rank list algorithm.

Dr. Chan: Wow. And I guess a specific question for you two during this time . . . so the rank list gets submitted February and Match Day is not until March. In between, the COVID-19 pandemic starts coming in waves across the country, and ultimately, they switched a lot of curriculum and events, like Match Day, to an online kind of virtual format.

What was your . . . this is the culmination of eight years of hard work. How did it feel from your perspective just all these changes and just kind of the loss of control and the ambiguity of the last few months of your medical education? How did that look from your perspective as fourth years?

Rudi: Quinn is currently looking at me right now with a big smile on his face because I actually had a really hard time dealing with it. I am somebody who loves to celebrate. I think I throw way too many birthday parties. But I was extremely looking forward to Match Day and everything that people talk about. You hear you get this letter. You open it.

So we figured out the Tuesday before Match Day that it was going to be virtual. There would be no in-person event. And I think, initially, there are many emotions, anger, sadness. I was quite frustrated. I was like, "I realize this is a health problem, but why now? Why is there a pandemic right before our huge . . . what people call the golden time of medical school where you're supposed to celebrate and travel and just live freely? Why is this happening now?"

But Match Day turned out to be much better than I expected. It was a beautiful day of celebration. It was absolutely gorgeous out. We were able to celebrate outside with our two little dogs and plenty of food.

And then since Match Day, with quarantine, I think we've actually had quite a fun time. We made a quarantine list of things to do, from packing to just random board games, poetry match-offs. So yes, we're not able to travel like we wanted to. Yes, we weren't able to like celebrate in person with our friends. But we're making the best of it. And quite honestly, it is a golden time with medical school. We're having quite a bit of fun.

Quinn: Dr. Chan, your description was on point.

Rudi: Spot on.

Quinn: For me, I prefer to kind of exist behind the scenes. So Match Day in and of itself . . . there are two aspects of it. First of all, you know about this as a pre-med. I mean, you see it. You know what it is as a first-year. It's like, "Oh my gosh, those crazy fourth-years. Wow. They're geniuses. They know everything." Definitely not true, but it looks that way just from looking at a different perspective.

And each year, it gets closer and it builds. Oh my gosh. Second year, you're like, "Wow, two years this will be me." And then third year, you're like, "Holy man, I think I can do this. I got this. Wow, I have a lot of learning to do yet, but yeah, this is going to be me next year." And then fourth year comes and you're like, "Wow, this is it. I can't wait."

And then to have it . . . the four-year letdown was pretty severe, but at the same time, for me, I'm not that public figure kind of guy. So the idea of this really public display of this culmination of your work didn't . . . it's not exactly how I wanted to celebrate it, but I was ready to be there to support all the classmates and support Rudi.

So the initial cancellation wasn't a big deal for me. But what actually hurt me the most, what threw salt in the wound, was hearing how other schools were handling the complicated situation. There were just some really nice, really eloquent solutions to a virtual match that we weren't able to take part in. And that's when I kind of like, "Oh, man, that would have been . . ." Sort of missed opportunity. That one hurt the most for me.

Dr. Chan: I'm sorry. I mean, from an administration/dean's office perspective, it was so hard on our side as well because there was so much planning and thought, and it really is a beautiful ceremony. Not to take away what we were able to do through Zoom, but it's just not the same.

Quinn: Yeah. That was the thing. And it was all hindsight, so it's not like anything . . . I mean, in the situation, I doubt I would have done anything . . .

Dr. Chan: Yeah. And the hard part too is . . . you know, you're a diverse class. There are 125 of you. The original conceptualization of Match Day, I think, worked really, really well. But then when you start going down this road of, "Okay, we can't do that. What are the different ideas?" and people had large families or small family, and everyone started bringing forth, it's hard to kind of pick one and champion it through all this. Yeah, it's 125 different people. You put 125 doctors in a room, you're going to get 125 different great ideas.

Rudi: Right.

Dr. Chan: So where did you two match to? Where are you headed? Let's do the big reveal.

Rudi: We're going to University of Wisconsin Madison.

Dr. Chan: Woohoo. Go Badgers. This comes full circle with the Green Bay talk at the beginning of the pod.

Quinn: It does. Complete full circle.

Dr. Chan: So sell the listeners on this program. Why did you guys rank it as high as you did? What's so great about the Madison program? Let's talk about that.

Rudi: For me, doing an away rotation, it was precisely the family field. After night shifts, you go out to breakfast. After night shifts, you'd go have cheese curds and a beer at a bar. And it was an incredible . . . even as just an outsider, they brought you in. The attendings that I worked with, they knew me by name in passing. They just remembered you. It was a very good inclusive feeling.

And then I have goals to go into palliative care, do that on the side with emergency medicine, and they had just a phenomenal attending there who . . . he spoke and you just felt better about life. He was able to really articulate his thoughts and your thoughts very well. The feel is really what Madison did for me.

Quinn, on the other hand, has a childhood love of helicopters.

Quinn: I do.

Dr. Chan: I think I'm about to learn something about helicopters and Wisconsin. Go, Quinn. Tell me.

Quinn: Yeah. Here I go. So absolutely everything Rudi said. First, I have to say, having your partner do an away there is an incredible window into the program. I was actually accepted for an away rotation for the block after her. Obviously didn't do that, because as far as we described, the strategy doesn't really work well. But I was really excited to go there, really excited to hear what she thought. She loved it. She was super happy. She felt super supported. And those are major things. I really wanted to get a program that has a family feel, and she just time and time again said that.

On interview day, I was also blown away by their leadership. Dr. Hamedani there is just . . . I honestly was in awe. She was absolutely the kind of person that I wanted to learn under, and I am extremely excited to work closely with her, hopefully, and then in their department in general.

Now, helicopters. Justin was a wild man who worked through med school. I don't know if I'm supposed to say that or not. We can edit it later if we're not. But he introduced me to helicopter EMS. So he's a paramedic. He's a flight medic. And in med school, he kind of overheard that I was . . . he was just talking about what he does, and I said, "Oh my god, you have the best job in the entire world." And he just kind of laughed and he said, "Well, you can come check it out if you want." I said, "What? Are you kidding me?"

So you've got to go through some training and there are some restrictions and, of course, I made sure to make it through all the red tape. Yeah, I went to the Park City helicopter EMS base, got super lucky, had awesome calls. We landed on Snowbasin ski resort. I'm a skier, so I've seen helicopters come in. I was actually on the helicopter coming in, blowing snow. No one could see.

Dr. Chan: Wow.

Quinn: Yeah. So it was really dramatic. I actually wrote this in my personal statement to Pittsburgh. I know which helicopter is passing over my head just by the sound that it makes.

Rudi: It's disturbing.

Quinn: I know the different types of helicopters. I know what IMC uses or IHC, and Utah, two different types. So I really, really, really love flying.

I was actually super bummed about general surgery because I figured out surgeons don't really fly ever, and I kind of left it there. And then I figured out that emergency medicine does fly. Not always. I guess we probably should have mentioned that in our residency program. There's a whole list that we had on our Google Docs that I mentioned, whether or not they offer flight and whether or not it's just physicians who fly or residents can fly, and if residents fly what year do they fly.

And so that's actually why I ended up at Pitt. It has a huge helicopter EMS program that allows the residents to fly. I flew again in Pittsburgh. I had a shift, and it was fabulous. I loved it.

Dr. Chan: Just to clarify, Quinn, you're on the helicopter administering first aid and life-saving. You're not actually a pilot, correct? Or is that part of the . . .

Quinn: I would love to be a pilot.

Dr. Chan: Okay. This is where Rudi probably gets nervous.

Rudi: No. Exactly. I'm like, "Oh, man."

Quinn: But you're absolutely correct, Dr. Chan. Well, actually, I was doing nothing. This was an observer shift. But the trained residents and trained medics and nurses were doing exactly what you said. A lot of it was transporting. For example, we flew from Rock Springs back to The U just because someone had had a . . . well, a suspected STEMI that actually ended up being a stroke, a heart attack that ended up being a stroke, and needed a higher level of care. So transported them back to The U.

So I was very interested in programs that offer this, and Wisconsin is definitely known as one of the programs that flies quite a bit. So that was a column in our rank lists of which programs would permit me to fly and when would I be able to fly. And then more importantly, are you forced to fly? Because it's not everyone's cup of tea, and that's actually one thing we ran into. Some programs would really force EMS on all of their residents when that wasn't the best fit for them.

So the helicopter EMS, I am extremely excited about it, and that was a major factor. But then one kind of little "aw" moment was after I did my interview at Pittsburgh, I went to do my second interview at Madison. We had our whole list there, and we write notes after each interview. I highly recommend that. It just helps with thank you letters, with everything, and just your feel of the program, because that's ultimately what we went off of.

And in the box for Madison . . . I hadn't been home for 10 years. I visited, of course, but I haven't lived there for 10 years. And I just wrote, "I think I'm ready to go home." And that is actually what sort of . . . I never changed that comment and that was a big thing. So the leadership, the helicopter EMS, willingness to be close to family for a few years, training environment, the Midwest I'm familiar with, those are all what did it for me.

Dr. Chan: Quinn, that's beautiful. Rudi, this is beautiful. I think we just passed the hour mark, so, unfortunately, we're going to have to bring this to an end. But I want to circle back to you guys in about a year and just find out how your journey is.

Quinn: Yeah, man.

Dr. Chan: Beautiful. You guys have such a cool story. And from the bays that are green in Wisconsin, to the rice paddies/jungles of Vietnam, to the mountains of Salt Lake City, you guys have had quite the journey thus far. So yeah, let's stay in touch, all right?

Quinn: Absolutely. Love to, Dr. Chan.

Rudi: Thank you, Dr. Chan.

Dr. Chan: All right. I'm going to turn it off and then let's chat a little bit afterwards, all right?

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of the Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Chan: How do you find balance between medical school and your wellness and life outside of school? What's it like having your third-year clerkship rotation cut short because of COVID-19? How does a career in business and football prepare one for a career in medicine? Today on "Talking Admissions and Med Student Life," I interview Bridger, a third-year medical student about to start his fourth year here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." This is our first Zoom interview because we're going through some COVID pandemic. On the line I've got Bridger. How are you doing, Bridger?

Bridger: I'm good, man. Thanks for having me on here. It's going to be fun.

Dr. Chan: Yeah. And what year are you in med school right now?

Bridger: I'm a third-year. Well, I guess I'm a third-year until tomorrow when I pass my OB/GYN Shelf, and then I guess I'll technically be in between third and fourth year.

Dr. Chan: And just to get into it a little bit, what rotation were you on and how were you notified that you were pulled off for safety reasons? Like, how did that go from your perspective, from a med student perspective?

Bridger: So I was on OB/GYN, and as you know, that's a really hands-on specialty. And so I did my first week on obstetrics. It was a lot of fun. We got to see a lot of deliveries and stuff. And then I was on nights when things started changing, but because I was on nights, it was a little bit different. I was the only med student, and it was a little bit more . . . flexible may be a good word, because they actually had me still on the procedures and stuff. And so I was still able to participate during my week on nights.

And then I had my weekend call shift that Saturday, and so, again, I was the only med student, so I was still able to participate in the surgeries and the deliveries and stuff. And then Sunday is when we got the email that said that we got pulled from clinical duties. And so I only got two of the six weeks on obstetrics this year. We did two weeks online after that, and then next year we'll have two more weeks that we kind of plug into our schedule whenever we can figure it out.

Dr. Chan: Were you surprised or could you kind of see it coming based on the chatter with the docs in the hospital, or were you completely blindsided by it?

Bridger: Well, I wouldn't say I was completely blindsided by it. I think it was kind of tough, like I said, being on OB with it being such a hands-on specialty. The original talks were, "Well, you guys can go. You can be in the hospital. You just can't see patients, and you can't have PPE. So you can't be in contact with the patients, but you can still do everything else." And I'm like, "Well, what is everything else?"

This is OB/GYN, right? If I'm going to show up at 4:00 in the morning to write a couple of notes and then sit around until 5:00 p.m. not being able to talk to patients because I can't wear masks or deliver babies because I can't wear a gown and gloves, this is going to be a little bit different OB/GYN experience than I was planning on.

So that was kind of my initial thoughts. I was like, "If I'm not going to be able to do OB/GYN and it's kind of just like trying to figure out how to keep the clock rolling on us, I'd rather just do the time later where I can actually see patients and learn the things that you learn on OB by kind of doing it."

Dr. Chan: And I know, from an administrative perspective, there was a lot of late night phone calls and emails and a lot of reaching out to . . . it's not just the University of Utah Hospital, but the partner hospitals, like IHC, VA, and everyone kind of has a different structure in place. It was stressful. It's still very stressful, but I just remember that week very clearly. There were a lot of things that started moving very, very quickly.

Bridger: Yeah, totally, I can imagine. I mean, I think it's hard for the students to realize this is not something that you guys have ever been through before on the admin side of things. I think we all are so excited to be in the hospital and finally learning with patients and learning the hands-on side of things after being stuck in the classroom for the last couple of years pretty heavy. And so I think it was kind of hard for a lot of us to swallow going back to laptop med school, you know?

Dr. Chan: Online learning, yeah.

Bridger: Yeah. I mean, it's just, like you said, kind of unprecedented times trying to figure it out as we go.

Dr. Chan: Yeah. And then I think we're still trying to figure it out both on, I think, an international/national level as well as a local level about "How do we move forward?" And I think there are some good ideas being put out, but the details are still kind of fuzzy because the virus is still among us, so it's really hard. It's really difficult.

Bridger: Yeah.

Dr. Chan: So we'll come back and talk about that a little bit near the end, but I want to focus on really positive things.

Bridger: Let's do it.

Dr. Chan: So, Bridger, let's go back to the beginning, man. When did you first have the idea that you wanted to go to med school? Walk us through that process. Was it a moment, kind of like epiphany, or was it a series of moments? What was your journey like at the very beginning? Where did that come from?

Bridger: For me, the earliest memory that I can think of, period, not just medicine related, like my earliest memory, is I was probably 3, maybe 4, and we were at my house and my little brother and I were playing around. He's two years younger than me. And he was walking around, running around, and he went up to my mom as my mom was cleaning a glass frame, and the glass slipped out of the frame and hit his back and give him like a little . . . I don't know. I'd probably say it was a couple of inches, little gash on his back. And so he started bleeding, and I lost it. I was like, "What is going on?"

So we get in the car, we drive down the street to the Alta View emergency room, and I remember the nurses and people coming up to check him out. And I was so protective and I was so worried about what was going on with my little brother. Would he be okay? And the doc walked in, he looked at me, and he gave me a pair of gloves, and he gave me a mask, and he was like, "I'll let you sit here, I'll let you watch, and I'll let you help, but you've got to calm down." So he caught me off guard.

So he gave me a mask. I'm sitting there wearing gloves, and I'm just sitting there watching as he stitches up my little brother's back. And I just remember, at that moment, looking at that guy like he was a superhero. I looked at that guy like he just saved my little brother. He just took control of the situation. He calmed me down, which nobody could do. I think that's when I was first really impressed by the medical field, and I think that's where my original desire to want to go to med school came from.

And so that was kind of my plan growing up. It was always go play football, go to med school, and become a doctor. And then when I was playing football . . . I was that guy that didn't really have to study in high school, like, ever.

Dr. Chan: Where'd you go to high school, Bridger? Because I assume you were a football star at your high school.

Bridger: I was all right. I went to Jordan.

Dr. Chan: Jordan? Okay. And what position did you play?

Bridger: So at Jordan, I kind of played everything. I played receiver on offense, and then . . .

Dr. Chan: Punter? Were you a punter too?

Bridger: I did punt, actually. Yeah.

Dr. Chan: Okay. I love it.

Bridger: You were trying to make a joke, but yeah, I actually was. So I punted, I returned, and then on defense, they kind of played me wherever depending on the team we were playing, so I'd either line up the safety or linebacker.

I had to play D-end a couple of games when we played . . . who was that? I don't know. We played somebody that had a really good tight end, so I had to play D-end, which sucked at 180 pounds.

So in high school I kind of just played wherever, and then when I got to play in college, I played safety.

Dr. Chan: Again, we don't have too many people who matriculate to med school who played college football, so I have to ask were you recruited? Did you walk on? What was that experience like, and were you pretty open that you said, "Hey, I want to go to med school after this," or did you kind of keep that hidden? How was that process?

Bridger: Yeah, so my recruiting process was kind of a mess. I had some offers to some smaller schools. Brown was one of the bigger schools, obviously, being Ivy League. But the way that their scholarship process worked, I think my GPA was like a 3.89 and my . . . I couldn't even tell you my ACT number, but all I can tell you is the combined total of my ACT and my GPA didn't get me a full-ride scholarship. I didn't qualify for a full-ride scholarship to an Ivy League school.

And so I was thinking about just going out to Brown and just paying for that first year until I could just kind of roll my academic qualifications from my first year of playing to, I guess, qualify me for the scholarship or whatever.

And then I went and talked to The U, and it just felt like a really good fit. I did tell them that I wanted to go to med school and they were like, "Yeah, that's great." I mean, it's kind of a different story than they're used to hearing from a lot of their recruits. But that was the original plan.

But going back to where I was saying I didn't really study in high school, I just didn't have the study habits when I got up to college. So I was taking pre-med classes, and I was spending way more time focusing on football than I was academics, and I figured that's kind of how I'd always been, and I'd figure it out, and it wouldn't be that big of a deal. And I got a C in my first . . .

Dr. Chan: Oh, no.

Bridger: . . . pre-med biology class.

Dr. Chan: I call that jokingly a gentleman's C, right?

Bridger: Yeah. There you go. Exactly. So I got smoked in my first undergrad biology class and quickly realized that I didn't have the study skills at that time to manage football and pre-med.

So I kept playing football. I switched my degree to business, played for a few more years, and then I actually got a concussion and decided that I wanted to use my head for something other than smashing into people. So I stopped playing football and kind of did the business thing for a while.

Dr. Chan: Was it hard to walk away?

Bridger: Oh, yeah. Definitely. It was weird going to school not playing football. I hadn't done that since I was in, like, second grade, third grade. It was always kind of just that's what you did. You woke up early, you worked out before school, you went to school, you went to practice, and that's just kind of the routine. And so, when I took that football piece away, I didn't really like school anymore.

I've always kind of looked at school like if it's getting you to a profession that requires school and requires a degree, then it's awesome, but if you're going to school for something that you could learn elsewhere and you could do kind of a more hands-on approach, that's always kind of been the way that I did it.

And so I went and I started a couple of businesses and did that side of things. And it was two weeks before I got married actually. We had a house, brand-new truck, and we were just kind of living it up for being some young kids. I was doing pretty good at . . .

Dr. Chan: Well, what were your businesses, Bridger?

Bridger: So I had a window-cleaning business that I started with a couple buddies and sold. After about a year and a half, we sold that. And then I had a sales company. It was basically . . . what I did was I had managed and trained sales teams, and that kind of helped on the corporate side of things, like managing the . . . Basically, it was kind of like a liaison between the operations and the sales side of things.

So I did that for a little while, and then I had a contract that I was ready to sign a couple of weeks before I got married with a really nice salary, awesome benefits, and everything just kind of made sense on paper, but I just didn't feel good about it. It was kind of weird. I knew that once I kind of made that call, that's what I was going to be doing, you know?

Dr. Chan: Mm-hmm.

Bridger: And so I drove over to the house. My wife was living in the house at the time, or my fiancÈe, I guess, at that time, and I was like, "Hey, I don't know about this." She's like, "Well, what do you think kind of what's going on with the numbers?" I'm like, "The numbers are great. Everything looks like it makes sense." She was like, "Well, figure it out and let me know."

So I kind of took a few hours, I hiked up into the mountains, and I kind of just got quiet. I was just kind of thinking about, "What do I really want to do? What are my motivations?" And it was at that time that I was like, "Man, I think I need to go back to school and be a doctor." I was like, "Gosh, that's going to be brutal. I'm just about to get married. I don't want to go to school for the next 10 years or whatever it's going to be."

And so I came home and I told her. I said, "Hey, I think I need to go to med school," and she was like, "Cool. Whatever I've got to do to support you, let me know. If that's what you feel like you need to do, let's do it."

So we got rid of the house. We sold the truck. We moved into a basement apartment. We downsized big time. And right after we got married, I went out and worked for the summer to try and make as much money as I could to kind of fund this journey, and here we are seven years later.

Dr. Chan: Bridger, did you already have your degree by then or you already graduated, so you had to go back to school and do some post-bacc pre-med reqs?

Bridger: Exactly, yeah.

Dr. Chan: What did that kind of look like for you?

Bridger: Exactly. So, basically, I went back and I had straight pre-med classes to go. So I was taking pretty much biology, chemistry, physics every semester. I had to start from the very beginning, and so it was basically just . . . Because of the two-year, four semesters, I guess it's five semesters, chemistry track, that's what it was. So it was two and a half years of pre-med, knocking out all of those prerequisites, and then just working when I could and studying for the MCAT.

Dr. Chan: Did you feel when you went back to school . . . you mentioned earlier the studying skills. Was it better or different as . . . I'm going to use the term as kind of a more "nontraditional student." Because it sounds like things were different in your life. You didn't have football. You were married. You kind of had more focus, I would guess. I mean, did you notice that when you started taking these classes, you were a little bit older than the other students? Do you understand what I'm saying, Bridger?

Bridger: Yeah, I understand the question. For me, I've always been able to learn really well. I've always really enjoyed learning and studying on my own. I just never had to do it for academics before. I love reading. I love learning. I love that mental game, almost, of just "How much information can I gather?" But I'd never had to do it before in a structured setting of, "This is the chapter you've got to read. These are the questions you've got to do."

So, as far as, my approach coming back, I just kind of told myself that this was what I wanted to do now, and I wasn't studying because I had to. I was studying because I wanted to. And I think that was the shift for me, was being able to take my natural inclination to want to learn and want to work intellectually, and just knowing that this wasn't something that I just had to pass the class or whatever, like academics kind of was before for me. You do good just to do good. But for me, it was like, "This is going to get me where I want to go."

And so I think just the perspective shift on doing it because I wanted to and I was interested in it, and because it was going to help me get into med school, rather than doing it to just pass a class was really the biggest difference that made kind of the change for me.

Dr. Chan: Bridger, you wrap up your studies. You take and pass the MCAT. What was your reasoning? Like, how many schools did you apply to? What was kind of your thought process? What was your kind of strategy, I guess, when you started applying to med schools? What did you look for and how you kind of worked through that?

Bridger: So I've kind of done this a little bit nontraditionally, I'd probably say. What I did was I kind of went for the numbers. That's just where my mind goes. I had a couple of med schools that people had mentioned. People that I knew went to this med school or that med school, so I knew a couple of those. And then I just read a lot of the online forums.

And then what I did was I went on every med school's website that I was looking at, and I figured out how many students that they took from in state. If it was an out-of-state school, I figured out how many they took from in state. And then I took the number of males and females as far as their percentages went per class, and I kind of averaged that out. And then I looked through their class directories almost, and I was like, "Okay, how many students have they taken from Utah before, or what percentage of students are coming from their surrounding states?" And so I went super heavy on the numbers and I only applied to, I think, 13 or 14 schools.

Dr. Chan: Okay, so a decent number. It's a good number. Not cheap.

Bridger: Yeah. Gosh, man, that was another shock. I'm like, "Holy moly, this is expensive."

Dr. Chan: Yeah, it's like Amazon. The more boxes you click, the more your checkout cart grows.

Bridger: Yeah, exactly. Holy moly. So I kind of just went pretty heavy on the numbers, and I looked at schools that were going to be historically favorable to a white guy from Utah.

And I kind of just sent them out. I got quite a few interview invites, but lucky for me, I interviewed at . . . George Washington was my first school, and then the week later, I interviewed at The U. That was right before Christmas break, and so everything kind of quiets down over the holidays. And then I came back. I think it was early June. No, early January, sorry, where I got the phone call from you. I was actually pulling into work when you called me.

Dr. Chan: I remember that, yeah. You were driving. I remember that.

Bridger: Yeah. I think I'm the only med . . .

Dr. Chan: I don't recommend anyone driving and answering their phone, but I notice a lot of people tend to do it when I call. Public service announcement.

Bridger: Yeah, I think I'm probably the only med student that, as soon as I said it, I was like, "I can't believe you just said that." But it was funny. You were like, "Hey, Bridger, this is Dr. Chan. Do you have a minute?" And I vividly remember my response was, "Hell, yeah, Dr. Chan. What's up?"

Dr. Chan: That's great.

Bridger: And I was like, "You just said that? All right. Good. Well, let's see if they still want you in after that one."

Dr. Chan: Going back to your interview day, Bridger, I'm curious. You've played in a lot of big games. Is it kind of the same anxiety right before the big game? I mean, did you feel kind of like that competitive sense and were you able to kind of quiet your nerves, or was it a completely different sensation before a big interview day?

I'm talking performance, kind of like, "Okay, you're on the big stage." I'm just curious what your thought is, because you've played in a lot of really important games, and I would argue interview day is also very important game day.

Bridger: Oh, yeah.

Dr. Chan: So I'm curious what your strategy was and your thoughts about that.

Bridger: For me, my interview day, I honestly thought you guys were pranking me. So I'm in the room and I thought you guys were just like . . . because of the athletic background or whatever, I thought you guys were like, "Oh, let's kind of just see where his head is at."

So out of my interview group, everybody else gets called out of the room and I'm sitting in the old . . . I guess it's now Academic Success, but before it was Academic Success, I was sitting in that office, and everybody else had gotten called out to their interview. And so I'm sitting there and I still haven't been called out, and they're like, "Oh, your person is just running a little bit late." And I was like, "Okay."

So I'm sitting there by myself, and then I get pulled back into . . . they were doing construction back there, and I get pulled into this room and there's a guy with an impact rattle gun on other side of a piece of sheet rock. And so it literally is me and this lady who showed up 15 minutes late for a 20-minute interview sitting in this teeny tiny room that's kind of like a makeshift office while they're doing construction. And it sounds like I'm in a mechanic shop, so we're basically yelling at each other.

And I'm like, "This is kind of funny." I literally thought you guys were just messing with me. I thought you guys were watching how I'd handle the stress. And I'm just like, "This is kind of crazy."

And so we have our super quick interview, and she's like, "Okay, well, sorry I showed up late, but it looks like you'll do a good job." So I had no idea where I stood there.

And then I went into my next interview, and I remember . . .

Dr. Chan: Because this is before MMI. Yeah, I think you were getting traditional interview style back then.

Bridger: Well, I had two traditional interviews, and then I had the MMIs after. So I was in that hybrid year.

Dr. Chan: Okay. That's right.

Bridger: And so my second interview, I go in there, and I remember who it is, but I won't call him out. He was like, "I do this a little bit different. I've been doing this for a while. So I've already looked over your application. I just have two questions." So he asked me the two questions. And like 5 minutes in to the 20-minute interview, he's like, "Okay, we're done here." And I was like, "Oh my gosh, I blew it. Five minutes and, 'We're done here'? I get, 'We're done here'?"

Dr. Chan: As the admissions dean, this stuff makes me cringe. I'm sorry, Bridger.

Bridger: No, it's okay. So I get back into . . . I'm back in the little waiting room with the lady that's running the day, and she's like, "You just want to hang out with me today." I was like, "I guess that's the plan," because I sat in there for 15 minutes with her the first time and 15 minutes on the second one.

And so, for me, honestly, I think the whole situation was just kind of so bizarre to me. I don't know if I was nervous or if I was more just kind of like intrigued by the whole day. But maybe that didn't answer your question. I guess, for me, the big day is never the time to prepare. You know what I mean?

Dr. Chan: Yeah.

Bridger: Game day, when the lights are on, that's . . . if you're trying to prepare it that time, you shouldn't be there, you know?

And so I kind of looked at the interview days and the second look day and that kind of stuff, I look at that as kind of fun. The games are when it's fun. All the practice, and all the early mornings, and the late nights, and all the work that you put in beforehand is kind of where I feel like it makes sense to stress. I feel like when it's game time, that's when it's time to have fun. That's when it's time to just kind of let go and prove that you deserve to be there rather than worrying about all the other stuff.

Dr. Chan: That's great. So, Bridger, you decide to stay here, come to our school. How was that jump from more or less pre-med reqs, undergrad classes, to med school itself? Was that a smooth transition? Did you have to learn new study skills? What was the first couple of years like?

Bridger: Oh, yeah. I remember that first Foundations quiz that we had, and I remember I got a decent score on it and I was like, "Oh cool. I deserve to be here." You know what I mean? And then I saw the average and I was like, "Oh my gosh. These kids are geniuses." I was like, "What in the heck? Maybe I don't deserve to be here."

I thought I did pretty well, and then I saw that I'm on the backside of that curve and I was like, "Holy moly. I worked like crazy for this, and I didn't even hit the little top of the curve. Wow, this is next level. This is as big of a jump as it was going from high school football to college football. Everything is just a completely different level and a completely different speed."

Dr. Chan: And did you have to redo how you studied? I mean, how many hours a week were you putting in, and changes you had to do to your routine, or how did you kind of tackle that?

Bridger: So I totally changed my routine. I would not recommend this route for anybody, and I've said that in some of the talks and stuff that I've given to the other classes. But my personality is really pretty all-or-nothing. I kind of struggle with balance big time.

And so, after that first quiz . . . I worked pretty hard. I studied quite a bit, and like I said, I thought I did well, but to see where I was at compared to everybody else, I was just like, "Hey, this is going to require another level."

And so what I did, and like I said, I wouldn't recommend this, but I kind of just buried myself in school. I was at the library as they'd open it every day. I was the first one there, and then I would study all day. I wouldn't really eat. I had those Uncrustables, horrible little peanut butter and jelly sandwiches that I'd buy by the box at Costco, and I'd throw a couple of those in my backpack and I would just sit and study all day.

I wasn't exercising anymore. I wasn't sleeping near enough. I kind of just lost myself in the studying side of things, and I just worked like crazy. Yeah, my scores went up a little, but honestly, the bang for the buck that I was getting from everything that I was putting in wasn't worth everything that I was giving up on the personal and the health side of things.

Dr. Chan: Yeah. And then did you feel like . . . you said balance. Did you feel that as far as exercise, and wellness, and your relationship with your wife and your family, did that go through a rough patch during that time? I mean, what are your thoughts on that?

Bridger: Yeah, totally. So I came in . . . and it's funny. I guess I'm probably the only med student you've had on here talk about their weight coming into med school and then changing, but I . . .

Dr. Chan: Yeah, that's one of those questions I don't routinely ask, but if you want to spontaneously talk about it, go for it, man.

Bridger: Yeah, exactly. So I came in at like 185, 190. Yeah, I was pretty healthy, in pretty good shape. I had maintained taking care of myself pretty good during my pre-med years. I had a couple of shoulder surgeries that kicked me back, but overall, I was still taking pretty good care of myself. And by the end of the first year of med school, I was like 165 pounds.

Dr. Chan: Wow.

Bridger: I just withered away. I just wasn't taking care of myself. As far as my life with family and stuff, my family has always kind of seen me dive into whatever it was, and so, for them, this wasn't anything new. There was no concern of, "Oh, well, he's not really taking care of himself." It's more just, "Well, he's got something in his sights that he wants to do and this is kind of how he feels like he's going to accomplish it. So it is what it is."

I think, for me, what I would do differently, definitely just on the family side of things, is I missed a ton of family stuff, whether it was little weekend vacations or just going out to eat or hanging out on the weekend, kind of just fun little stuff. I passed on a lot of that so that I could study, and I would definitely go back and prioritize time with family a little bit better if I could go back and do it again.

Dr. Chan: Okay. Third year rolls around, and you kind of mentioned at the beginning that it's kind of a pivot. You go from more classroom-based to much more experiential learning, being in the clinics, the wards, the different hospitals. Was that an exciting transition for you to get away from the classroom and do more hands-on experiences?

Bridger: Oh, 100%, yeah. This is why I went to med school. Seeing patients, doing the work, kind of like the teamwork side of things, figuring out how to work with all of the different staff in the hospital, and the patient and their family. I was so excited to get out of that damn library and get into the hospital and start really doing what I came to med school to do.

Dr. Chan: What was your least and most favorite rotation during your abbreviated third year as it were?

Bridger: So I came to med school to be a surgeon. It was never a matter for me whether I was doing medicine or doing surgery. It was always just like, "What kind of surgery am I going to do?" So I spent a ton of time before med school, during my first and second years in the OR, just getting to know surgeons and getting to a place where they knew that I was going to be somebody that would one day be their colleague so that they would kind of give me more learning opportunities than I would have otherwise had as a third-year med student.

And so I loved my surgery rotation. I did trauma surgery at The U and I had an absolute blast. I was pulling, like, 100-hour weeks and I just loved it. I loved being at the hospital first thing in the morning and I loved leaving when it was dark. I loved the grind and I had a blast.

But then I got on psychiatry and something was just different, and I fought the . . .

Dr. Chan: Really? Interesting.

Bridger: Yeah. So I'm actually going into psychiatry.

Dr. Chan: Oh, you spilled it, Bridger.

Bridger: I know. Sorry. Yeah, so I'm actually going into psychiatry.

Dr. Chan: That's fascinating, Bridger. I want to learn more, because, again, if you loved surgery so much, what is it about psychiatry that changed your mind, I guess?

Bridger: Yeah. So it's a really hard question to answer because I don't really know if I can name one thing. I've got classmates that wanted to go into surgery, and then they got on their surgery rotation and they did the trauma surgery and they just hated it, right? They hated the hours. They hated the work. They hated the people. It was just . . .

Dr. Chan: They hated the grind? Yeah.

Bridger: Yeah, exactly. And they're like, "Hey, I've got to find something else." Where for me, my first two weeks on . . . sorry, I guess it's three weeks. So it was three weeks and three weeks before and after the holiday break for me. So my first couple of weeks on psychiatry, I was just like, "Man, like I really like this."

I've always been fascinated by psychology and the mind and kind of how the mind affects everything else. And so I've always studied psychology and that kind of stuff on my own and it's always been fascinating, and I've always thought that it was the most interesting field of medicine. I never considered it as a career because, like I said, I came to med school to be a surgeon. I didn't even have a crack in that door as far as something else sneaking in and changing my plans.

But as I was on psychiatry, I talked to a couple of the attendings about it, and I loved the specialty. I loved that my ability to communicate and connect with patients really made a difference, right? I'd had some experiences on medicine, or surgery, or some of the other rotations where the patient was being extra difficult and I was able to kind of go in there as the med student with a little bit more time than everybody else and really communicate with the patient, kind of connect with the patient, and get a little piece of information that they weren't really going to give up because they didn't like us, or didn't trust us, or didn't want to be there.

Dr. Chan: Yeah, or the team was in a hurry but you had a little bit more time. This is beautiful, Bridger. I love it.

Bridger: Exactly. So I'd had those experiences where I was able to connect with somebody who nobody else could or did, and it made a difference in the care. I saw that everybody else was like, "Yeah, great. Good job. You talked to the patient. We don't really care. Just, 'Give us the information,' or, 'This is going to kind of steer the course of what we're trying to do.'"

But when I got on psychiatry, I was on child and adolescent, and we had a . . . he was 16, 17, 18, something like that. He was just really difficult, right? We'd come in and he'd be swearing at us and yelling at us and kind of just angry and ornery all the time. And the attending is like, "Well, why don't you give it a shot? The kid obviously hates me, so see what you can do." You know what I mean?

And I was able to connect with him, and I was able to kind of help him take his guard down and just be like, "Look, man, we're here to help. And all the things you're saying, you might think they're true, and that's fine. You're not hurting our feelings here. But you're here, so why don't you get something out of it?"

I was pretty direct and just kind of approached it the way that I just naturally would. I wasn't thinking from a textbook on how to say this so that they do this or anything like that. I kind of just like approached it in a natural way for me.

And we walked out and the attending was like, "Kid, you've got a gift. You're pretty good at this, and your ability to do that will help you in whatever field you go into, but you've mentioned that psychiatry is interesting to you. If you pursue that path, you could be a pretty exceptional psychiatrist if you learned all the things that you'd learn through that training on top of kind of just your natural ability to read people and communicate."

And so, over the holiday break, that kind of stuck in my mind of, "This might actually be something that I could do." I kind of opened that door a little bit, and I was talking to one of the attendings that I worked with and he said, "Just try it on. Try it on. Go around for a couple of days like that's what you're going to do. When people ask you, tell them that you're going into psychiatry. See how it feels. See what they say. See how their reaction is and whether that bothers you or not."

He said, "Because that's one thing that's different than going into plastic surgery. People ask, 'What are you going into?' And you say, 'Oh, plastic surgery.' And they're like, 'Oh, wow.' When you say psychiatry, they go, 'I thought you were in med school. I thought you were going to be a real doctor,' and all that stuff."

Dr. Chan: Welcome to the club, Bridger. I'm excited.

Bridger: Yeah, there you go.

Dr. Chan: You've got great insight, little nuggets. I love it.

Bridger: Yeah. And so it was actually really interesting the first time somebody asked me and I said, "I think I'm going to do psychiatry." It just felt good to say. That sounds weird, but I smiled as I said it, where before it was like, "I don't know if I'm going to do plastics, or ortho, or trauma, or peds." I was always fighting, fighting, fighting for the decision on, "What's the right call? Why do I want to do this? Why do I want to do that? The patient population and the hours and the training."

It was always such a chaotic decision for me because I could see myself kind of doing well on all of them, but that was the first time that I said, "This is what I'm going to do," and I just felt really good about it. And after that, I was like, "Man, that advice to try it on was gold."

And so I came back from the break and I was like, "I think I'm doing psych." I was at the VA for my last three weeks and I loved it. I totally threw myself in. I mean, I tried to do that all year, kind of throw myself in of, "If I were actually in the specialty, if this is what I was going to be doing, how would I act on this?" Because I guess I didn't really know, but I figured, "I'm here, I'm paying a ton of money to be here, I might as well dive into the experience head first and kind of get everything I can out of it."

But that was the first time that I was just like, "This is definitely what I'm going to do." And as much fun as I had on surgery and other rotations, every experience that I've had since making that decision has just confirmed that that's what I want to do.

Dr. Chan: Bridger, I love it. It's just a beautiful story, and it so resonates with me. I can just tell by the way you describe it how . . . yeah, it sounds like a journey. And I always talk to the students about a journey going from pre-med to med to eventually a practicing physician, and it's just kind of a beautiful transformation that's taking a hold of your life. And as you kind of figure this stuff out in the midst of a COVID/coronavirus pandemic, it sounds like you're in a good place with your decision.

Bridger: Yeah, definitely.

Dr. Chan: We're running out of time, Bridger, so just a couple of more questions.

Bridger: Sure.

Dr. Chan: The first one is you kind of talked about your weight, and apparently you're well known for some type of exercise regimen. So can you talk a little bit about that, and just where that came from, and what that entails?

Bridger: Yeah, sure. So I guess I'm like the med school nut job. People look at me like I'm crazy. But after I kind of let myself go that first year, I decided that I just wasn't going to let that happen again. I was going to be waking up at 4:00 a.m., hitting the gym before I had to be up to the school. I was still going to be at the school by 6:00. And so it was one of those things where, with me living off campus, I had to factor in the commute time. So I was waking up at 4:00 a.m. working out every day.

And then I came across this . . . it's not really a workout program. It's almost like a mental toughness program that this guy came out with. And what it is, is two workouts a day. Each has to be 45 minutes. One of them has to be done completely outside. You drink a gallon of water a day. You take a five-minute cold shower. You have to stick to a diet, and you've got no cheat meals, no dessert, no sweets, no alcohol. You read 10 pages of personal development, business development type reading, like nonfiction. Let's see what else. Ten minutes of goal-setting meditation visualization kind of stuff in the morning. And it's 75 days straight of that.

Dr. Chan: No days off, no weekends, just full straight up?

Bridger: No, nothing. Exactly.

And so, when I came across this program, I was like, "When would be the absolute worst time in my med school schedule and the seasons?" Being in Utah, the winters are pretty rough outside. And so what I did was I decided to do it during surgery, peds, and then it tailed off in psychiatry, but that also happened to be over Halloween, Thanksgiving, Christmas, New Year's. So that's what I did.

The first time I tried it, I got, like, 18 days in, and then it was my 24-hour call on trauma surgery and we were literally in the operating room all night. And usually, I had been able to . . . I had my first call while I was doing it and I did fine because I just ran around the hospital outside for 45 minutes, but that second time, I literally couldn't get out of the OR. I just didn't have any time. And so I failed my first attempt on Day 18, and then I made it through the 75 days.

There are different phases to the program, so I finished Phase 1 during my family medicine clerkship while I was down in Manti, which was also freezing cold. It gets super cold down there. So I did that while I was on my rural family med rotation.

And then I actually just barely, over this last weekend, failed Phase 2. Well, I guess it's the third phase, but it's called Phase 2. When I was out roofing this chicken coop that I just built in my backyard, my water bottle rolled off and spilled, and I did not remember to factor in the water, so I actually failed on Day 21 of Phase 2. I guess that would have been my Day 130-something that I'd been doing this dang near straight, and I failed by 10 ounces of water, so I just had to start over three days ago.

Dr. Chan: But even with the starting over, have you seen a change either mentally or physically? Can you talk a little bit about that?

Bridger: Yeah, totally. So the physical change has been an awesome byproduct, honestly, but I think the program is 100% a mental program. There are so many takeaways for me just as far as not negotiating what you want. So many times before, I would want something, but I'd let things get in the way, like that first year being a perfect example, right? Everybody says you go to med school and, "Oh, wow. Well, you're really going to have to work like crazy for the next four years and kind of sacrifice everything else," and that's just seems to be the story that everybody tells themselves. But I just decided that I was going to challenge that story and I was going to do it during the worst possible time for my schedule just to prove that it could be done.

And it's actually been kind of cool because a lot of people in the med school, like you said, it's kind of getting around. It's funny that I'm talking about this on a med school podcast. But it is kind of funny that it's gotten around and people have been like, "Wow, you're able to do this during med school, and not only during med school but during the worst possible time in med school?"

And I did it at that time, one, because I think, for me, the bigger the challenge, the more excited I am to kind of do it. But two, I really wanted to do it during that time so that when . . . I've had several classmates and underclassmen and people kind of hitting me up about the program, and making their attempts at it. And one of them has finished it and the other one is on Day 20-something right now. And a bunch of them have kind of gotten a few weeks in and failed and started over and whatever.

But it's been really, really cool to me to kind of just know that that's the impact, I guess, that I'm having on some of the students. They look at me and they go, "If he can do it, I can do it," and I love that. And so it's been, actually, really fun to kind of not only push just for myself, but on the days that I really don't want to do it and it's freezing cold outside and I don't want to go do a 45-minute outside workout when it's freezing and snowing on Christmas Day, it was like, "Well, if I don't, then that just kind of gives everybody a reason, 'Well, on these kinds of days I don't have to do it.'"

And so I just kind of took all those options off the table and just . . . it's actually been really fun to kind of get all the messages and stuff from different med students that are like, "I'm on Day 7 and it's awesome, and I'm starting to see some change." It's just been kind of fun.

Dr. Chan: That's beautiful. I love it, Bridger. This is all . . . I don't know. It's just so great how far you've come in such a short amount of time.

I guess the last question before we have to sign off, Bridger, can you tell us the Utah football tuxedo story? Because that's kind of legendary in my mind.

Bridger: Oh my gosh, yeah. So I think that story has evolved. It wasn't quite a tuxedo, but it's funny. Man, I was not planning on telling this story. I think Sam probably put you up to this. He's always trying to get me to tell this story.

Dr. Chan: It's a good story.

Bridger: Yeah. Gosh. Okay. So my very first day of football at the University of Utah was worse than anybody . . . like, you could make a movie out of it and people would be like, "Yeah, that would never happen."

So I meet with Coach Whitt and I'm wearing dress slacks, a shirt, and tie. We're in his office and we're kind of finishing the "welcome to the team" kind of deal. And because of the way that my timeline worked out with different schools that I was talking to, I was like a week behind as far as the recruiting curve, I guess.

And so I'm in his office. I'm wearing the dress clothes, whatever. I'm wearing a pair of brown wingtip dress shoes. He goes, "Okay. We'll just go down to the weight room, tell the coach that you need your workout gear, and hop in on the workout, and we'll just get you rolling right now." So I said, "All right." So I walk downstairs to the weight room.

Dr. Chan: So it's Sunday dress. You were dressed in your nice clothes, right?

Bridger: Yeah, I looked like I'm ready to go to church.

I walk through the doors of the weight room and I'm like five minutes late, and so everybody is in their workout gear. And at The U, you don't just show up in gym clothes. You have to wear the outfit for the workout, you know? So I walk in and there's a little strength and conditioning coach. He's probably like 5'8". He's balding and he's kind of chubby.

And I walk over to him and I go, "Hey, I'm Bridger. I was just up with Coach Whitt. He just told me to get the workout gear and jumping on the workout." And this guy just tears into me. "If you're here for all the free crap . . ." Man just starts going off. I obviously can't repeat what he said on the podcast, but he just starts tearing into me and I'm like, "Who in the heck is this guy? What did I do to piss him off?"

So he goes, "If you're going to get in on the workout, that's what you're wearing. I'm not walking away from the workout to get you workout gear." And I'm like, "Okay."

So I just jump in line while they're doing all their warm-ups and stuff, and lucky me, it happened to be leg day that day. And so I'm wearing wingtip dress shoes, freaking slacks, a shirt, and I took the tie off and put it in the corner or whatever. But we're doing box jumps, and squats, and deadlifts, and lunges. And so, of course, we're doing a box squat and I drop down and blow the back end of my left pant leg out. So I've got this huge hole in my pants. You can see my underwear and I'm like, "What in the heck?" And everybody's looking at me like, "Who is this kid?" I haven't met a teammate yet. Nobody knows who I am.

Dr. Chan: This is your first impression.

Bridger: This is my first impression. So I walk in, I'm doing this workout, my pants are blown out, I'm doing box jumps in dress shoes so I'm sliding all over the place, and everybody's looking at me like, "Who in the hell is this kid and why is he here?" So I'm the most uncomfortable I have ever been in my entire life. Of course, nobody is talking to me. Nobody wants anything to do with this weirdo that's working out in dress clothes.

And so we go to the locker room and it's like we're going out to practice. It was a Monday, and Mondays we do shells, which is basically just a foam vest instead of actual shoulder pads. And so you just throw the foam vest on under your jersey and then you're just wearing shorts and your cleats. Well, nobody told me that and they apparently didn't have shells for me, and so they just put my pads in my locker, and so I'm like, "Okay." So I just put on all my gear.

And the way that it worked is I was supposed to go to meetings, but I didn't know where my meeting was, and so I kind of just sat in the locker room and I put my stuff on.

So I went out there and I got out there early, and I'm the one kid out of 135 guys wearing shoulder pads. And so everybody else is just wearing shorts and their little foam vest under their jersey, and I'm suited and booted and I'm the only one. And everybody is like, "Who is this guy?" People were literally thinking that it was some kind of . . . you know, somebody won a contest where they got to hang out with the team for a day. And so they're like, "What?"

Dr. Chan: Do you think it was almost like hazing? Did that go through your mind, like, "They do this to everyone"?

Bridger: Yeah, it totally went through my mind. I'm like, "What in the heck is going on?" So I'm just trying to blend in. I'm just trying to hide behind everybody. When they're calling people out for drills, I'm just like, "I am not getting anywhere near this field today." And of course, "New guy," somebody yells. So I have to go out there and I'm on punt. And I'm lined up against Brice McCain, who played in the league for quite a few years after he finished up.

But they line me up on punt team and I'm like the kill man, so that means I'm lined up out wide. And basically, my job is get off the line, get past the defender, and basically just fly down to the guy that catches the ball. I had done that all through high school, whatever.

I go, I line up, and I'm lined up just like I always have, and they snap the ball and I go to do my little, I don't know, jab, step, swim move to get off the line that worked every single time in high school, and I'm literally upside down before I even realize what's going on.

He had gotten under my pads and just had thrown me, and then I'm trying to get up off the ground and he just keeps shoving me on the ground. I literally couldn't even get off the line and four yards down the field before I had gotten pushed down three or four times. Of course, he starts talking crap. "Welcome to college football," this and that, and I'm just like, "Oh my gosh."

Dr. Chan: Wow.

Bridger: And so, after that, we get back in and nobody is talking to me. Everybody is like, "Who is this guy?" And so I didn't know that they did your laundry up there. You just leave your stuff in your locker and they wash it and put it back in there. So I'm packing all my stuff into my gym bag so that I can drive home and wash my clothes for the next day of practice. And everybody else thought that I was just quitting. They thought I was literally packing my crap.

Dr. Chan: Oh, wow.

Bridger: And so they're like, "You're done?" And I'm like, "What do you mean?" They're like, "Dude, they do the laundry here. Just leave it." I'm like, "Oh my gosh." So, after that day, I was just like . . . I literally had never had so much uncomfortability tossed at me at once. It was, by far, the worst first day of anything I think anybody has ever had. And so, after that, I was just like, "Well, can't get any worse than this."

Dr. Chan: That's a wonderful story, Bridger.

Bridger: Yeah.

Dr. Chan: And then looking back, did everyone just kind of laugh about it and you were kind of known for that?

Bridger: Oh, totally, yeah. I wouldn't say I was known for it. It was something that people would laugh about and talk about, because after putting in the work and always . . . like, after that day, I committed to just be first one there, last one to leave kind of thing.

I kind of grew on the team and I was actually somebody that contributed and it was funny to laugh about it looking back of where I started to where I ended up.

Dr. Chan: And did Coach Whitt . . . he heard about this, right?

Bridger: I mean, he was the one that called me out for getting out there on punt team and . . . obviously, you can't blend in when you're the only one wearing full pads and whatever, so I'm pretty sure . . .

Dr. Chan: Did it make him a smile at least, or who knows?

Bridger: Yeah, honestly, I think it was one of those things where it's just like all you can do is laugh. It's one of those situations where there's not really another option that makes any sense at that point.

Dr. Chan: Well, Bridger, this has been fantastic. It's good talking to you. I'm just so happy with how far you've come. Just hang in there. Stay safe and healthy during this time and we'll get the rotations going soon. And I'm excited you're going to become a psychiatrist, man. That's great. I'm really pumped for that.

Bridger: I'm really excited. Yeah, it'll be a lot of fun. Thank you for . . .

Dr. Chan: We'll have you come back in a few months and give a little update about . . . I think it's also fascinating, too, going through the residency application process, especially with COVID and everything going on. I would love to have your insight and take on things because it's going to probably look a little different. Yeah. Cool.

Bridger: Anytime, man. Let me know.

Dr. Chan: All right. Thanks, Bridger.

Bridger: Okay. I'll talk to you later. See you.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Chan: How does COVID-19 impact one's clinical clerkship experience? What do you look for in an MD-PhD program when applying to various schools? And what's it like to be an MD-PhD student? Today on "Talking Admissions and Med Student Life," I interviewed Claire a third-year medical student here at the University of Utah School of Medicine. Helping you prepare for one of the most rewarding careers in the world.

Announcer: This is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Welcome to another edition of "Talking Admissions and Med Student Life." I've got another great guest today, Claire, future Dr. Bensard. How are you doing?

Claire: I'm doing well this wonderful Monday morning.

Dr. Chan: And then where are you exactly in the curriculum? Because you've had a longer journey than most, for obvious reasons which we'll talk about. But where are you exactly?

Claire: Yeah. So I'm in my seventh year, technically, at the University of Utah, but I'm in my third year of medical school.

Dr. Chan: And let's talk about, you know, what's going on right now. What rotation were you on and how did that come down when like people were asked to leave and, you know, how did that unfold in your eyes?

Claire: I was on my OB/GYN rotation and I was started on OB. And so I was through two weeks of my days on labor and delivery. And I was really enjoying it. The residents on OB were phenomenal. They were incredibly communicative. They were great teachers. And so when all of this started happening and we started seeing uncertainty across the clinical setting, they were very upfront with us about, "Look, we're going to be reducing our interaction with patients. We're going to be reducing our interaction with other providers. This probably is going to affect you guys. We're going to try really hard to, you know, maximize your experience but just be prepared that something might change."

So in a way, we had that preparation to know that our experience in OB/GYN might not be the same as everybody else's who had already gone through it. And so when we got pulled that Friday, so at the end of my second week, that we were told we were going to transition to a virtual curriculum. It kind of like made me like, kind of balk inside because I was thinking, "Well, how do you deliver babies virtually? How do you learn about . . ."

Dr. Chan: I hadn't thought about like that. That's a great point.

Claire: And I think part of it is because I teach wilderness first responder through the University of Utah. And one of the things we talk about is like how to manage an expecting mother if she happens to be, you know, hiking and go into labor. And a lot of the folks that I teach are just like, "Well, okay, like this video that you showed us doesn't really explain the actual process." And now that I've actually seen it, I realized how poor the virtual environment can be in terms of something as visceral and hands-on as a delivery or, for instance, in surgery or any of those other really hands-on, technical procedure-driven fields.

Dr. Chan: Wow.

Claire: But even then I will say that I think the OB/GYN leadership, our clerkship director, Tiffany, Dr. Tiffany Weber, did a phenomenal job of getting us access to all sorts of virtual curriculum, so videos, surgical videos, wonderful lessons, and resources so that we felt confident. At least I felt confident opting in to take the shelf as opposed to waiting to take it.

Dr. Chan: Yeah. Claire, I want to dive more into that, currently what's going on, because I know you've done some really amazing work and efforts. Let's go in the time machine. Let's go back. You know, well, how old are you? Where were you? I mean, like what happened? Like MD-PhD, when did that first enter your mind? Like where did that dream come from to not only be a physician as well as a scientist? What was this like high school, or is it undergrad or was it before high school? Like, when did that first enter your mind?

Claire: I'm a little bit of a funny case because I knew I always liked medicine and I always liked people. I loved interacting with people and hearing their stories and I loved always trying to fix things and trying to help people that way. My father is a physician. He's a trauma surgeon. Like in high school, I was like, "Yes, I'm going to be a doctor. I'm going to go to med school. It's going to be great." And then as I went to college, I rebelled a little. I got very interested in engineering, again, fixing things, solving problems. And I got really interested in tissue engineering.

And so that's where I started into the research lab, working actually in cartilage tissue engineering in the lab of Stephanie Bryant and at CU Boulder. And I had a blast. I loved it. And then I took a cancer biology class and I loved that and I wanted to do cancer biology research. And I did an undergraduate research project with Dr. Joaquin Espinosa again at CU Boulder. And I started thinking, "Maybe I'm going to go to grad school, maybe even get a PhD." But then I had also through college, again, kind of like nurtured this love of medicine.

I got my EMT. I worked as a wilderness first responder. I was a camp counselor that took kids on trips. So I got to fix all manners of scrapes and bruises. I was really kind of hitting this decision point of when everybody was applying in my junior year of college. I was like, "I don't know. I don't know what I want to do." And I went to a panel, and to be honest, I did not even know that an MD-PhD combined program was a thing until this panel in my junior year of college.

Dr. Chan: It was the big reveal. Like, "Oh, you can combine both of your loves into one program." Yeah.

Claire: Yes. I mean, particularly in all my dad's surgical colleagues that are close family friends, they do research but they kind of were this accelerated, like they wanted to get through their surgical training. Not a lot of them have a dedicated, like research training in the sense of a PhD or a degree. But a lot of them do research. I was thinking, I was like, "Well, I am an MD. I'm definitely going to do some research." Which we see high-quality research across the board coming from MD run labs. So it was more that I had really found this love of research in the cancer field that provoked me to say, "Hey, this combined degree program sounds awesome. It sounds like exactly what I want. I want to be well trained in medicine. And I want to be well trained in PhD level science."

Dr. Chan: And the length of the program didn't dissuade you. It's like anywhere from 7 to 12 years. I don't know.

Claire: It can be.

Dr. Chan: Yeah.

Claire: Yes. It is a long road. And I think part of that was, in college, I was a pretty efficient person in college. I took a lot of credits. I also raced mountain bikes, and so it didn't really scare me that it was a long program and that there was a lot of work entailed. I think in my head I was like, "Oh yeah, I'll definitely be on the shorter end. I'll be on the seven-year program." But things quite never work out.

Dr. Chan: I'm not allowed to talk about the seven-year because like that's like Valhalla. It's like the Viking conception of heaven, no one . . . everyone dreams about it, but I'm not sure too many people actually get there.

Claire: Very true. And, you know, people even say like, "Oh, well, if you do a computational PhD, it'll be shorter." And that's not true either. It totally depends on the science that you do and whether or not you're lucky. One of my favorite mentors is Dean Tantin. He's a professor of pathology. He said, "If you want to do a three-year PhD, you better plan for two years because you know about a year's worth of work is going to go wrong." And he said the same thing, "If you want to do four years, you got to plan for three years."

I've gotten very good mentorship along the way, but the length didn't scare me. And it was something that I thought was a really good investment. And part of this was coming from talking to a lot of MDs who also run labs. They had a startup process. It took them a couple of years to get their feet wet in research and really understand how they wanted to run their lab, how to get grants. And so I figured I would get that done in a mentor-guided environment while getting my PhD.

Dr. Chan: So you went to CU Boulder. You're living your life. You're doing all that you need to do. How do you start winnowing down what programs to apply to? What was your thought process? I mean, what do you look for in a combined MD-PhD program?

Claire: So I made a list. I had different aspects of training that were really important to me. One, I knew I wanted to stay academic because I love the idea of being on the forefront of medicine, of delivering high-quality care to very rare cases and being able to like learn from that and to work with other tertiary centers across the nation that do the same. So I knew I wanted to stay academic. So I wanted to find a really vibrant academic setting that had an undergraduate campus attached to it.

And the reason for that was I wanted to have the ability, when I did my PhD, to mentor undergrads. And I got a chance to do that while I was doing my PhD in Jared Rutter's lab. And that was really important to me was finding somewhere that had undergrads available to learn like I did at CU, that they love research and to really culture that passion. And then part of it is too, is that in this training we're always teaching. We're always learning and we're always teaching. And so I thought it would be really valuable to also have that as a part of my training so that I would learn how to teach effectively in multiple different environments.

So number one, academic center attached to an undergrad campus. Then number two was kind of more of the, again I'm thinking about the length of the program. "Like where do I want to live for about 8 to 10 years? And let's plan on the decade. Where do I want to spend a decade?" I kind of drew back on my interests outside of medicine and outside of science. I'm a pretty outdoorsy gal. I love to hike and ski and mountain bike, and I have a dog. And so those are attributes of the city in which this academic center was situated that the kind of had to meet my needs.

So I was looking for something that was close to the mountains or at least some sort of outdoorsy spot or a good park system, and then somewhere where I could actually find a house with a yard. I didn't want to have to live in an apartment, and I didn't really want to live in a concrete jungle, especially because I tend to have dogs that are more like working breeds. I have an Aussie lab right now.

Dr. Chan: They need their freedom. Yes.

Claire: He does. He needs squirrels to bark at. So that was kind of another attribute. I was like, "Where's the city?" And then I think the third part that I'd gotten very good guidance from folks as I was applying is that you'll find your fit, so interview around. But you'll find programs where the student body really inspires you. You'll meet professors that you really jive with and you can kind of see how well connected the community is. Like, do they have kind of an open-door policy, or is it more of a you have to email and set up a meeting?

I was told to apply to a lot more places. Again, because option two of like I really wanted a city and a program to fit my lifestyle, I decided on my applications that, "You know what, I'm only going to interview places that I would actually move to." So New York City went out the window. L.A. went out the window. San Francisco while beautiful and having a lot of beautiful access also was a little bit tough for me to think about. So I really kind of restricted myself to programs in the inner Mountain West and also some in the Midwest but more to the North, like Wisconsin and Michigan. And then I also looked in the Pacific Northwest, so because Portland and Seattle does have a little bit better kind of flows to their cities. I have to be honest, I completely forgot about Salt Lake City. I'm from Denver. I thought that Denver was the biggest, best city in the West.

Dr. Chan: Oh, yeah. Like the whole Denver-Salt Lake City rivalry. You're stumbling into it. I love it.

Claire: Yeah. And so I didn't even think about it. And I happened to be interviewing . . . I was actually interviewing in Oregon. And somebody said, "You know, you sound like you'd be a great fit at the University of Utah. Did you apply there?" And I said, "The University of Utah has an MD-PhD program?" So obviously I had overlooked some things, and that's why I think it's really important to, you know, really take a big look at places and really look at the map well because that was something that I didn't do a great job of. And look at where I ended up.

So I was very fortunate because this was an early interview. And so I was able to meet all the deadlines to apply to the Utah MD-PhD program and get in on one of the last interview dates. So very fortunate. Very, very fortunate because it worked out really well. And when I think about all the other programs that I interviewed at, I enjoyed them. You know, it was kind of I could see myself there. But I noticed some interesting quirks about either the way the MD-PhD students kind of presented themselves and how connected they were. And then I came here and I could not believe how hospitable it was.

I couldn't believe how interconnected the community was. Everyone knew everyone else. And that was MD-PhD students in their eighth year talking to the first years, to the professors, to the assistant professors. And people really wanted you to find your space and your home. And I just felt incredibly welcomed. I felt like I fit in very, very well. It was a group of people that I knew wanted to see me succeed. And it was a group of people . . . Oh, sorry, go ahead.

Dr. Chan: And as long as we're being honest, Claire. Like, I started this position in 2012 and you were actually one of the first memories I have with the MD-PhD program, because I just kept on hearing about, "Oh, Claire Bensard, we need to get Claire Bensard." Claire Bensard this, Claire Bensard that. And I just remember like, "Wow, like this is like a rockstar." And I remember back then the program was smaller, and I think it's really grown over the years. And I think you have been very instrumental in that as far as like recruiting and like getting the word out and like, you know, befriending and helping answering questions.

Because like we're interviewing a lot more people from the MD-PhD program. But yeah, one of my first memories of the MD-PhD program is Claire Bensard this, Claire Bensard that. Everyone seemed to fall in love with you and just really wanted you to come here. It sounds like that was reciprocal. Like you are feeling Utah love too.

Claire: 100%. I mean, I fell in love with this place and with the people. I mean our program administrator, Janet Bassett is just the heart of the program. And you could just tell she really cares about everybody, but that also comes through in how everybody in the whole training process of the graduate school, as well as on the medical school side, you felt that. It felt like everybody was really invested in the students' success. And also the students were really empowered to reach out to experts. Experts were not on a pedestal. They were not unapproachable.

I didn't realize how important that was especially in an academic setting, because that's how great ideas are born, when you get the chance to talk to somebody and kick around an idea over coffee or like as we walk around our beautiful campus. It was really just kind of one of those things where I just my eyes opened and I was like, "This is the place. This is where I want to go. Oh my gosh, I hope I get in." And I still remember to this day, I was working as a research tech. So I took a year off between undergrad and college or undergrad and an MD-PhD. And I was working in a research lab. And I was sitting at my desk analyzing PCR. And the director called me and said, "Claire, we've got a spot for you." And I just started screaming. I was like, "Yes, yes, yes. When can I move? I'm coming. I'll see you in June."

Dr. Chan: So you get here, Claire. How is that jump from undergrad to med school? I mean, was that an easy transition for you? Or like was the amount of work, amount of material, is it something that you were able to keep up with, or did you have to kind of redo your studying skills? How was that for you?

Claire: I think my sister and my mom would probably say that, in general, I definitely love to learn. I do have a hard time sitting down and being very dedicated about my studying. I tend to like to study in kind of short bursts because then I tend to get like kind of like, "Ooh, what's over here. Ooh." Like, "Someone to chat with." So I like, I have a really hard time studying like in the library, for instance, because people walk by and I always want to say hi to them. So I have to be like kind of in this zone to study.

I would say that the jump, the material, the first year of medical school is geared to ramp us up. So we started in our phase one unit where it was fast pace, but it was a nice overview. And so that was really helpful for me because I was coming from a very solidly molecular biology background. I'd never taken anatomy. I had never taken physiology. And so it was really good for me to kind of get up on par with some of my classmates who were anatomy TAs in undergrad. It was very helpful to have that kind of balance.

And so I found that really manageable, and it also helped me learn how to study in medical school what was really important. It was important to get the facts down, just finding some sort of like either question bank or a flashcard system so that I could test my knowledge randomly. But then also I love to read textbooks. I'm a little bit odd that way. And then I would also just make sure that I had my time to read.

Dr. Chan: It sounds doable. It was doable. You've kind of alluded to it, but with your PhD did you come in thinking you would do X but then turned out to do Y? I mean, how did you arrive? I mean, I know there's kind of a way, as I understand it, you rotate in different labs, you get exposed to different mentors and different science, but ultimately it's your decision about which lab to join and pursue your PhD work. And summer before med school starts there are some rotations. And then I know there are some more in between first and second year. But ultimately I think you're supposed to choose after your second-year med school. How did that process work for you? How did you go through it?

Claire: So I'm definitely the dinosaur version of this because we have changed. And so now people get a lot more rotations, and that was something that they took kind of from our experience. It used to be that you would spend a whole summer in one lab, so you'd only get two rotations. And if you can think about the University of Utah, how many wonderful research labs we have, you have to be very selective and kind of do your homework about, "Oh, like maybe I should go to a couple of lab meetings before I commit to rotating in this lab."

So my experience was, you know, it kind of felt like I had two shots to find a lab. There was an option that if you weren't totally sold on your first day, you could do a third after the second year, but it was kind of like a year matching into that one. So you're going to be joining that lab. That was kind of an intense part of the program was finding your PhD home. I got good advice again, and I think that also kind of came down from the more senior MD-PhD students. They said, "You really want to find a project you like, like you're interested in but it doesn't necessarily have to be this is my life's work. This is my 100% passion. I'm going to always do this. I'm always going to work on something like this."

They said, "Find a place that you enjoy the project but really that you enjoy the professor who leads the lab. That they are an excellent mentor, that you connect well, that you could see yourself." If something, let's say, for instance, I'm not speaking personally here, that you knock something over and maybe lit your lab notebook on fire, that you'd feel comfortable telling that person that happened. And maybe in the course of that event, that's some very valuable samples that took about six months to create were ruined. Like, you have to have that kind of relationship, somebody that you feel completely open, open communication and you trust 100%.

Dr. Chan: And vulnerable. Sounds like being vulnerable.

Claire: Yeah, being very vulnerable, because getting a PhD is really that process. You are wrong a lot. You're wrong all the time. And experiments fail all the time. So it's, one, about being vulnerable and also about building resilience.

Dr. Chan: So which lab did you end up picking? Which discipline?

Claire: Again, I had this kind of funny background. I did cartilage engineering. I did cancer biology. And I thought, I was like, "Oh man, this is my time to swerve. I could try anything." So I decided to do a rotation in metabolism in a yeast biology. Like they use yeast as a model organism and that studied different metabolic transporters and enzymes. And this was with Jared Rutter. And I thought, "You know what? I think this is going to be a really fun rotation. I really liked the lab. I really liked Jared, but I think metabolism is just really going to help me for my first year of medical school, because I keep hearing about this Krebs cycle that I have to memorize."

So like I'm just going to get a leg up. So I rotated in that lab and I really enjoyed it. And there were two MD-PhD students who preceded me in that lab, who had started pivoting away from yeast and started moving kind of up the chain of model organisms. So they were working in cell lines, and they were starting to get a mouse project going. And so, and then I thought, "Okay, that was a great rotation. I probably won't join that lab." And so then I did another rotation where again I swerved because, again, I always liked medicine and I liked kind of outdoorsy things.

So I thought maybe I'd really like muscle. And so I did a project with Gab Kardon, who's a wonderful PI, studying congenital diaphragmatic hernia in mice. And this is a wonderful skill set because I learned how to work with mice. I'd never done that before. And then I also learned a lot about muscle and muscle stem cells. And surprisingly, this all kind of comes back and they all kind of came back. All these skills I learned in my rotations helped me in my final PhD project and my thesis. So I was kind of coming down to that decision point.

I'd done my two rotations, and I just felt like metabolism really started to intrigue me. I kind of came back to really wanting to study cancer biology, really cancer initiation. And so I talked it over with Jared, and he was really excited about supporting me in this project of studying how our stem cells, especially in the gut and the colon, how they initiate metabolically in order to support a brand new cancer. And so we kind of came up with this project, and the best about this, as I told you that I did this rotation because I wanted it to like learn, master, and then never think about the Krebs cycle again. My entire PhD centered on the connection of that pathway with the rest of the cells metabolism.

Dr. Chan: So you know the Krebs cycle like the back of your hand? You could like, yeah, you're probably dream about it and sleep about it.

Claire: Yup. Isocitrate, yeah, like all the way around all the different offshoots, how the cell doesn't really always run in a circle. It kind of sometimes runs backwards and forwards and siphons things off as it needs. And I loved it. I thought that was a really fascinating thing. It kind of married all of my interests. Like I love to cook. I love to think about how do we like to do things in our daily lives to be healthy. And there's a lot of things in the media about, you know, don't eat this, it could cause cancer, don't eat that, it could cause cancer. And that was really actually testing like, well, if you change how the cell itself eats, how it metabolizes things, does it become more likely to become cancer? And we were able to kind of peek into the answer of that question. So that was really fun.

Dr. Chan: Is that your main hypothesis? You know a lot more about this than I do. It's been years since I've studied the Krebs cycle. So I mean, like from a 30,000-foot view, what was your research on? I mean, how does it apply to kind of the broader scope of medicine or in science, I guess?

Claire: So what we kind of studied was let's take healthy colon cells, so the cells that line your large intestine. There's little stem cells in them. They regenerate very much like our skin, but it's on the inside. And so what we did was we actually altered the way that cell handles its metabolites. So when it sees a molecule of sugar and it says, "Okay, I'm going to do this with this molecule of sugar," we've actually changed the pathway so it can't go down one route. And so it's, "I can do all this other stuff with sugar, the sugar molecule, but I can't use it in the Krebs cycle."

And so then that actually that kind of metabolism, that kind of program looks a lot the normal stem cell. So we effectively gave stem cell-like metabolism to the entire colon lining. And then we just watched and we asked whether or not that would predispose a mouse with this kind of genetic mutation in its gut to form colon cancer. Like every good PhD student, you get a little antsy. So you decide to add a couple of little extra things because you don't want to wait for the entire length of the mouse's life. So I had two models where I had one, which I called the Western diet where I kind of fed the mice some carcinogens and gave them a couple of bouts of diarrhea. Then I looked to see if they had formed colon cancer or not. And it turns out that our genetic mutation giving the lining of the gut a more stem-like or more regenerative type of metabolism promoted the formation of cancer. So it's kind of a double-edged sword. You're really good at regenerating but you might form cancer.

Dr. Chan: So this taking the next step forward, this could have implications on how we treat colon cancer or like diet modifications, because I know there's a lot of pop sciencey stuff around this.

Claire: Yeah. So I guess like kind of my dream goal would be to prevent the formation of colon cancer. So understanding the process of initiation means that then we can block initiation. So the easiest way to think about that as well, if we had a molecular target, could we drug it? But then you think about that, like the risk to benefit ratio, we're going to end the number needed to treat. We would have to effectively put something in the drinking water. And people already balk at having fluoride in their drinking water. So that probably wasn't going to be a valuable solution.

So it's really on that second point of the question you asked. It's really on, how does this inform what kind of cancer forms and what are its susceptibilities? So what's really interesting in the practice of oncology now is how folks are thinking about attacking a cancer cell. One is through . . . In chemotherapies, there's kind of two flavors of chemotherapy. Some attack a cell that is dividing, and some attack a cell based on its metabolic program. And sometimes those things kind of overlap. And so we're really interested in figuring out, "Well, how does having this background metabolic program inform the cancer and make it somehow vulnerable?"

I like to think of it as like a highway construction project. So if I've blocked one part of a highway, you have to divert and go around. But that might be slower. That might also come with its own problems. Maybe there's a pothole and maybe we can make that pothole bigger and we can stop the cancer from going forward and becoming even more malignant or metastasizing. So that would kind of be where I would think about going next with this project.

Dr. Chan: Wow. Claire, this is amazing. Like I've just learned so much. Jumping back.

Claire: So fun.

Dr. Chan: I just want to pivot, just jumping back like to the med school part, was it hard? The way I kind of see things is, you know, you start med school and like you're with your classmates and you're in the classroom and all these small group discussions and clinical exam and like all that type of activity. And then for you to essentially step off and do research, like how was that like transition away from your classmates, I guess? And then vis-‡-vis, like I think almost all of them have graduated and moved on to residency.

Claire: Oh, yeah.

Dr. Chan: I mean, you knew it was coming, but I don't know if that made it any less difficult to say see you later or goodbye to a lot of your classmates. I mean, how would you approach this? How did it go?

Claire: Well, and I always like to highlight this too. This was back in the era of mandatory attendance at the U. So I really knew my class. Well, we sat through every lecture together. You know, people were always in the room. Like we had 100 people in a lecture hall every day. And so it was really hard to watch folks go on into clerkships and rotations and figure out what they want to do. And I think part of that was that I realized that that day would come for me. I stayed apart of what they were going through and maybe tried to collect a few little tidbits of things of how to be successful. But then also just to celebrate with them, that they had reached this milestone that they had worked so hard for.

And that really just culminates in match day, which was just so much fun to watch all my classmates match and be excited and see where they were going. And then I've stayed in touch with quite a few, and some have even stayed in Utah. We've stayed really close, and they've been great mentors to me as I transitioned back. But I think it was also because I had chosen to do an MD-PhD. Leaving medical school, it was hard, but it wasn't as hard because I was really excited about getting started on my PhD. And I got to kind of integrate and meet a whole new host of people in the graduate school side and different journal clubs. And then I also still had my people.

The MD-PhD program itself it kind of became more of my home. And those are the folks that I knew I was going to spend the next, you know, six years with.

Dr. Chan: And then you alluded to it, Claire. But like the reentry back into the third year, how was that? Was that smooth? Was it difficult? You know, again, like, you know, you're just kind of jumping into rotations. I know they have a class with some like breakout sessions, but I don't know if that can truly prepare anyone to like okay, to go from nothing to all of a sudden you're a third-year student on busy rotation. So how was that transition for you?

Claire: I thought it was okay. It's definitely challenging. And I think that I was fortunate that in my lottery picks for my clerkship schedule, I kind of eased myself into third year. Actually my paper or my thesis was done, defended, done, but my paper hadn't been accepted yet. So I did two weeks. Actually my first two weeks of third year were still in the lab. So I had a two-week research elective to try and finish up my last experiments. And then I kind of had bubbling in the background, I had this paper manuscript that I was editing and figures that I was, "This is all through."

But then I decided to actually do a two-week elective in pathology, in forensic pathology, because I figured this would be a setting in which I could ask lots of questions. I would be able to learn a lot about different pathology that I would see in the actual hospital space, but it would be a little bit less pressure. And then I would also get a chance to kind of review my anatomy. So I was very strategic about picking this elective.

Dr. Chan: Was it like CSI Salt Lake City?

Claire: It was. Everybody I've talked to that has also done this elective, you kind of get immersed into the crime beat and you start like following the news really closely and be like, "Oh, I'll probably see. I'll see that."

Dr. Chan: There's a body in the reservoir up there. They found a body in the desert. Yeah.

Claire: Yup. Mm-hmm. Surprisingly Lake Powell, because it's so deep, it's like a refrigerator. So they actually recovered a gentleman who had fallen off of his houseboat unfortunately and passed away. And he was like remarkably well-preserved because it'd been like . . . he was at the bottom of Lake Powell. That was an interesting standpoint from, you know, just learning about how the human body reacts to different environmental stresses.

Dr. Chan: So forensic pathology, and then what was your next couple rotations?

Claire: And then I had neurology, which is a little bit on the shorter side. So it's about four weeks. I mean, that is like fast. You have to be able to study efficiently. But it was two weeks of inpatient and two weeks of outpatient. And this was great for me because it allowed me to kind of dip my toes into how both of those services, how do they work, and how to prepare for them. And then it was also a little bit more narrow. Now, while neurology touches all parts of the body and the physical exam is all over, so really kind of getting my physical exam skills back, it was very focused on processes of nerves and the brain. That made it very kind of, again, like it was able to kind of put it in this box and study really hard for it and ultimately like do okay in my exams.

But again, it kind of felt like I was taking off a little bit of a bite as opposed to having the whole cake in front of me. And then I was ready for the whole cake. Then I went into internal medicine. That was hard. It was a lot. I had to study. I think I set up my study schedule where I would come home every day and I would study for at least an hour to two hours, and then I would go to bed and I'd wake up and do it again. And that was every day that I was on service. And then when I'd have my days off, that would be at least six hours of studying. And then I did practice. I did four practice tests for that shelf exam.

Dr. Chan: And, Claire, you kind of alluded to it, but like you talked about with your PhD in science and the grad school part of your training, you kind of had to find your people, find your lab. Were you able to find that yet in third year? I mean, do you know what kind of doctor you want to be? Or are you still like a pluripotent stem cell and that's not been determined?

Claire: I think I have a very clear subset that I'm thinking about. So after internal medicine, I did my surgery rotation and I loved it. I think this has a little bit to do with . . . You know, so some folks kind of, you kind of think that, oh, if you're an MD-PhD, you're most likely . . . and this is true. I mean, you look at the stats, most people go into internal medicine, and then they kind of specialize from there. And I could see that path for myself. I could see myself going internal medicine to heme/onc and then continuing my work in colon cancer from that avenue.

I feel like I thrived, like I just completely blossomed in the OR. I loved the procedures. I loved taking care of those surgical patients. I loved the evaluation. It kind of brought back some of these when I was an EMT when we were doing our 24-hour shifts in the trauma bay. And I also loved the science of surgery. There's quite a bit in how we practice the art of surgery that is still very much under investigation. Again, I could do general surgery, become a colorectal surgeon, and still work with this patient population that I've worked with my PhD on.

But I'm also considering kind of a swerve again. I really enjoyed my vascular surgery rotation. And I loved that I was all over the body, in terms of there's blood vessels everywhere. And then actually the metabolism of blood vessels is fascinating. And then also the coagulation cascade. So another wonderful biochemical pathway for me to dive into.

Dr. Chan: It's like you just can't quit it. You just keep on going back to it.

Claire: That's kind of where I'm thinking. I think with a lot of my classmates, we were disappointed that we haven't been able to finish our third year the way that we had thought and hoped. And part of that for me is that I wanted to give my OB/GYN rotation a really good shake because it's again another kind of surgical subspecialty that has some really interesting clinical questions for research that all, again, can kind of center back on metabolism. And again, we can talk about pluripotency. And so I was kind of bummed that I didn't get a chance to finish that rotation out.

I'm still kind of putting that one a little bit on the board of, "Well, maybe I'm going to try and get through the rest of that rotation when we do get back to clinic." Maybe I'll completely surprise myself and end up applying OB/GYN. I think those are my three that I've really found myself loving that I couldn't imagine myself doing anything different. So general surgery or vascular surgery or possibly OB/GYN.

Dr. Chan: Wonderful. Well, Claire, like this has been great. And I guess I just want to take the last few minutes, you know, I've heard so much about your journey, but with the coronavirus, COVID-19, I know you've been very visible and very active in trying to help out. Can you just talk about some of your efforts? Because I think that would be very interesting to a lot of listeners out there.

Claire: Yeah. Thank you for bringing that up. So when we got pulled from clinic, we ended up with having, you know, all this free time. I'm used to studying only an hour to two hours every day after I'd been at work all day. And now I had all this dedicated time to study. And I also recognize that you could kind of see across the nation. Everybody was talking about how there were protective gear shortages. And Utah was a little bit . . . Like we only had a very few number of cases.

So I thought that this was an opportunity to create a stockpile of protective gear so that we could protect our healthcare workers when inevitably we would get kind of the spread of the virus and potentially have a surge. And then we kind of had this timing where we would be a little bit ahead of that, so people would still kind of be out and about and able to donate what they might have. So I took inspiration from other medical students across the nation who had also organized these kinds of drives. So we organized a four-weekend personal protective gear donation drive, where it was just drive-through drop off. Folks could just look through their garages or their homes, supply closet, see if they had any unused items, and then drop them off.

And I didn't realize how this would actually impact the community I think and our medical student community in kind of two ways. One was it kind of fed how I felt. Like I really wanted to be able to do something. And I could see the other medical students really were looking for ways like, "I need to be able to do something. I need to help. This is what I've been training for, and not only to help the patients but also to help my team, my provider team, the people that have been my mentors." And for me too, a personal connection. A lot of my friends are residents who are on the front lines. So it was really inspiring to be able to do that and provide an avenue with our volunteer base that people could volunteer to do so.

But then the second part of that was that the community also wants to be able to help out. And we saw people clapping, cheering. So excited to drop off, you know, one N95 mask that they had bought years ago. Or even one woman, she just burst into tears. And she said, "You know, I'm a retired nurse, and I just can't even believe that it's happening. And I'm so grateful that you guys are doing this so I have a chance to give back."

And it was something like that, but I didn't realize how important it was for our community to be able to show how much they care. So it's been really, really heartwarming, and I've been completely touched by the generosity of the Greater Salt Lake area in running this donation drive. To date, we've collected over 1,300 N95 masks. And that's just one segment of all the things that we've collected but kind of that like hot ticket items that we think about.

Dr. Chan: That's great, Claire. And so you said it's been going on for four weekends. And where do people go and is it all over or can people still donate?

Claire: We're actually heading into our last weekend. So we hope to see you. It's going to be at Rio Tinto Stadium in Sandy. And we're going to be running Friday, Saturday, and Sunday, 12:00 to 4:00.

Dr. Chan: Is it you and the medical students, or is this another organization you partner with? Who's kind of taking part in it?

Claire: So it's driven by us. It's University of Utah medical students. We are the volunteers. We are the people that have organized this. But we have been so fortunate to partner with Real Salt Lake Foundation, as well as the Rio Tinto Stadium, in order to bring this kind of last big drive. And so we're really hoping people will be able to turn out. We have a big, large parking lot to use, so that'd be great.

Dr. Chan: How did you get in touch with them? I mean, like are you a big soccer fan, or it was just they were willing, or how did you connect with them?

Claire: So I started with reaching out to just a lot of different people. Yes, I do enjoy watching soccer, go U.S. Women's World Cup, go Royals and go Real Salt Lake. I really enjoy going to soccer games. But it was also just thinking about . . . I was looking very strategically on the map. I was like, "What would be some of the best places that we could run these drives? What are the things that are central that have good drive-throughs?" I just called them, and they got back to me and they were really excited about partnering and have just been so supportive throughout this whole thing. So the value of the cold call.

They bought in very early on, probably early April. And we've been having a couple of weeks to kind of plan and roll things out. So we're really hopeful that, one, we'll be offering the community, as they drive out, one of the white ribbons that you've been seeing around. We as medical students, we practice our sterile techniques. So these have been sterilely pinned and they will be available for the public to take a clean one. And then second is that Real Salt Lake, the foundation is planning on offering some sort of merchandise either at the time of we're able to have it packaged in a way that's safe for the public to take or to redeem later when this pandemic has passed. So look forward to that.

Dr. Chan: Well, Claire, I mean, you had to defend your dissertation. So I imagine doing a cold call with Real Salt Lake was easy compared to that. Right?

Claire: Yeah, it was, I don't know. Like, I wrote out a script and I had my mom read it.

Dr. Chan: For your dissertation? Your mom is great.

Claire: She's both.

Dr. Chan: Okay. I love it.

Claire: She said it was a little easier to get through the cold call.

Dr. Chan: Well, last question, Claire, what advice, what counsel would you give someone out there who was just like you? Like seven, eight, nine years ago, and just thinking about MD-PhD or thinking about medical school. What would you say to them? What counsel would you give to someone?

Claire: I would say reach out. Reach out to the people that you know that have followed this path. And if you don't know anybody, do the cold call. We as a community, as a profession are incredibly welcoming and want to hear from you and that's at all levels. You don't have to call the chair of the department but you can. But if you're interested in this, give your local students a call. Find out from them, connect with them, and figure out if this is . . . like shadow. I would have students come and just shadow in the lab to see if they liked it. So yeah, we're here. We want to be a resource for the next generation. I mean, the people that are going to take care of us.

Dr. Chan: Very true. Very true. Well, Claire, this has been fantastic. I'll have to have you come back on because I'm curious if you're going to pick gen surge or vascular surgery or OB/GYN. I think, yeah, the future is wide open, and we'll get through this COVID-19 pandemic and pretty soon you'll have your own match day, not too far away in the future.

Claire: Yeah. I'm looking forward to it. You know, if it has to be a virtual format, I'm okay with that. It's still reaching that milestone and being able to celebrate with all the people that I know. And sometimes a text message could be just as powerful as a hug.

Dr. Chan: Well, thank you, Claire. I appreciate your time. You take care.

Claire: Thank you so much.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan. The ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.

Dr. Chan: How does being a medic in Afghanistan inspire one to become a doctor? Why is it important to start both the admissions process and relationship building early? What is medical school like as a non-traditional student? Today on "Talking Admissions and Med Student Life" I interview Carson, a fourth-year medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, another great medical student, a fourth-year medical student. Carson, how are you doing?

Carson: I'm doing great. It's nice and sunny outside, so it's a good day so far.

Dr. Chan: And just a little bit about yourself, a fourth-year?

Carson: Yep.

Dr. Chan: And excited for the match, which is very soon.

Carson: Excited, apprehensive.

Dr. Chan: We're not going to talk about that just yet.

Carson: Sure.

Dr. Chan: I kind of like to build this momentum, just like . . .

Carson: Got to keep them waiting.

Dr. Chan: All right. So let's jump back a few years.

Carson: Okay.

Dr. Chan: When did you decide to become a doctor? Where did that come from?

Carson: So to actually become a physician was . . . it's going to sound clichÈ, but I was actually in Afghanistan when I decided I wanted to be a doctor, working as a medic. Going through high school, like, I'd done phlebotomy classes and stuff like that, knowing that I wanted to do something in medicine. Worked as a sterile . . . I can't even remember what it's called now but cleaning surgical instruments in the [inaudible 00:01:23].

Dr. Chan: A scrub tech?

Carson: Well, no, I wasn't a scrub tech. But it was a sterile tech, because I was the one cleaning them, packaging them . . .

Dr. Chan: The autoclave?

Carson: Yeah, yeah, all that stuff. And then worked in a lab, and then got an EMT when I joined the National Guard here in Utah and started working as a combat medic while in uniform. Deployed to Iraq and worked as a line medic there, and, you know, I was really happy with doing that. And then, got deployed again to Afghanistan and we had a very . . . the base that I was on kept getting rocketed all the time, and sometimes it made it so that, you know, the physicians couldn't actually get to the hospital where casualties were coming in just because they were sheltering in place and stuff like that.

And there was one casualty, very, very specific casualty that it seemed like it took days for the providers to get there. And just me practicing my skills that I, you know, was comfortable doing and doing what I knew just wasn't enough, and it's like, "Okay, I have to be able to do more." And that kind of started me down the road. I started looking into, you know, what does it take to get into medical school? I ordered some MCAT study prep stuff and had it delivered out there. And yeah.

Dr. Chan: Does Amazon deliver to Afghanistan?

Carson: Amazon doesn't deliver to Afghanistan, which is really . . . well, at least they didn't then. This was back in 2010, I think. Yeah, 2010, exact. But I delivered it to my house. And then from there, it's easy to ship anything to an APO. But yeah, that's where it started.

Dr. Chan: But I'm thinking Carson, like, let's jump back even further, like what prompted you to join the military? And then how old were you, and did you come from a family of military or . . .

Carson: My grandfather retired from the Air Force. My stepfather was in the Air Force, medically retired out of there. Actually, I was kind of peer-pressured into it a little bit.

Dr. Chan: Oh, really? Okay, let's hear it.

Carson: I mean, not peer-pressured, but I had a couple of . . .

Dr. Chan: Those recruiters cornered you?

Carson: No, my friends cornered me, which was horrible. I shake my fist at them every time I think about them now, just kidding. No, they had joined the Utah National Guard as electricians to work on helicopters, and I was like, "Oh, that's really cool. Like, you guys are doing some really cool stuff, and I want to be cool," was part of it, I'm sure. And then I wasn't in school at the time when I joined. I was 23, and I had just barely moved back to Salt Lake City from Boise, Idaho. And I was just tired of working 80 hours a week, and I was like, "Well, I know I want to do something. I need an education. I've been putting it off for years." I'd had a four-year gap in my undergraduate studies, and I was like, "Well, I can't pay for school without this job. But I don't want to be in this job. I want to be in school. So what else can I do?" And that's when the National Guard money started weighing in, because hey, you know, you can get money for school and they'll help. So that was, I say, you know, the biggest reason to join the National Guard. But like I said, I'm sure my friends had some play in it.

Dr. Chan: Were you aware that you could be deployed?

Carson: Yeah, I was aware.

Dr. Chan: Okay.

Carson: I mean, this was 2007. So, I mean, we'd been at war for six years already and stuff along those lines, so I knew it was . . .

Dr. Chan: Possibility.

Carson: Possible. But at the same point in time, you know, I enlisted as a medic. The unit that I enlisted into down in Riverton, which is just south of here, their medical unit, they set up a hospital. So I didn't think it was going to be any frontline work or anything along those lines. Typically, the hospitals are a little bit more reserved from what I knew at the time and held back a little bit. So, like, yeah, I'll be fine, not a big deal.

Dr. Chan: How many times did you go over?

Carson: I went twice. In 2008 . . . well, years, 2008 I went to Iraq, and that was with a unit out of Washington State. And then in 2010, I went to Afghanistan with that actual unit I enlisted into here in Utah.

Dr. Chan: Which was better for you?

Carson: They were both great.

Dr. Chan: Okay.

Carson: So Iraq has . . .

Dr. Chan: Because sometimes, like, when I talk to vets, they say like, "Oh, this happened . . . Iraq . . . " Like there's a huge difference between the [inaudible 00:05:33].

Carson: Yeah, so I mean, some big things happen in Iraq. I mean, I call it the fun deployment, because I was part of a cavalry troop. So we were out on the roads driving around all the time, going from place to place. And I was working as a line medic, so . . .

Dr. Chan: What's a line medic?

Carson: So a line medic is someone who's forward with the people out doing the boots on the ground, that kind of work.

Dr. Chan: So a World War II example is they have the little cross on their helmet?

Carson: Sure.

Dr. Chan: Okay.

Carson: I mean, I really like "Band of Brothers," and I really like those red crosses on the helmets, but I would never wear a red cross on my helmet.

Dr. Chan: Okay.

Carson: But, yeah, out there with . . . you're forward with whoever it is.

Dr. Chan: Again, just to really simplify it, and I feel bad. Like, if someone gets hurt, do they really scream, "Medic"?

Carson: You'd be surprised.

Dr. Chan: Okay.

Carson: Yes.

Dr. Chan: All right. And whatever you're doing, you drop everything and run.

Carson: Medic or doc, something like that. Yeah, drop what you're doing and go running. That part's fairly accurate.

Dr. Chan: Fair, okay.

Carson: But yeah, I mean, Iraq was, you know, I call it the fun deployment. It really had the opportunity to build some really strong connections with some people I was with, because, you know, we were out running around, getting shot at, doing all sorts of fun stuff. Well, getting shot out wasn't fun, but you know what I mean?

Dr. Chan: Wasn't as fun.

Carson: It wasn't as fun. No, that wasn't as fun. It was a little scary the first time, and then about after the 30th, it's like, "Meh, there's armor on these vehicles, it's fine." And then I call Afghanistan the educational one.

Dr. Chan: Okay.

Carson: So I was still a medic. I was a more senior medic, and so I was kind of responsible for helping train some other medics and making sure their clinic runs smoothly. And since I had some more experience, I was allowed a little more leeway with what I could do, because there's a very, very well-known "see one, do one, teach one" mentality within military medicine. And if your providers are comfortable with you doing something, you know, check in with them, "Hey, I'm going to do this," and you get the sign off, go for it.

And I got to . . . at first, it was just working in the outpatient clinic, and then it was as a like supplemental staff to the trauma bay. So when more patients came in than they could handle, then I would sneak my way onto a bed and work there. And then I would see the individuals or casualties come in and go from the trauma bay to the operating room, and I would peek my little head around the corner and be like, "What's going on in there?" And then that turned into me weaseling my way into there, and then working as a circulator. And I got the excellent opportunity to first assist on a couple of cases, and it just kind of built. So it was very educational. And I think that's actually why I fell in love with surgery actually, which we'll probably talk about later. But yeah, super great exposure, super great experience.

Dr. Chan: And how much schooling had you finished during this time?

Carson: So I was about halfway through my undergraduate career.

Dr. Chan: Okay. And during your deployments, are there online classes available?

Carson: Oh, sure.

Dr. Chan: Because sometimes like, you know, I've had other vets come through, and there's that joint services transcript. So I get the sense there is some educational lessons that can be done even if you're in some foreign country. So tell me about that. Carson: So the joint services transcript from my understanding is basically a transcript of everything that you've learned or all of the classes or courses that could potentially translate into university credit.

Dr. Chan: Oh, I see. Okay.

Carson: So for myself, since I went and got an EMT-B and then continued that out with what we call whiskey training from the medic field, a bunch of those hours, actually none of those hours transferred over to this university, to the undergrad university here in Utah, but at other schools that could have transferred and counted for some general education electives. I think I got four hours for physical education that transferred over onto my transcript. But outside of that, like I tell my soldiers going through deployments, like when you're off, you're off. Make sure you guard your off time, because there's always going to be work to do, but if you're off, you're off.

Dr. Chan: There's always something to do.

Carson: And there's always the opportunity. I mean, you can take online courses, you can do whatever you want. Well, not whatever you want, but I mean, if you want to take an online course, there's nothing stopping you.

Dr. Chan: Okay, okay. And had you taken the pre-med reqs before you left, or was that something you needed to do afterwards?

Carson: That's something I needed to do afterwards. I actually started working on a biology degree at Utah State University in 2002. Like I said, I took a multiple-year gap to go work, and then had the realization I need to get back into school. And that's when I kept going on that biology degree path. And then coming back from Afghanistan is when I really hit the pre-med reqs really hard.

Dr. Chan: Was it hard to walk away from military? Or what did you think about? Because I know there's [USUHS 00:10:20] and . . . there's all these kind of different paths to becoming a doctor within the military.

Carson: Sure, yeah.

Dr. Chan: I'm just curious how you ended up choosing your particular path, yeah.

Carson: So luckily, I haven't had to walk away yet, which is great. I'm actually still a combat medic in the Utah Army National Guard, which is great. I turned 13-years army old last month, and it's actually been really good. National Guard is part-time, you know, one weekend a month, two weeks a year. I'm air quoting here for whoever can't see because sometimes it's a little bit more than that.

Dr. Chan: Just a little bit more sometimes.

Carson: Just a little bit more sometimes. But they've worked with me very well. Schools worked with me fairly well to make sure that I can do that because I actually really do like it. I did apply to Uniformed Services, interviewed there, was waitlisted. I mean, but ultimately, Utah is home, so I was happy to come back to Utah.

Dr. Chan: Okay, all right. So you're going through the application process, tips, advice you would give to those out there? Looking back, would you have done anything differently?

Carson: I would have started a lot earlier.

Dr. Chan: Okay.

Carson: That's probably . . . Yeah, the number one tip is start early. Before I was accepted to medical school here, I was in graduate school at Tulane working on a master's degree.

Dr. Chan: Yes. I remember when I talked to you on the phone, you were right around Louisiana.

Carson: Yeah, I was in Louisiana. I'd just gotten back to Louisiana from Germany, but yeah, running around Louisiana. And I had gone to the pre-medical advisor there. Even as a graduate student, they were willing to help, which was awesome. And one of the things that they had said over and over, have everything ready to go so when you can click the button, you click the button, because, you know, first off, no one likes to, you know, procrastinate and stress at the last minute. Some people in my family would say that if I didn't procrastinate, I'd get nothing done, which was probably right at some level, but start early.

If medicine is something that you really want to get into medical schools where you definitely want to go, build the relationships with the individuals who can help you there . . . help you get there, excuse me, early. I mean, being on the admissions committee here as a student member . . .

Dr. Chan: As a fourth year.

Carson: . . . as a fourth year, right, sorry, some of the greatest things that I see, that I enjoy seeing are extremely long shutters . . . Wow, that was a weird word, extremely strong letters of recommendation from professors from wherever who really know the individual that they're proffering the letter for. It lets us know that it's not just, you know, someone that you went to ask at . . .

Dr. Chan: Some template, yeah.

Carson: Yeah. It's not a letter that I'm going to worry about finding different pronouns or anything along those lines because it's a copy and paste job. And, I mean, put your nose to the wheel. I mean, getting into medical school is a hard job. And then completing medical school is a hard job, and just get ready for it. Tell yourself, "Hey, it's going to be hard. It's going to suck for a little bit, but it's worth it."

Dr. Chan: How did you end up at this program at Tulane? What was kind of decision making that went into that?

Carson: Yeah, so . . .

Dr. Chan: Because I get asked this question a lot about . . .

Carson: Should I get a master's degree?

Dr. Chan: Yeah. Like, kind of post-bacc master's degree programs? And it's very controversial in the pre-med world, so . . .

Carson: Yeah, so to be completely honest, I didn't get into medical school . . .

Dr. Chan: The first time you applied.

Carson: Yeah, the first time I applied, yeah. My GPA wasn't horrible. I thought that I could use some more work in science just to kind of bolster that GPA and give me an opportunity to find some more letters of recommendation. And I really wanted to show to the committee that I was continuing forward momentum that because I got to know I didn't, you know, stick my head in the sand and sulk or something . . .

Dr. Chan: And feel sorry for yourself.

Carson: Yeah, and then just reapply next year and have the same questions asked, "Well, you know, what has he been doing?" That could have some demonstrable evidence that I was still working towards that goal.

Dr. Chan: Okay, great. So I guess I'm curious, like I got a series of questions in my mind, like, when you started medical school, do you feel your undergrad and your master's program prepared you academically? Or do you feel like oh, this is like a whole new ballgame? Do you understand what I'm saying?

Carson: Yeah, absolutely. So I think that part of my graduate school, a lot of it helped me.

Dr. Chan: Okay, good.

Carson: Because my master's is in cell and molecular biology. So understanding signaling cascades, all sorts of random stuff like that really helped in some of the courses to the point where I probably didn't study as much as I should have. I felt a little overconfident, but I got that confidence from taking those courses.

Undergraduate school, to be completely honest, I don't know. I think for me personally, and it's going to sound kind of weird because I'm an older . . . I was an older candidate, but it took graduate school for me to kind of grow up to realize that, you know, it's not just go to class for three hours and then go hang out with friends and then whatever, but it's actual work.

Dr. Chan: Did you feel that was an issue at all being a non-traditional student and being older than the average classmate? You know what I'm saying?

Carson: You know, I didn't think it was until a medical school that I interviewed at asked me how I felt about being so much older than every other applicant. And part of me kind of went, "Wait a minute, I'm not sure they can ask that."

Dr. Chan: Yeah, they're not supposed to.

Carson: But, yeah.

Dr. Chan: But I can ask you that in a podcast right now because it's all retrospective.

Carson: For sure, for sure. You can't kick me out now Dr. Chan. You already accepted me. I didn't think it was a problem getting into class. I mean, we all kind of, for whatever reason, social explanation you want to, all kind of tend to gravitate to those who are like us, right?

Dr. Chan: Yes. People self-select, and there's, I think our school is really great for non-traditional students. I think there's a lot of people in their 30s, 40s who are here, so . . .

Carson: Exactly. And that was, I don't want to sound vain or anything along those lines, but walking into class going, "Yes, I'm not the oldest one here," was kind of, it's kind of nice. Because, I mean, I was 32 when I started medical school. But no, I don't think age really hurt me in any way.

Dr. Chan: What kind of activities were you doing, Carson, for a couple of years, like in terms of research or community service?

Carson: Yeah. So admittedly, I probably didn't do as much research as I should have. Community service, I was volunteering with . . . backup here a little bit. I actually enjoy education. So spending time with Anatomy Academy and young physicians and stuff along those lines, just helping expose high school and elementary and junior high school students to medicine and to the sciences and stuff along those lines was where I spent the majority of my time.

Dr. Chan: Okay. And then, you know, the first couple of years, the preclinical years, you know, what I know about you then, if I'd asked you, I probably would have heard surgery or emergency medicine. Would that have been accurate? Were you kind of leaning that way?

Carson: Yes, surgery and emerge . . . I can't talk. Surgery and emergency medicine were probably tied for first.

Dr. Chan: Okay. So let's talk about third year. Well, how was your third year? What did you start off with? What was your experience?

Carson: I describe third year in like three separate sections. The beginning of third year was horrible for me, at least I felt so. I felt like I didn't know what I was doing. I had no idea about anything like what medicine was. I felt like, you know, my hair was on fire just standing around saying, "This is fine." But I learned a lot in the first three blocks.

Dr. Chan: What were those three?

Carson: So they were neurology, surgery, and internal medicine.

Dr. Chan: Okay, some pretty heavy hitters there. yeah

Carson: Yeah, pretty heavy. And I kind of wanted . . . it's actually neurology, internal medicine, and then surgery. I knew I didn't want to go into medicine. So I kind of wanted to use medicine as a warm-up for surgery, so that's why it's kind of stacked that way. But it was super busy. I felt extremely inefficient, like I didn't know anything, and that I was being tolerated. And that was just an internal feeling. That wasn't anything that I experienced out on the wards or anything along those lines.

And the next couple of blocks, things got better. Knowledge-base and how to operate in a hospital was a little bit better. I was feeling a little more sure of myself. I knew I didn't know all the answers, but that was okay, because no one's expecting you to. And then the last third of third year was just, I had fun. It was great. Actually, one of my funnest rotations was psychiatry.

Dr. Chan: Okay.

Carson: I was over a UNI.

Dr. Chan: Tell me.

Carson: Yeah, I was going to say. I'm sure you'd love this, just over at UNI just having a blast because while, obviously, I'm not worried about all the medical problems in the background, but there are things that still play into it and lead to disease processes, and it was just really, really fun. I really enjoyed it.

Dr. Chan: Yeah, it's like, I would argue, you know, like each discipline, each field has its own culture.

Carson: Oh, sure.

Dr. Chan: And each discipline has kind of its own patient population to a certain extent, and there's just these personalities among the different doctors and the nurses. And something I've heard, you know, over time, with talking to a lot of students is like as you pick a field, you kind of have to find your people and like what's kind of this culture you want to submerse yourself in? So kind of like third year is kind of like a tour, right? You're going to be a psychiatrist for six weeks, a pediatrician for six weeks, and how does that make you feel? And how do you do? You know.

Carson: Yeah, exactly. I mean, that's kind of something that I was thinking in the back of my head when you started talking there for a second was that that third year like really opened my eyes to the different cultures. And once I saw the different cultures, I mean, I will unabashedly say that I stopped trying to fit in because I had found my people in the surgery world. And that doesn't mean, you know, I was walking around, you know, trying to be a jerk or anything along those lines, but it was just, "All right, there's something here to learn. I don't really fit in here. I kind of feel like an odd duck, but that's fine because there's . . ."

Dr. Chan: And I was opposite, like, I obviously chose to become a psychiatrist, but I liked visiting the surgeon world, but just it was really different. Like oh, yeah, you know, because we got to get at the hospital so early to do all the rounding because the OR opens at 7:00 and everyone has to get to the OR on time, and, you know, it's this cascade effect, and then, you know, you're operating, and all this stuff is happening on the floor. You know, just . . .

Carson: People are poking their head and saying, "What about this?"

Dr. Chan: Yeah.

Carson: Absolutely.

Dr. Chan: You know, I remember just watching surgeons operate and returning pages because like there's a scrub nurse. Like she would hold the phone while, you know, and like the doctor would be giving orders. It was just like, "Wow, this is a lot of multitasking," a lot of stuff going on.

Carson: Yes, there's definitely a lot of stuff going on. But, you know, I definitely appreciate it and enjoyed my time on the other rotations, because like I said, there was something to learn. And really, I think when people start thinking about their specialties, as long as they kind of keep that in the back of their head, there's, you know, there's something to learn here that it makes everything tolerable.

Dr. Chan: Did the pace remind you of your medic days? Or is it completely different? You know what I'm saying, like?

Carson: Pace of third year or . . .

Dr. Chan: Pace of the hospital, you know, just the way things operate, and how there's somewhat of a hierarchical nature to things, and . . .

Carson: Yeah, so the hierarchical nature definitely reminds me of it. There's not an attending physician that I don't call sir or ma'am, for better or worse, just because that's . . .

Dr. Chan: Interesting.

Carson: . . . how it works. And yeah, the hierarchical nature definitely reminds me of my medic time. I would say some services, like the pace, anyway, some services more closely resemble it than others. But no, I'll call it the ring structure of medicine is very harkening to those days.

Dr. Chan: And so it sounds like the hardest part for you was the beginning. And do you think it had anything to do with those first three rotations or is much more just like you transitioning from a second year to third year?

Carson: I think was more of the transition.

Dr. Chan: So anything could have been first and it could have been a little rough?

Carson: Yeah, I'm sure I could have had psychiatry first, and I'm sure I would have enjoyed it. It would have been like, "What am I doing here yet I know nothing?" But no, I think it was just getting in, getting acclimated to the pace, learning how to be flexible, because I think a lot of, well, at least for myself, I don't want to speak for a lot of other people, but I tend to try and find patterns and figure out how things work as far as like stepwise fashion and things along those lines, just because that's how it makes sense in my mind. It's a mystery why, you know, I'm going into surgery, right? And so learning how things flow and everything along those lines. And you switch to another service where the flow is completely different, and it's like, "Wait a minute, there was just a rug underneath my feet. I felt it there a second ago, and now it's gone." But just learning to be flexible, because no matter what you're going to get it just might take a couple of minutes.

Dr. Chan: Did you flirt with any other field, or once you did your surgery rotation, you're all in?

Carson: Yeah, so I've done a lot of surgery rotations, and I still love surgery. Anesthesiology is a sneaky one.

Dr. Chan: Oh, yeah, other side of the table.

Carson: Other side of the table here. The physiology is amazing.

Dr. Chan: You get to kill people and bring them back to life because . . .

Carson: Exactly, it's great.

Dr. Chan: Yeah.

Carson: I shouldn't say it's great. You know what I mean.

Dr. Chan: Yeah, I know.

Carson: The physiology is great, the medicine is great. The pharmacology is confusing but still great. And all the anesthesiologists I spent time with were really awesome about, you know, explaining what was going on, and we'd have a lot of table talks and stuff along those lines. But at the end of the day, I mean, I can't even count the number of times I'd be talking with my anesthesia attending and then find myself peeking over the curtain, seeing what was going on on the other side and be like, "Oh, they're getting ready to do this," and wanting to be like, "I can get that for you. Let me, you know . . ." But anesthesia is sneaky.

Dr. Chan: So you flirted a bit.

Carson: I flirted.

Dr. Chan: A little footsie, a little footsie.

Carson: Yeah, just toeing the line a little bit, just trying to see where it's at.

Dr. Chan: Okay. And you mentioned other surgery. Which ones did you end up doing?

Carson: So I have done plastics, vascular surgery, and foregut bariatric.

Dr. Chan: Wow, that's kind of a diverse group of . . .

Carson: . . . and then a trauma surgery rotation.

Dr. Chan: Okay. Which one did you like the most?

Carson: Yes. I like . . .

Dr. Chan: C, all the above.

Carson: Yes.

Dr. Chan: Okay.

Carson: I liked them all for different reasons.

Dr. Chan: Okay.

Carson: The first one I did was the trauma service. And I loved it because it was kind of . . . it took me back to the days of operating in the trauma bay.

Dr. Chan: Cars crashes, gun shot wounds . . .

Carson: Absolutely.

Dr. Chan: . . . falls.

Carson: Tons of blunt trauma.

Dr. Chan: Fights, drunk fights, yeah.

Carson: Good knife and gun club stuff.

Dr. Chan: Yeah.

Carson: The hours were horrendous, lead long, but I loved it. I thrived. The general surgeons were great. I learned a lot from them. Next one I went to was vascular surgery. Again, very long hours, but it taught me new approaches to stuff, because a lot of vascular surgery is all done endovascular now. So seeing some of the advancements in EVAR and TEVAR and stuff along those lines, I felt that, you know . . .

Dr. Chan: Little toys now.

Carson: Exactly, like my head would explode on every other case, like you can do that? Foregut bariatric was really awesome because I think there's a really on the bariatric side, people who, you know, you can help a really awesome patient population, who, for whatever reason, you know, really need some help, and you can do that, and you can be there for them. And I really liked that one because it wasn't just, "Okay, come in for surgery, we're done." It's a very long, drawn out and involved care process where those surgeons are plugged in with those patients forever.

And, you know, we'd have patients who were, you know, 11 months out and have an issue and guess who's taking care of them? We are, because that's where the service that they belong to. And then plastics was just mind-blowing as well.

Dr. Chan: Yeah. The whole concept of reconstruction, yeah.

Carson: Sure. I mean, I will be 100% forthcoming say, "I'm totally naive thinking about plastic surgery." I'd never really thought about in the past. I thought it was going to be a lot of, you know . . .

Dr. Chan: Cosmetics.

Carson: Rhinoplasty, augmentation things along those lines. And I didn't see a cosmetic procedure until the last week I was on the rotation. The very first case I was on was a woman who had a fungating mass on her right shoulder down to her chest wall. And so she had a forequarter amputation done where they took off her right arm right at the base. And we, I say we, I mean, I was in the room, I didn't do any of the work. But the surgeons actually took a flap from her anterior thigh and actually hooked all the tubes and everything up, all the vascular supply . . . I shouldn't say hooked all the tubes up.

Dr. Chan: No, no, but I like it. I like it. You're talking like a surgeon, yes.

Carson: I do know some words that make me sound smart sometimes. But hooked all the vascular supply up and closed her, and then I followed her in the hospital for a couple of weeks, and she's back at home now.

Dr. Chan: Wow, that's amazing. It's amazing what they can do. Yeah. I know I like to make fun of surgeons and surgery, but I think they do a phenomenal job and . . .

Carson: Yeah, I mean . . .

Dr. Chan: It's a hard life because the OR is long and there's a lot of risk involved.

Carson: Sure. Sure.

Dr. Chan: But we need people to be surgeons.

Carson: I mean, at the same point in time, if you can watch someone rebuild . . . I mean, if you can rebuild a pelvis from a fibula, that's an awesome skill to have.

Dr. Chan: So you're going through this experience, Carson, and you're definitely surgery.

Carson: Definitely surgery.

Dr. Chan: How did you pick which path on surgery for fourth year? Because you have to submit your residency application.

Carson: Right.

Dr. Chan: What was your thought process? How did you do that?

Carson: So my thought process is that I'd seen a lot of general surgery just from my time in Afghanistan and the trauma service, which is a general surgery service when there's not trauma going on here. And seeing other surgical services kind of out in the periphery, I will say in the periphery, but obviously they're working just as hard, and wanting to know what I could do past general surgery. So I applied to general surgery and . . .

Dr. Chan: How many programs did you apply to?

Carson: Seventy-seven.

Dr. Chan: Okay.

Carson: A bunch.

Dr. Chan: A bunch.

Carson: A bunch.

Dr. Chan: A bunch.

Carson: But here in academic center, we're very, very lucky because we have a lot of extremely specialized individuals for foregut bariatric, colorectal, plastics, vascular surgery, etc., cardiothoracic, on and on, and I wanted to expose myself to those other subspecialties. So I just started whittling through them. The ones that I thought were most interesting. Vascular, foregut, plastics were the top of the list. And that's everything that I could squeeze in with all the other requirements.

Dr. Chan: I see, okay. So you applied to 77 programs. Did you do any away rotations?

Carson: I did not.

Dr. Chan: Okay.

Carson: General . . .

Dr. Chan: What was kind of your philosophy going into that?

Carson: Yeah, so I sat down with one of my advisors, and we looked over everything and just the general gestalt is that general surgery is not one that you need to do an away rotation. There's definitely others that you 100% have to. Emergency medicine, you have to do an away rotation, but you don't necessarily need it. If there's someplace that you 100% absolutely want to go, I don't think it hurts you. And that was the same advice that I got. I don't think it hurts you. But if you're going to go there, you need to go there under the assumption that you're going to work your tail off. And you're going to walk out of there with an honors in the course and letters of recommendation that have, you know, written in gold ink, basically.

And I don't want to say I didn't want to put the stress on myself, but let's be real, medical school can be expensive. And having to travel to another state, afford lodging, and everything, that played a very large part into it, so . . .

Dr. Chan: So you applied to 77. Are you comfortable sharing how many interviews did you go on?

Carson: Not enough.

Dr. Chan: Not enough.

Carson: Yeah. I think that's the answer that, and pretty much everyone will give you.

Dr. Chan: Okay, all right.

Carson: Yeah, not enough.

Dr. Chan: So you went on not enough interviews?

Carson: Yes.

Dr. Chan: What's going on out there on the interview trail? What was your experience? Are some programs asking you, "Hey, we want to see you stitch," kind of like . . .

Carson: I'm lucky.

Dr. Chan: Okay.

Carson: No one asked me that. I've heard horror stories from other individuals who actually interviewed at places that I wanted to, but didn't get the opportunity to interview at, where they were taken into the operating room and . . .

Dr. Chan: Really? Wow, a lot of pressure on that.

Carson: Yeah, I don't know what I would do. I mean, I'm nervous enough sometimes.

Dr. Chan: Watch you scrub in as fast as you can.

Carson: Yeah, exactly.

Dr. Chan: Ooh, you missed a spot, yeah.

Carson: See, that's a trick though because you're supposed to spend a specific amount of scrubbing, so that's where they try and get you.

Dr. Chan: I'm sure all the doctors we've ever seen have always hit that mark.

Carson: Exactly, not at all. I want to say that someone was asked to tie, which is fine. I will say that if you're thinking about going to surgery, start now because it is a very perishable skill and sometimes when you're under pressure and people are staring at you, you are all thumbs and that's not good in tying suture.

But, you know, my experience on the trail was pleasant. It was fun. I met people from across the nation who I don't want to say were just like me, but we kind of had the same mentalities, had the same goals, and . . .

Dr. Chan: What kind of questions were the residency programs asking? Did they talk about what happened here in med school? Are they talking about, you know, your military service? Like what kind of things would come up?

Carson: Both. Kind of a mix. There were some interviewers at different places that, I don't want to disparage anyone, but it almost seemed as though that they had no idea who I was. And we did a very abbreviated, this is who I am, this is my story. One of the advisors here, I mean, I'm sure you know this, you know, you need to have, you know, a two-minute story about yourself . . .

Dr. Chan: The elevator pitch.

Carson: Yeah, exactly. So I got to practice my elevator pitch a couple of times. Some interviews only focused on my military service, which was great. I can talk about military service all day if somebody wants to hear about it. I'm sure they were yawning as soon as I left the room, but whatever. Very few actually asked about my medical school experience, actually.

Dr. Chan: Interesting.

Carson: I would get it seemed like generic questions. How's school been? What have you liked? What have you enjoyed? But then they'd come with a curveball. And it was just some of the toughest questions right out of the book. It's like they asked you the easy questions first just to . . .

Dr. Chan: Kind of soften you.

Carson: . . . kind of soften you up, and then it's . . .

Dr. Chan: Were they like, what is surgery?

Carson: What are your deepest, darkest fears? Stuff like that.

Dr. Chan: Oh, so it's more like . . .

Carson: No, that was like . . .

Dr. Chan: Oh, I started to say like, was it like surgical trivia questions? Like . . .

Carson: No. No pimping or anything like that. But, you know, what's your greatest weakness? And, I mean, we all sit back and talk, you know, think, well, if I'm asked this.

Dr. Chan: I work too hard.

Carson: Yeah. They don't want to hear that, not at all.

Dr. Chan: Spend too many hours at the hospital, yeah.

Carson: It seems like every answer I gave, which I was genuine and saying, you know, I think I'm weak in these areas, I would get push back, "That's not a weakness, that's everybody. What else?" Just like I have no idea how to appease you right now. That's how I feel, I'm sorry.

Dr. Chan: Well, to kind of transition, Carson. I mean, the match is a little under a month.

Carson: Less than that. March 20th.

Dr. Chan: How are you feeling? What's the emotional kind of . . . to me, like, as I talked to the students, it's just an emotional roller coaster, right?

Carson: It is.

Dr. Chan: And the internet is fantastic, but I think it just causes more panic on certain levels. And I'm sure you've checked out all these websites and, you know, and everyone in your classes, you know, who is also going into gen surg. So, like, how's it feel right now? What's going on?

Carson: So to be completely honest, I haven't really gone online.

Dr. Chan: Okay.

Carson: I've told myself it's going to be what it's going to be, and I don't need to worry myself. So I've kind of detached myself from that. Listen to the Dean of Student Affairs here and, you know, his pitch and the information that he's provided, the data he's given. And I found that satisfactory enough to be able to say, "I'll accept that, and that's great because I can't really change anything at this point in time." But you're absolutely right. It's a totally emotional roller coaster. Can't even say it right now, like choking up about it.

Something that I find interesting is that everyone's on that same roller coaster. It's just whether or not it's uphill or downhill at the same time. And occasionally you meet someone who's at the same spot. But it's nerve-racking, but at the same point in time, it's one of those things I can't do anything about it. So let me go read up on this anatomy so I can look okay in the OR tomorrow instead.

Dr. Chan: Are you the type of person that you allow your brain to like even entertain the idea that there is like a slim possibility you won't match, or do you not let yourself go there?

Carson: I'm the type of person that has a very large portion of my brain that will say, "You're not going to match."

Dr. Chan: Wow, wow.

Carson: Yeah. But again, what can I do? It would be very unfortunate if that were the case. I wouldn't say large. I'd say I'm about 60-40 right now, 60 I'll match, 40 I won't, which is frightening now that I think about it. But that much mental energy has gone to it.

Dr. Chan: But you start thinking about it then, but then, like, a part . . . to me like a way to kind of like modulate that is you have a backup plan. So are you the type of person that's just preparing yourself to like, "Oh okay, we'll I'm going to . . ." we call it the SOAP, the Supplemental . . . I can't remember.

Carson: Offer and Acceptance Program.

Dr. Chan: Yeah, okay, good. And are you someone that's like I just need to practice. I'll take anything. So you'll go to a different field that might be open outside gen surg? Are you the type of person like, kind of like in your past like you redouble efforts? Okay, I'm going to do more research and then redo the match next year and do gen surg for sure?

Carson: No, I have a plan, for sure.

Dr. Chan: Okay.

Carson: I am actually kind of the person who says, "Plan for the worst, hope for the best." So I am planning on SOAPing actually, and working towards that right now trying to make sure that my extreme phone speed dating skills are up and so that if I do get a phone call from a program, I'll be able to instantly turn on the . . .

Dr. Chan: The elevator pitch over the phone.

Carson: Yeah, yeah, exactly that interview switch with different letters and things along those lines, and then starting to kind of put together a plan of what happens after that, if that isn't successful. So there's definitely plans. I've definitely thought about it. But again, I don't want to get emotional or anything about it just because it's one of those if it happens, it happens. And I'll have a plan.

Dr. Chan: Well, Carson, what I know about you is you're a fighter. You're a survivor. You've accomplished so much. And again, I feel bad that like, this roller coaster is part of it. But you're going to be a great doctor.

Carson: It's life. I mean . . .

Dr. Chan: You're going to be a great doctor.

Carson: And I think that's something that I can . . .

Dr. Chan: You're in the worst spot now because it's ambiguous, and you're in this gray zone, and it's hard.

Carson: But, I mean, even really that same kind of emotional roller coaster has gone back. I mean, applying to medical school, am I going to get in? Am I not going to get in, right? I think that's some something that even medical school applicants experience. And suffice it to say is it doesn't go away, it just changes. So it builds character, that process. It builds character.

Dr. Chan: So does serving in the military and going on multiple tours just . . .

Carson: That's just fun.

Dr. Chan: Okay.

Carson: That's just fun.

Dr. Chan: Well, Carson, I really appreciate you coming on.

Carson: Absolutely.

Dr. Chan: Do you mind coming back on after the match and . . .

Carson: Sure.

Dr. Chan: No, not like the day of but like, you know.

Carson: Oh, I won't be here, so . . .

Dr. Chan: Have some time to process it, whatever happens.

Carson: Yeah, I actually won't be here for match day.

Dr. Chan: Oh, where are you going?

Carson: I'll be in Morocco.

Dr. Chan: For fun or for protecting our country in some roundabout way?

Carson: Yes. For anybody who is in the military who might be listening here, I don't want to sound very OPSEC-y. Sorry, I have to put that in there though.

Dr. Chan: Oh, thank you.

Carson: I will be in Morocco.

Dr. Chan: Okay.

Carson: Yeah.

Dr. Chan: All right. So they'll let you know via email then.

Carson: No, I've instructed someone to open my envelope and call me.

Dr. Chan: Okay. Do you have to like sign a form to give permission to someone or you just say, "Hey?"

Carson: I don't know.

Dr. Chan: Okay.

Carson: I mean, I told somebody with witnesses around that it was okay if they stole my envelope and call me.

Dr. Chan: And then they would call you immediately?

Carson: Yeah.

Dr. Chan: Okay. If it's 10:00 Utah time, what time is it in Morocco? Have you already figured this out?

Carson: I can't do math. I don't know.

Dr. Chan: I was just thinking you're going to get this phone call in the middle of the night, so, yeah.

Carson: No, it won't be in the middle of the night.

Dr. Chan: Okay.

Carson: Actually. No, it will not be the middle of the night. But it'll be fun. That will be great.

Dr. Chan: Well, Carson, I really enjoyed this.

Carson: Me as well. Thanks for having me.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school, a production of The Scope Health Sciences Radio online, at thescoperadio.com.

Dr. Chan: Why does someone decide to go into triple board residency program? How do you promote wellness and balance during a five-year residency program? What's the difference between West Coast swing dancing and the jerk and pull swing dancing found in Utah? Today on "Talking Missions and Med Student Life," I interview Dr. Powell, a second year psychiatry resident and triple boarder here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Missions and Med Student Life." I have a repeat guest back here, Dr. Powell.

Dr. Powell: Hi.

Dr. Chan: How are you doing?

Dr. Powell: I'm doing really well.

Dr. Chan: And you are in your second year of residency?

Dr. Powell: Yes.

Dr. Chan: All right. And you were on the podcast about two years ago, give or take.

Dr. Powell: Yeah, third or fourth year. Anyway, med school.

Dr. Chan: All right. So when you graduated, what did you go into?

Dr. Powell: I went into a combined residency program at the University of Utah. The three programs that it combines is pediatric medicine, adult psychiatry, and child psychiatry. And just to give you some perspective, in the country there are nine of those programs versus the 900 pediatric programs I could have chosen from if I had just gone into pediatrics.

Dr. Chan: Lot of pediatricians.

Dr. Powell: Yes.

Dr. Chan: A lot of pediatricians. Okay. And why did you want to do the triple board program? What attracted it to you originally?

Dr. Powell: So when I was on the wards during my third year of medical school, when I started medical school, I actually had written off psychiatry and pediatrics. I thought I was going to go into family medicine, maybe some geriatric medicine. And then as I'm getting on the wards, I just got more and more excited about kiddos and I'm on the pediatric wards. I'm enjoying talking to kids. I'm enjoying talking to teenagers and kind of keyword talking there. I liked the medicine but something felt like it was missing. And then when I did my rotation on child psychiatry, I realized I really like this but I don't want to leave out this medicine piece. I like these medically complicated kids. I like these kiddos who have a lot going on and they need somebody who can really dig in there with them and work on their medical and psychiatric problems. And so that's why I decided on a combined program.

Dr. Chan: Was it daunting to think that you needed to be like do three programs in one? Was that kind of exciting or . . .

Dr. Powell: It was. I think kind of like the decision to go to med school and then residency, you don't want to think about it too hard otherwise you can get into your head and kind of talk yourself out of it. I do get a lot of from attendings and other residents and other programs, "Wow, you're going to do three at one?" But for me, it just makes so much sense that they just naturally fit together. Right now I'm on child psychiatry rotations but I'm at the children's hospital and so thinking back to when I was walking around as a pediatric intern at the children's hospital and the things I was thinking and what I was concerned about and how I was getting things done, I can see the growth in a year. And it's so fun to now on the psychiatry side be supporting the medical teams. And I know what the medical teams need and the way they need it because I was there just last year.

Dr. Chan: So I want to talk about the jump. Like I have a theory and you can agree or disagree that the jump from undergrad to med school is pretty big. But I feel personally that the jump from med school to intern year is huge.

Dr. Powell: I would agree.

Dr. Chan: So I'm curious, what was your experience for your intern year? What did that look like? How hard was it? How stressful was it?

Dr. Powell: So I remember, wrapping up fourth year I did everything that I at least thought would be important to kind of wrap up and make my intern year easiest as possible. I ended up staying here at University of Utah. I was a medical student here so I was lucky enough I could stay in my apartment. That was nice. I took a nice, big vacation at the end of fourth year. I went out of the country.

Dr. Chan: Where did you go?

Dr. Powell: I went to Oaxaca, Mexico, and probably butchering that name still.

Dr. Chan: I just want to say the word Oaxaca.

Dr. Powell: Even when I was there for a month, I was still saying it wrong. But I went there and I did something totally and medicine related and loved my time. I'd never been to Mexico for an extended trip like that. It was fantastic. And so just a lot of the time, kind of like, "Okay, here we go." Once intern year did start, I think going in just knowing it's going to be hard, just expecting the hours to be long, just setting your expectations in a place that you're not going to be disappointed because I can't change the weeks. I worked 80 hours. What I can do is take care of myself on my days off and not get too down on myself and just be okay with the learning curve that I'm in. I actually I felt like I was putting more pressure on myself in retrospect than everyone around me was because I was an intern. I was a new intern.

It was July and everyone in the hospital in the teaching hospital knows that's when the new interns come in. So in retrospect, I actually could have asked for help a couple more times, even for things that I thought was really simple. But, yeah, it was hard but you kind of just get down and you do it. That was the biggest thing. When I asked for help, and then people would respond, it was lovely because then you felt supported and you knew where you could go for help.

Dr. Chan: Did you feel your tactic of trying to take a lot of intense fourth year electives, did that help you or it was just tough to say?

Dr. Powell: So I actually stacked all my intense fourth year electives in the beginning of my fourth year, all the required and electives that I had chosen and then I had a few earlier in the spring and fourth year and initially starting fourth year like my plan was to kind of work right up really hard, right up until intern year. And then I changed my tactic personally because I just realized I was going to be very burnt out on med school and if I just rolled straight in from hard things from fourth year to intern year I wasn't going to have the energy reserve I needed to get through that year.

Dr. Chan: That's why we needed the fish tacos in Oaxaca.

Dr. Powell: Yeah. That's why I was there. It was lovely. It was absolutely lovely.

Dr. Chan: All right. So intern year, what were your first . . . the entire year is pediatric, right?

Dr. Powell: Yeah.

Dr. Chan: So you're essentially a pediatric intern.

Dr. Powell: Yes.

Dr. Chan: What does that look like exactly? Like what kind of teams rotations did you start and what time were you going to the hospital? And how is this different than being a med student?

Dr. Powell: My first two weeks as an intern were actually on night flow. So I was arriving at 5:00 p.m. and leaving at 6:00 or 7:00 a.m. the next morning. So for the first two weeks that was quite a jump because already you're transitioning your sleep schedule and now you're trying to learn this hospital system as an intern, and you're doing it on nights where . . .

Dr. Chan: Things are closed.

Dr. Powell: . . . things are closed.

Dr. Chan: So what is the night flow? What does the night flow look like?

Dr. Powell: Yeah, so I was on what's called the hospitalist team. So the general medical teams in the hospital. So kiddos who don't necessarily need to be admitted to a sub-specialty team like gastroenterology or cardiology, instead are admitted to hospitalist teams. So kids are coming in with pneumonia or maybe babies with some weight loss that's unexplained. Just very general kind of bread and butter pediatric things that would be admitted to the hospital and it just happens to be that these kids showed up at night. So I'm the one admitting them with the help of my senior resident.

Dr. Chan: Okay, let's just say you weren't alone. Did you have a buddy to kind of . . .

Dr. Powell: Yeah. So there is a couple of interns. And then at the kind of the top of the pyramid, there was a senior resident that's overseeing these different interns. And then I don't believe that first two weeks we had medical students around. But then like the weeks next that I switched over to them, that's when the medical students started coming because when they were coming for the beginning of their third year for their clerkships. And then we also had our sub-I's for their fourth year showing up later in July as well.

Dr. Chan: And were you supervising the med students?

Dr. Powell: Not initially but by the end the second half of intern year, I was taking more leadership, at least with the sub-interns. The third year medical students were still supervised by the senior residents, but as an intern, I was given responsibility with some of the sub-I's because that's what they are. They're sub-interns. They're kind of be expected to be functioning at my level. So it's best to pair them up with a more experienced intern.

Dr. Chan: And would you say as an intern, you just had a lot more responsibility and a lot more duties compared to a med student?

Dr. Powell: Yeah. Occasionally as a med student, I remember looking at my interns or even my seniors, and I'm like, "Oh, I feel like they're ignoring me." And then once I was on the intern side, I realized, like, if we're ignoring you, it's not on purpose. We have one million things to do but only one of the one million is something that you can actually help with because the rest of them need that like MD signature or whatever it is pass off to make it happen. So yeah, I would that was also part of a learning curve is not only learning how to be an intern, but learning how to now supervise medical students when I was just one a year before. But I think by the end of intern year, you have your feet under you enough and you're able to start, especially if you have a medical student that shows up and is enthusiastic and wants to learn and help even if it's not something that they're interested in, but they're still like, "Nope, I'm here to work and learn." Those are the best students to rope into the team flow.

Dr. Chan: That's awesome. And did you get to pick what you did during the intern year or did they just kind of tell you?

Dr. Powell: Somewhat. The categorical pediatric resident, so those who are just doing a regular three-year pediatric program and not the combined program I'm in, they have a little bit more flexibility during their intern year than I do. But what I did get to choose, I did get to choose a couple of different four-week electives. I chose endocrinology, especially with kiddos with diabetes, that's a chronic lifelong illness. There's an overlap there with behavioral health and psychiatric care. So I wanted to see the medicine side of what those kiddos are experiencing. I also chose gastroenterology outpatient for four weeks. So a lot of what we would call functional abdominal pain, kiddos who are really anxious and maybe have other psychiatric issues and they end up not in a psychiatrist office but a gastroenterologist office because their presenting symptom has to do with their stomach.

Dr. Chan: The mind-gut link. Yeah.

Dr. Powell: Yeah, it's really powerful. So I wanted to see what is the workup, what does it look like when these kids do get sent to these specialists? And also those who do have, again, lifelong chronic illnesses that they will see a gastroenterologist for the rest of your life and whether they have premorbid or comorbid psychiatric disease, just kind of seeing what does it look like and how is it taken care of in these sub-specialty offices? So those were a couple of my choices that I had in addition to the work on the hospitalist teams.

Dr. Chan: And then did you have a clinic, an outpatient clinic?

Dr. Powell: Yes. Yeah, I have . . . it's called pediatric continuity clinic. It's a half day once a week and this is something that I'll do for my entire residency. And it's general pediatrics, so ages, you know, newborn to 18 and it's sick visits, you know, "I have a cold, is it pneumonia? And my belly hurts, is it something with my belly or is it something anxiety-wise?" I see teenagers for mood checkups. I see newborns that I met when I was in the Well-Baby Nursery as an intern.

Dr. Chan: The [WBN 00:12:01].

Dr. Powell: The WBN. And we hit it off myself and the parents and since they were planning on coming to the clinic I was already working at they chose me as their primary care provider, their PCP. And some now I've actually have a couple of kids that I've followed for every one of their well child checks from since they were born. Until now, they all just turned a year old a couple months ago.

Dr. Chan: So even if you're on a child's psych rotation, you still have your pediatric continuity clinic one day a week, an afternoon a week. That's pretty cool.

Dr. Powell: Yeah. It's a fun break, especially some days are hard on psychiatry. So it's a brain break to like, "Okay, I'm going to go do some well child checks. I'm going to see some of my healthy kiddos or even just do some quick sick visits and remind myself what a cough and a cold looks like and what looks sick and not sick in a child." And then vice versa. And a few years, I'll actually start my kind of a continuity clinic for psychiatry as well, then I'll be doing that in addition to my peds continuity clinic. And so then I'll be doing both of those no matter if I'm on the psych side of rotations or the pediatric side.

Dr. Chan: And going back to this combined program, so, like it's five years, how do you split up to three different specialties within the five years?

Dr. Powell: So there's an official document from the accrediting board nationally for these programs and that it's this percentage and this percentage of my time in pediatrics, this percentage of my time child psychiatry, and this particular percentage of my time in adult psychiatry. I forget the exact percentages. But what each program has done is crafted what they feel is the ideal schedule for getting exposure in a good order of now you're able to build your skill. So even though I'm switching from pediatrics to child psychiatry, I'm using my skills as a pediatrician but now applying it in my child psychiatry rotations and then progressively, just like with any residency program, you kind of do harder and harder things as you go on. And they've also they've kind of woven that through all three programs.

Dr. Chan: Okay. So it's very integrated.

Dr. Powell: Yes. Yeah. So you mentioned my intern year, that was entirely pediatrics. And that's for a couple of reasons. The way the U has chosen to do that is they want us to be able to get to know our pediatric cohort that is going to be here for three years and we'll graduate after three years, and then I'll be staying on for another two years. So they want us to have that kind of home base in pediatrics and feel like we belong there. Especially since they'll be turnover when by the time we're seniors. And also, I think, and I'm happy for this is that pediatric intern year is intense. There's a lot of hours, there's a lot of kids, and then at the program here, it's high volume. So you are seeing a lot of kids very rapidly . . .

Dr. Chan: Lots of kids in Utah, I've heard.

Dr. Powell: There's a lot of kids in Utah.

Dr. Chan: Lots of kids in Utah. Yeah.

Dr. Powell: So I think it teaches you not only good medicine as a pediatric intern, but just how to be a resident like it's very like here's this time intensive thing of like how to be a resident. So then when I make that switch, the first switch I made was to adult psychiatry my second year. So July of my second year I'm on adult psychiatry for the first time and I'm the equivalent of a psychiatry intern. But in that I'm new to adult psychiatry, but as far as my workflow and my and knowing the logistics and being able to get things done, I'm a second year resident. And so it's kind of fun because attendings, you show up and they're like, "Oh, I have one of the newbies," and they're like, "Oh, I have the second year newbie."

Dr. Chan: Yes, yes. I have a triple boarder.

Dr. Powell: Yeah. So it's kind of it's one of the . . . there's a couple of different switches that we make. And then when we show up and everybody is happy to see us because we're there and we're going to work hard and we already kind of know how the hospital works.

Dr. Chan: Yeah. How do you find balance? How do you find your wellness during intern year? How do you do that? Because I get the sense 60 to 80 hours a week . . .

Dr. Powell: Yeah, yeah, is a lot.

Dr. Chan: So maybe one day.

Dr. Powell: One day off.

Dr. Chan: It's usually not the weekend. It's usually like a . . . or it is the weekend? I don't know. Is it a random Friday?

Dr. Powell: It's usually like a random weekday. So the blocks that I was working six days a week, it was usually not a weekend that I got off. It was a weekday and then occasionally when I was on outpatient rotations I'd get one day or both days of the weekend off. And so you got two days off on a weekend, it was like, "Wow, this is what a normal weekend it is."

Dr. Chan: Yeah, what is this feeling I have? Yes, yeah.

Dr. Powell: So I looked at my schedule at the beginning of my intern year and I realized that a lot of my inpatient rotations were over winter break or like the winter season, I should say, and I realized I'm like, "You know what? I do like being in the mountains. I know how to snowboard, but I want to learn how to ski. I've been here for four years and this is now my fifth winter here. I want to learn how to ski."

And it was I would say a little bit of an ambitious goal for an intern to be like, "I'm going to learn how to ski during intern year." But once I realized some of my days off were during the week, I knew there'd be less crowds, less traffic, and the mountains are already so accessible. So I say that relatively like there's actually not that much of a time to get to the mountains here to go skiing. But I bought a pass and I was skiing on, I would say, most of my days off even if it's only for an hour or two because the rest of the time I wanted to sleep in or get some groceries, or anything like that, but just to get outside and experience something new. And so I prioritize that.

I really liked dancing. I'm West Coast Swing dancer and during med school I was doing it competitively. And I realized, "You know what? I want to try something new." And so I kind of put that on the back burner for a year. And it was a conscious choice because I knew I wasn't we have time for both. And since West Coast Swing dancing, most of the dances happened late at night and I was going to be on a regular schedule of getting up really early. That's kind of why I chose to like "Okay, now I'm going to like maximize my daytime hours and I'm going to maximize them outside since I'm going to be in the hospital most the time." So I switched. That's how I found the balance back here.

Dr. Chan: That's beautiful. What is West Coast swing dancing?

Dr. Powell: Yeah, it's a type of swing. Actually most people when people think of swing at least in this area, they like think of kind of what I call as like Utah jerk and pull because it's actually just like this like really . . .

Dr. Chan: Is that like where in front of businesses with those big inflatable people then like blows the air and goes like that?

Dr. Powell: No, it's lead and a follow, holding hands and it's like a partner dance.

Dr. Chan: Jerk and pull.

Dr. Powell: I call it the jerk and pole. It's this colloquial. It's actually like most people just call it country swing, but West Coast swing is actually the nickname. It's like the ballroom of swing because it's a smooth swing.

Dr. Chan: Is there an East Coast Swing?

Dr. Powell: There is an East Coast Swing. That's the one that most people know of. It's like kind of like more like Lindy Hop like you're like really upbeat or like the jitterbug. Those are all closely related. It's a lot more . . . there is swinging involved. But it's a lot more like up on your toes and fast whereas West Coast swing is you're actually flat footed and going really smoothly through the music.

Dr. Chan: And you do competitions?

Dr. Powell: I haven't recently, and again like I did a lot during medical school because I would get weekends off regularly and that's when the competitions are held. But as added intern year I was like, "You know what? Switching gears I'm not going to be able to compete this year. So let me like focus on a different hobby, something that I can do during daylight hours and not have to stay up late for." And then, during second year, I have gone to a competition or two not with the hopes of winning anything and I didn't. I fell horribly on my face because I was out of practice, but it was fun being there with my friends and reconnecting with my friends who I hadn't seen for a while.

Dr. Chan: That's wonderful. I had no idea you did that. That's really cool. And your second year in, any wavering, any doubts, like, "Oh, I really like pediatrics. Maybe I'll just switch and be a categorical pediatrician"?

Dr. Powell: It's usually . . .

Dr. Chan: So you know what I'm talking about?

Dr. Powell: Yeah.

Dr. Chan: Because it's a long program. It's five years.

Dr. Powell: It's a long program.

Dr. Chan: You straight [inaudible 00:20:07] grade on your pediatrics.

Dr. Powell: I might have more feelings like that, especially at the end of my third year is I see my pediatric cohort graduating, either moving on to being an attending in a general pediatric office or moving on to fellowship. I think it on my good days, which I would count today as a good day, I feel perfectly happy and content and I don't feel rushed that I have to make my next career decision. I'm happy just being in a space where my job is to just learn. And also I get to choose some rotations and things of things that I know that I might never see again. So I see it as a privilege to like learn and understand these different patient populations.

And so it's just cool to be in that space. Because once you're out of residency and fellowship, that changes. You're here, this is your specialty, this is what you're doing a little. I definitely on days where it's been long hours, I've had a really frustrating day. I definitely I'm not immune to the thought of, well, I could actually quit a year early and I'd still be done with pediatrics and adult psych. And then I could just like do one of those. Not necessarily combine them. I wouldn't have the child psych finished. But yeah, I have thoughts like that. And then I have another good day and I'm okay with it.

Dr. Chan: Okay. So it's like as long as a good days outnumber the bad you're on the right track.

Dr. Powell: Yeah. Yeah. And I mean, sometimes, and I have known there's people been in my program who made the decision like, "No, actually, this isn't for me. I have to make a switch." And it's hard. And med school, I thought it was impossible in med school. And so I didn't think that wasn't even a thing. But I've realized, you know what? If that does need to happen, you can make it happen. It's difficult. You might be behind, you might be starting over. There's a couple of people that I've known for my program that they finished their program and then they restarted as an intern in another program just because they like, you know what I got to do what's going to be best for me and what I want and what my goals are. And I realized the first choice I made wasn't the best one. That it's not common but it's not uncommon if that makes sense.

Dr. Chan: Yeah. People don't realize that from the outside that there is some switching that can happen within residency programs. It takes a lot of work.

Dr. Powell: It does.

Dr. Chan: Bridges might be burned a little. But, yeah, I mean, I think for a lot of students, they think that the residency is going to be like X and then they start doing the residency and it turns out to be more like Y. Like, "Oh, well, this is not what I envisioned for myself." So people sometimes can switch residency programs. People graduate residency programs, go and practice and then they get disillusioned or they want to do something else and they can . . . you can do two residency programs. A lot of people like my age who are thinking about going back and do another residency program. So to each his or her own.

Dr. Powell: Yeah, occasionally, also on bad days, in addition to just thinking like, "Okay, I can be done at this point in my residency and I'll have enough qualifications to work." I also have the thought of, "Oh, maybe I'll just go back to undergrad and do something totally . . ."

Dr. Chan: Yes. You might have to eat a lot of money.

Dr. Powell: They're going, "Yes, that's silly."

Dr. Chan: Yeah, it's debt thing. Yeah.

Dr. Powell: Let's pay off my debt first. That's when I start calculating how many years I have to work as a doctor and pay off my debt and then . . .

Dr. Chan: How many years would I have to yes, as not a doctor. Yes. All right, so Rebecca, like where do you see yourself practicing? Because I know you're from Southern Utah. So do you see yourself ending up down there or like what are your current thoughts?

Dr. Powell: There's a chance. As an undergrad, I did a lot of volunteer work in the Four Corners area of Utah, Arizona, Colorado, New Mexico. And I'm from St. George, the opposite end of Southern Utah. So I just liked that area and I like that space. I like that desert landscape and that's where a lot of my family is. And then as a medical student I spent more time down there in the Four Corners area for six weeks through my family medicine rotation and loved it again and actually just this week I am working with the schedulers on the adult psychiatry side to see how many weeks I can get down to the Four Corners area again for psychiatry rotation, so I keep being drawn to that area and making connections and networking down there. So I think that is a possibility I could end up there for at least.

Dr. Chan: What is it about Southern Utah that like excites you? Like what attracts you to it?

Dr. Powell: Initially, it's like I do have family there and so like that like special piece of like spending time there with my grandparents in the summers is always fond memories. It's just a beautiful area and I like kind of . . . I think I'm more of a small town girl. Like I like the pace down there. I think I already said this, I'm going to say it again, it's a beautiful country and I can just see myself working really hard during the week and then every weekend just enjoying going camping and being outside. Cost of living would be fantastic.

Dr. Chan: And there's a huge need because I remember when I'm on service, we get a lot of children, teenagers from Southern Utah. And we can treat them up here in Salt Lake but like for aftercare follow, there's not a lot of providers in Southern Utah.

Dr. Powell: And generally and at least for on the psychiatry side and the child psychiatry side, in the state of Utah, there's only two counties that have the enough child psychiatrists per capita. One is Salt Lake. We have an academic center here. There's a lot of residents and attendings that are child psychiatrist and the other one is Washington County, which is St. George, Utah where I'm from and the only reason they have enough down there is because they have one child psychiatrist in that entire area. So it would also be interesting for me because there is a small part of me that I'm like, "You know what? It would be cool to take care of some adults in psychiatric in a psychiatric capacity, have like some percentage of my practice doing that." And in Four Corners, so they're in Southeastern Utah since it's very limited, I would kind of be able to like write my own ticket as far as this is how many kids I want to see, this how many adults I want to see because I would be not it but I would be one of the few who could provide the kind of services that they need in that area. That's really needed.

Dr. Chan: Like what I've seen is you probably have like a really busy like inpatient outpatient consult, you'll probably do a lot of different things.

Dr. Powell: Yeah. I think there were a lot of different hats, which is kind of what's fun about residency so far and I haven't . . . all the switches I've made between the three programs, inpatient and outpatient pediatrics, adult and child psychiatry, nothing's really stood out is like, "This is the one that I absolutely love." I just kind of like it all. And I think that's part of the reason why I'm drawn to that area is I could see myself wearing a lot of different hats down there and enjoying it and maybe eventually I'll kind of narrow it down to one. But early on in my career, I see myself being very happy kind of blazing the trail. And then getting other people down there, whether it's doctors or PAs or NPs and just kind of building what they already have down there. And like just making it grow.

Dr. Chan: Yeah, sounds like building a really good infrastructure.

Dr. Powell: Yeah.

Dr. Chan: This is wonderful. It's beautiful. All right, I guess last question, Rebecca, any advice? I love this question. Like anyone who's listening who might think they can't do it or is thinking about . . . they love this idea about triple board and they're not sure if they can do it, if they're not sure they can go on to med school or residency, what would you tell them? What advice would you give them?

Dr. Powell: I would tell them that at least explore it. And that means different things for different levels. For me as a premed, I was actually a finance major. And when I decided, "You know what? Maybe I want to go into medicine." I was a junior in my business program. So I went and found the office at my undergrad that was known for helping kids get into medical school. I said, "What should I start doing?" And they said, "Take this seminar, meet these doctors, come look at these guest speakers, start volunteering here, see if you even like it, expose yourself to it."

So I started volunteering in different hospitals just to get exposure to be like, "Okay, I like the idea, but do I actually like being there in the space?" And I did. And then the same with medical school, like I said, at first I didn't think I was going to do kids or psychiatry, but once I was exposed on the clerkships, I realized I really did like. And also there was a lot of pressure I feel like during first and second year of med school to be like to already know what you want to do because then you can go join student interest group. You don't know what you want to do. If you have a slight interest in something, go join that student interest group. Go listen to that guest speaker, go get that free meal, which is the best part of that . . .

Dr. Chan: Free meal, that is the best part of med school. Yeah, all the free food.

Dr. Powell: Just to hear and listen and like ask questions. And then just really take advantage of anytime that you have assigned clinical duties anywhere, whether it's a clerkship or a different class or something like that. Just really understand like, "Okay, this is a specialty I'm going to go see. This is what I'm seeing. Is this inpatient or outpatient? Is it community based? Is it hospital based?" Just really pay attention because something might grab your attention that surprises you.

So allowing yourself to be exposed and being open to something that does grab you and then when it does just start asking around like, "Hey, who do I talk to about this?" Because that's what the reason that the doctors and residents and people that work here were curious because they like part of that teaching and that mentoring environment. That's just part of it. And so being able to after you find kind of an interest even if it's just a slight interest, you can just ask. Start asking.

Dr. Chan: Rebecca, I'm so glad you're here. I'm going to have you come back . . . I want you to come back every year to give a little updates.

Dr. Powell: That's be great.

Dr. Chan: Even though, yeah, Southern Utah totally need you, like I hope you like stay in practice here and join us.

Dr. Powell: I might. I might. Even though I said I'm small town, Salt Lake's really grown on me. So there also is a part of me that might stay here. I'm in my second year so I have exactly three and a half years, not that I'm counting, left before I have to graduate.

Dr. Chan: Make that decision about where you're going to practice. Cool. Well, thanks, Rebecca.

Dr. Powell: Thanks, Dr. Chan.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio online at thescoperadio.com.

Dr. Chan: What's it like to move from the East Coast to the stunning Rocky Mountains of Utah? How does one decide to become a pediatric endocrinologist? Why is there such a demand for creating exceptional learning experiences and excellent educators in medicine? What is the Bills Mafia, and how does one associate with the Bills Mafia? Today on "Talking Admissions and Med Student Life," I interview Dr. Kathleen Timme, an attending physician in pediatric endocrinology here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." I've got Dr. Timme. How are you doing, Dr. Timme?

Dr. Timme: Great. Good to be here.

Dr. Chan: And so you're actually an attending physician, and what field are you in?

Dr. Timme: I'm a pediatric endocrinologist.

Dr. Chan: So take us back to medical school. How did you end up becoming a pediatric endocrinologist? What did that look like? What was your decision-making process?

Dr. Timme: So I actually was exposed to endocrine in undergrad. I took a bio-elective in endocrinology, and I thought it was one of the most interesting things I had learned about. I think the hormone pathways are really intuitive and just kind of fascinating with all these feedback loops. So I was exposed to the content kind of early on. And then at my medical school, our pediatrics department chair was an endocrinologist, and I really admired her and was able to spend some time with her in clinic and just liked that you could be a subspecialist but also have really good continuity and good relationships with your patients. For me, I see most of the kids that I treat every, you know, three to six months, so sometimes even more often than their general pediatrician. And I like being a subspecialist. I like knowing a lot about a more narrow arena but still feeling like I treat a lot of different conditions. I see a good variety of patients, so it keeps it really interesting.

Dr. Chan: When you mentioned the hormone pathways, I barely remember those. I remember there was a lot of arrows, you know, like TSH, you know, a lot of feedback loops and things like that. So you felt that came just naturally to you during school?

Dr. Timme: Yeah. I just thought it was really fascinating how the body works with these feedback systems and kind of keeping everything in checks and balances, and I thought it was really intuitive.

Dr. Chan: Now you went to med school back East. Where were you at?

Dr. Timme: I was at the University of Buffalo.

Dr. Chan: Okay.

Dr. Timme: And I'm from Buffalo, so that was my hometown school.

Dr. Chan: And then as you started looking at residency programs in pediatrics, how did you wind up in Utah? I mean, like, walk us through that. What was that like?

Dr. Timme: Yeah, so I made a stop in Connecticut before coming to Utah. I was in Buffalo both for undergrad and medical school, grew up in Buffalo, so really thought that it was time to, you know, experience living somewhere else. And I was looking for, you know, a medium-sized program that was close-knit, with great academic opportunities and ended up really falling in love with the program at Yale. So I went there for a pediatrics residency and started some really interesting projects in medical education that I wanted to see through during fellowship, and ended up staying there for endocrine fellowship as well.

And then after that, I realized I've only lived in the Northeast, and I really only knew Yale's way of practicing pediatrics and endocrine. And I always admired physicians who had kind of diversity in their training, experienced, you know, different ways of practicing, and I wanted that for myself. I didn't want to just stay in one institution. I wanted to kind of, you know, expand my horizons, see what else was out there, and also just personally experience living in another part of the country. By that point, I had met my husband who lived in Colorado during grad school and Arizona and New Mexico before we met in Connecticut, and he was really itching to come back to these mountains and it just took, you know, an interview trip out here to see what he meant by that. And I think Utah fits us really well in terms of our hobbies and hiking, camping, running and being able to be outside all parts of the year.

Dr. Chan: So you did all of your training back East and then you moved out West to become an attending physician.

Dr. Timme: I did.

Dr. Chan: Wow. It's a huge jump. Yeah.

Dr. Timme: So my first job after training was here. So it was a big move. I didn't really know much about Utah, Salt Lake, and, you know, I just kind of sent a cold email out this way, seeing if there was any opportunities available. And then, as I got further into the process, I realized I had a lot of, you know, mutual colleagues with some of the people here, and it's been a really nice fit so far.

Dr. Chan: And your passion for education, what I heard is that it started in med school, but also continued throughout your residency training.

Dr. Timme: Yeah.

Dr. Chan: What kind of opportunities did you have as a resident to be involved in teaching and education?

Dr. Timme: So I've always really loved teaching. I grew up in a dance studio. I loved kind of teaching the younger dancers, and there were even points where I thought that I might become a teacher instead of a physician. But in residency, my favorite part of interning was always having a medical student on the team because I felt like I finally had a piece of knowledge to share, and it was just really exciting to be able to share that and also for, you know, the few students that ended up going into pediatrics after rotating with us, it was just a really neat experience to watch somebody go through that process. So during residency, I got involved in the GME. I sat on a subcommittee for the executive subcommittees, so I got to see a little bit about what happens behind the scenes in curriculum development and program structure, which I thought was really interesting.

Dr. Chan: And GME is Graduate Medical Education?

Dr. Timme: Graduate Medical Education.

Dr. Chan: So UME is Undergraduate Medical Education, that's like medical school, and GME is like the residency afterwards? Okay.

Dr. Timme: Yeah. And then through networking, I was able to sit on the LCME faculty subcommittee later on in residency and just kind of see what process was like to review a medical school curriculum, which was really neat. And I just always connected with the people who were in education. I thought they were enthusiastic about the same kind of things that I was. And, you know, it just kind of blossomed from there into a research project and fellowship, and then I decided to pursue my master's in education at that point.

Dr. Chan: Wow. So you were able to get a master's in education while back East or . . .

Dr. Timme: Yeah, so I'm in the process . . .

Dr. Chan: Oh, you're still in the process, okay.

Dr. Timme: Yeah, from doing the Cincinnati program, the online master's, and I have 2 more courses of 10 left. So I was able to start it in fellowship, and I'm still working through it.

Dr. Chan: Okay.

Dr. Timme: Yeah.

Dr. Chan: And then, Dr. Timme, like, because I think back to my, like, a lot of my peers, you know, we graduated med school, and, like, I had this core group of friends, I don't know, like all of us who just love kids, a core group of us went into pediatrics. I went into child psychiatry. But I remember very clearly that all my friends who went to pediatrics, they were very excited about doing a fellowship one day, and then bless their hearts, residency was just long, it was hard, and most of them decided not to do a fellowship. So did you ever waver in this endocrine dream, or were you ever tempted just to become a general pediatrician and just . . . Do you understand what I'm saying, like . . .

Dr. Timme: Yeah, I understand what you're saying.

Dr. Chan: Yeah, like, how did you weather that? How'd you get through that? Like, what did that look like for you?

Dr. Timme: I mean, I think the temptation is there to stop training and finally start your life, but I was just so enthusiastic about the topic and I liked endocrine so much I even thought about OB/GYN and reproductive endocrinology and infertility. So for me, that was as important as the pediatric side of things. And I also really enjoyed my residency training. So I, you know, enjoyed the relationships that I made. I loved being in New Haven. I loved learning and taking care of kids. So I think sometimes there's also a temptation in the other direction too, like I just want to keep being a trainee for a little while longer and then, you know, face the real world after that.

And I just . . . for me, I have a ton of respect for anybody who practices more general fields, general pediatrics, but I would have been very overwhelmed having to know a lot, you know, about everything. I feel like pediatricians are the great gatekeepers to everything else, and I think I would be afraid of missing something or, you know, not knowing enough about every system or every possible thing that a patient could come in with.

Dr. Chan: So the fellowship is it . . . How long is it?

Dr. Timme: Three years.

Dr. Chan: Three years. And it was it all clinical, or was there some research or some education time built in or . . . What did that look like at Yale?

Dr. Timme: Yeah, the first year typically is heavily clinical and then the last two are a little bit more research-focused. I was the only fellow my year, so I had a very heavy clinical first year and kind of a mix of both in my second year. But by the third year, it was more research-focused and just kind of keeping up with some clinical activities. So, actually, it was a pretty intense first year, but after that, I had a better work-life balance.

Dr. Chan: And then you kind of mentioned at the beginning about that when you came out here to Utah, I mean, when you . . . I mean, this is a great conversation, because I talk to students about this, like, when you signed your first contract, when you were able to kind of become an attending, when you had a, you know, a very clear voice in what your career was . . . what you wanted it to be, like, how did you negotiate that? I mean, what did you ask for? I mean, because I assume that you could ask for more inpatient time or more outpatient time. Or did you ask for, like, you know, if you felt affinity for like, more, like diabetes, as opposed to thyroid issues? I mean, what did that look like? I mean, how did you do that as a fellow coming out to a new area, a new program, and how did you negotiate what you wanted?

Dr. Timme: Yeah, it was definitely a very foreign skill set. I think we're not used to asking for anything other than admission and acceptance and . . .

Dr. Chan: Yeah. We're kind of coached just to take it.

Dr. Timme: . . . you know, "Please just let me come and join the team."

Dr. Chan: So I think a turning of the tables.

Dr. Timme: Yeah, it was a very interesting, you know, process interviewing. Definitely turns the tables and, you know, feeling like you're being recruited or that you're a value to a program rather than, you know, the other way around was really interesting. So for me, my number one priority was having some time to work on medical education-related projects, specifically on helping people develop teaching skills. So any program or any, you know, potential place that didn't offer me those kind of opportunities in the near future, I kind of shied away from. And so that's one of the main reasons why I came out here because there were some really interesting opportunities to get involved, both on the UME and GME side, around training people how to teach. So that was my number one priority.

And then I really liked doing both general endocrine and diabetes, and some endocrinologists or some institutions really divide the two. But especially early on, I didn't want to lose either skill set, so it was really important that I had clinics on both sides and I enjoyed both sides equally. And then also a good mix of, you know, inpatient and outpatient without too much inpatient time, because that can be pretty exhausting.

Dr. Chan: So you mentioned the teaching. So tell us about the Students as Teachers Pathway. Was that already kind of being formed before you got here, or were you kind of the original force behind it? Like, how did that work out? And like, you know, just help people understand what that is.

Dr. Timme: Yeah. So the Students as Teachers Pathway is a really unique longitudinal experience for medical students to be exposed to some of the skills involved in being a clinician-educator. So the idea is that after medical school and even during medical school, we're tasked with teaching our peers, patients, colleagues, and eventually trainee students without much formal training on how to do so. I think medical schools now are a lot more mindful to that. But the pathway is for students who have this particular interest. I think it attracts people who have had experience in teaching and really want that to be a part of their career.

So it's a four-year program. The first couple years are based in these workshops and sessions. There's four every semester. We try to keep them very interactive and help, you know, build a teaching skill set. We also have our students teach in front of a classroom and get some feedback on that. So it's a nice way to sort of practice those skills. And then, as of right now, we just have first years and second years because it started two years ago, but eventually, in the third year, we hope to do more experiential learning alongside the clerkships, and then everything will culminate in a capstone education project where students identify a mentor and are really just trying to create an educational intervention and assess its impact. Their projects are very interesting. I'm very impressed.

Dr. Chan: So could you give me an example what kind of projects they're working on?

Dr. Timme: Yeah, so I'm working with one of our students on evaluating what an exceptional learning environment is through focus groups with students. We have other students who are doing more community-based projects where they're, you know, interacting with students from high schools or elementary schools and people in the community trying to teach on different topics. And a lot of it is tailored to their own clinical interests. So if someone's interested in pediatrics, they might take more of a pediatrics sort of flavor.

At this point, our second years are mostly developing project ideas and identifying mentors, so I haven't seen any through to completion yet, but it's, you know, very interesting. And the pathway started . . . it was developed before I came here, so I co-lead it with a neurologist. And he was working with one of the pediatric chiefs to develop the program, and then she ended up going to another institution. So right around the time that she was leaving, I was coming in. And so I took on kind of the co-director position.

Dr. Chan: When I talk about admissions and talk about our med school a lot, I would say a lot of our applicants and a lot of our students are very interested in teaching in an academic health center, first of all, kind of a career, but also just becoming better teachers. And I've talked about the Students as Teachers Pathways, you know, like teaching is a skill, like you said, and can we teach the students to become better teachers. And it seems to be really popular, and the students, it seems to really resonate with them. And I feel the students have very strong opinions about the quality of their education and who's a good teacher, who's not a good teacher.

So I think that's an excellent opportunity to challenge them, "Okay, you're going to be in front of the class one day. You're going to be in charge of that small group one day. You're going to be leading the clinic and teaching in the clinic one day. How are you going to do it?" I think that's a great impetus for like, change, because I think the students are fairly opinionated about this stuff. Like, does that match with what you see on your end? Yeah.

Dr. Timme: Yeah, I mean, I think even on the GME side, too, there's just more and more interest in becoming good teachers. And I don't know if that stems from kind of who your role models are. So in medical school, we look up to, you know, really great teachers, and I think the same thing in residency training, we really admire the people who teach well and teach effectively and I think we try to model our careers after them. I think that's some of it, and then also, just trying to create some balance in life. So I think people recognize that having a career that's 100% clinical can be really tiring. And for me, I like that every single day is different. I like that I can come and be here with you and then go to clinic in the afternoon. It's just a really nice way to keep my days interesting and keep me motivated and excited on both fronts. And I think the students are seeing that too.

Dr. Chan: If you can identify one thing that students struggle with as they become teachers, what do you see as a common theme? What do they have to work on?

Dr. Timme: I think it's something that we all have to work on, but more of like imposter syndrome, like feeling as a learner, how do you have something to offer? How do you have something to teach a group, and realizing that we're all just acquiring these micro-skills as we go and we do have things to offer and things to teach and even just different ways of approaching things. So I think some of it is just having the confidence to realize that you have something to offer and being able to do that. So I hope that our pathway gives them a safe space to kind of practice some of those skills and receive feedback in a constructive and kind way, so that they feel even more confident when they have residents to teach.

Dr. Chan: Yeah. I love what you said, Dr. Timme, because when I think about it, you know, what do we do as doctors, I mean we teach our patients about their bodies. I mean, my own personal philosophy in a perfect world, you know, everyone would go to med school, everyone would learn about their bodies, and we would take care of our bodies and things like that. You know, it's obviously not set up that way. So a core group of people, you know, go on to health science careers, and to me, they educate, they teach people about their bodies. And to me, that's what you do when you go in to see the doctor. Oh, you learn about your body, and you learn what's working well or not so well. You learn about this medication or that procedure.

And to me, medicine, the health sciences, it's like an educational endeavor. And, you know, I teach in our med school, I can always become better, but I like what you said. It really resonated with me because when I interact with students, sometimes they have this, you know, imposter syndrome. They don't believe they should be here. And I challenge them, like, "Look, look how much you know compared to like a year ago" right? "Look how much you know compared to two years ago. You have so much knowledge. How do you communicate that? How do you share that with others?" So I just love what you're doing. I love this teaching pathway that you're creating. It's beautiful.

Dr. Timme: Yeah, it's really fun. It's, yeah, one of the most exciting things I do.

Dr. Chan: Okay. So a couple of questions before we wrap up. These are kind of fun and silly. So the silly one is anytime I meet someone from Buffalo, I just have to ask about the Bills. So how many games you've been to? Are you part of the Bills Mafia? Do you know what I'm talking about?

Dr. Timme: I do know what you're talking about. I hope nobody from Buffalo is listening because I will not do the city justice, but, I'm, you know, an associate of the Bills Mafia. I'm not really a football fan. I don't have cable. I don't really watch games on weekends. But my brother is definitely like a rank and file member of the Bills Mafia. He's had season tickets since high school. He lives in Minneapolis and flies home for games and . . .

Dr. Chan: Wow. And for people who don't know what the Bills Mafia is, can you explain it to them? Because I have this image, but I'm not sure this image is the correct image, so . . .

Dr. Timme: Yeah, I mean, it's just the cult that follows the Buffalo Bills, you know, rain or shine, good or bad. You won't find truer fans than Buffalo fans.

Dr. Chan: And also I get the sense just watching clips online, they tend to get really rowdy pre- and post-game to the point where like, they're intentionally, unintentionally hurting themselves because they jump into tables. That seems to be a thing.

Dr. Timme: Yeah, jumping on tables. I mean, the tailgate is, you know, even more important than the game, so it's just a full day.

Dr. Chan: Does your brother jump on the tables?

Dr. Timme: You know, he probably wouldn't be the one jumping on the table.

Dr. Chan: Because it seems really dangerous.

Dr. Timme: But he might be, like, videotaping people jumping . . .

Dr. Chan: Cheering it on.

Dr. Timme: Yeah. He definitely would be a part of it.

Dr. Chan: Okay. And then in a more serious question, like, talking about diabetes. I'm just curious, like, what do you see with kids and teenagers nowadays with their diet? Is it getting better? Is it getting worse? I read about these insulin shortages. I mean, what's your take on all this?

Dr. Timme: Yeah, that's a difficult question. So, you know, in terms of type 1 diabetes, I think things are headed in the right direction. So there's definitely a lot more technology for patients and families to take ownership of their condition. There's continuous glucose monitors now, whereas, you know, not that long ago, the only way we could check glucose was through urine test strips. So we have a lot more real-time data, which I think allows us as clinicians to make more informed choices about insulin dosing and make more meaningful changes. And then insulin pumps, I think it really revolutionized things where you're able to just take a little bit more control of the diabetes and also go about living your regular day-to-day life. So I think, in general, things are getting better. There's definitely an increase in type 2 diabetes, and I think that's related to the fact that kids are more sedentary than they've ever been, you know, spending more time in front of the TV and less time outside . . .

Dr. Chan: So you see more type 2 in kids?

Dr. Timme: More type 2. Yeah.

Dr. Chan: Okay.

Dr. Timme: And, you know, even a fair amount of it here in Utah, so . . .

Dr. Chan: Is that reversible if the children eat healthy and exercise and lose weight? Because I remember learning about that with adults that, you know, there's, again, I'm not an endocrinologist, so I use very poor terms, but like there's this zone, where it's kind of reversible, if there's some things that start happening and like, you know, you can take the Metformin, but then kind of back off before you're full-blown on insulin-dependent. Is there still, like, a zone or . . .

Dr. Timme: Yeah, with type 2, I mean, there's still hope in coming off of insulin. So by the time I see kids with type 2, we're probably having that conversation about starting insulin and doing full teaching on diabetes, but with lifestyle modifications, a little bit of weight loss, exercise, oftentimes they can come off of insulin and maybe just maintain things on Metformin, or, you know, completely off of everything. So, yeah, but doing that is easier said than done.

Dr. Chan: In the past when I've talked to you, I've made jokes because as a child psychiatrist, I manage kids' diabetes from time to time inside Uni when people get a med for more of a psychiatric reason. I think it's really hard. I mean, I've seen, you know, because when you think about teenage adolescence and wanting to be your own person and having control over your life, and not all teenagers, but there seems to be this core subset, where this control issue kind of spills over into diabetic food control. And I think it's really rough. It's really difficult growing up, and again, like, everyone, I mean, people making choices, some people are making bad choices, and then just throw in this pretty serious disease and this need for constant management, it could be really combustible at times. So I don't know if you've seen that on your side at all, like, this control issue where teenagers kind of get into it with their parents and the diabetes, then it's kind of on the table to kind of manipulate or argue or fight over. Have you seen that at all?

Dr. Timme: Absolutely. And I think that technology, you know, also plays in an interesting way. So some of the continuous glucose monitors parents often have a share app where they can see where is the blood sugar. So then you also have, you know, adolescents who are trying to be independent and responsible for their health care, who are maybe out at a friend's house and then their parents are texting or calling saying, "Hey, I see your blood sugar is high. Did you forget your insulin? What's going on?" So it just creates a very interesting dynamic.

Dr. Chan: Fascinating dynamic. So the parents not only are monitoring their kids kind of, like, you know, "What social media sites are you on?" but they're also monitoring your glucose levels. It's fascinating.

Dr. Timme: Yeah and, "Did you give your insulin?" so . . .

Dr. Chan: Wow. So what's your official position? Like, should parents have access to that information? Should they have the app? Or are you kind of agnostic when it comes to this or . . . Or is that a complicated question?

Dr. Timme: I think it's an individual decision. I think for younger kids, it's very helpful for families to have that share app both for their peace of mind and for safety. So in the middle of the night, if their blood sugar's headed low, you know, for a parent to know about that I think is really crucial. But then I think there has to be this thoughtful, letting go process that the endocrinologist should ideally be having conversations with the families about, where you're sort of giving the child more and more responsibility and you're doing less of kind of the hovering and watching over things, and maybe just using that for spot checks every once in a while to make sure that they're doing what they're supposed to do. And certainly, if things are headed in the wrong direction, and you know, when they go to the doctor's office and the A1C is high and we can see on their downloads, whether or not they're bolusing, giving their insulin, then maybe that's time to negotiate some closer supervision.

Dr. Chan: Dr. Timme, I'd love to talk about this. So my last question and like, so, you know, teenagers are very good at, you know, there's parental controls, right? And teenagers can kind of get around those to access websites they shouldn't or whatever. Have you ever seen a teenager, like, I use this word loosely, "hack" the app? Have they been able to manipulate the data in a way? Or is that . . .

Dr. Timme: No, I haven't seen that. So there's two versions of the app.

Dr. Chan: Okay. Interesting.

Dr. Timme: There's the app that the patient downloads, and then there's the share app that the families download, so they're separate and on separate devices. I haven't seen anybody go in and delete their parent's app or something, but I wouldn't be surprised if that happens.

Dr. Chan: Okay. Well, I hope we didn't give that idea to anyone out there. I'm just curious. Because the reason why . . . I'm bringing it all back. The reason why I love medicine is that it's like the intersection of really cool science with people. It's like humanities combined with the scientific knowledge. And, you know, diabetes, insulin, it sounds like it's grown by leaps and bounds, you know, a lot cooler technology, a lot more knowledge. But at the end of the day, you're still interacting with people. And then teenagers and families and dynamics and communication, expectations, things like that. So that's why I love being a doctor, because it kind of combines both those spheres. And that's what I'd like to teach the students because I think they get at times overly focused on the science and I, like, "Well, your science is only as good as people who take the medication or do these things. And there's still this free will and humanity aspect to it."

Dr. Timme: Right, I mean, even with all this technology, we're not making big strides in A1Cs or diabetes control because there is that human aspect to it, which is the most challenging part but also some of the most exciting to navigate.

Dr. Chan: Okay. Well, Dr. Timme, thank you so much for coming on the pod. I think we'll be talking to each other soon, maybe on a future podcast.

Dr. Timme: I hope so.

Dr. Chan: But this has been great. Thank you.

Dr. Timme: Thank you.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.