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Interviewer: Amyloidosis is a rare and possibly debilitating disease, which affects about 4,000 people a year in the United States. If left untreated, the disease can cause severe organ damage, so early detection is critical. Dr. Aman Godara is an amyloidosis specialist at Huntsman Cancer Institute. Dr. Godara, first of all, what causes this disease?

Dr. Godara: So amyloidosis is a rare and complex disease where a protein misshapes itself, becomes the amyloid protein, and then deposits in different organs of the body causing damage.

Interviewer: So it collects in different organs?

Dr. Godara: Correct.

Interviewer: And for each patient, it could be a different organ. It could manifest itself differently.

Dr. Godara: The type of protein that's behind amyloidosis could affect what type of organ is involved in the body.

Interviewer: And the diagnosis for a lot of patients can be kind of an aha moment because it can manifest in different ways. Somebody could be experiencing some sort of abdominal pain and just really can't track down what it is, and it ends up being amyloidosis. Explain that a little bit more, that aha moment.

Dr. Godara: So the diagnosis of amyloidosis can be very challenging because, as we mentioned, there are several different types of protein that can cause several different manifestations in the body.

So usually, when a patient is being diagnosed with amyloidosis, the diagnosis requires a biopsy of an organ or a tissue in the body that we suspect would be involved with the amyloidosis.

There have been some newer developments in diagnosing amyloidosis, and that's the type of a nuclear scan that we have started using to diagnose a type of amyloidosis that we call as the ATTR amyloidosis.

Depending on the type of organ that's being damaged by the amyloidosis, the symptoms could vary along. If someone's heart is being damaged with amyloidosis, usually patients with heart damage from amyloidosis experience shortness of breath, they experience swelling in their legs, and when they go to see a cardiologist, they are usually identified to have heart failure.

When amyloidosis affects the kidneys, it can cause leakage of protein in the urine, which can manifest itself as a form of urine. Sometimes patients with amyloidosis have involvement of their nerves and that can manifest as painful neuropathy involving their arms or their legs.

Interviewer: So when somebody is experiencing some of those symptoms, they might go to their family doctor, right? And it sounds like this could be a lot of different things. Is it pretty easily misdiagnosed at first?

Dr. Godara: As the diagnosis for amyloidosis is so challenging, misdiagnosis occurs often because the type of symptoms that come along with amyloidosis can occur from other diseases and other conditions.

If a patient is experiencing symptoms of heart failure, that could manifest from a different number of reasons. When patients have kidney dysfunction, that can also occur from a list of different conditions that can damage the kidneys.

So often at the point of care, when these patients are experiencing symptoms that might be related to amyloidosis, the patients end up seeing multiple different types of specialists before they are diagnosed with amyloidosis.

And there are certainly some delays in diagnosis that, on an average, patients take 6 to 12 months to be diagnosed with amyloidosis from the time their symptoms start.

Interviewer: And that's important because time is really important with this diagnosis because the damage to that particular organ keeps occurring.

Dr. Godara: The damage from amyloidosis is progressive damage. So the longer we are taking to diagnose amyloidosis, the more damage would occur in that organ that's being affected by this disease. So timely diagnosis is of utmost importance.

Patients who are diagnosed earlier in the course of disease might have damage to that organ that could be reversible at that point. But ultimately, if we miss a diagnosis, and it takes a really long time for a patient to be diagnosed with amyloidosis, that damage to the kidney or to the heart could end up being an irreversible damage that even treatments would not be able to recover from.

Interviewer: That's really challenging because as a person that has a condition, sometimes you have to go through some multiple diagnoses to figure out what it is. Is there any piece of information that a patient might have that would indicate earlier than later that it is an amyloidosis?

Dr. Godara: So patients who are suspected to have amyloidosis usually require a comprehensive evaluation to identify the type of amyloidosis and to identify the manifestations of it. So the workup depends quite a bit on the type of amyloidosis that we are suspecting.

If we are suspecting lichen amyloidosis, that occurs from the excess of lichens, the first and the foremost test that we perform for those patients are blood and urine testing to identify if they have an excess of lichens, which could ultimately be causing amyloidosis.

If patients have an excess of immunoglobulin lichens in their blood or urine, the next step for those patients is to have a bone marrow biopsy to identify any clone in the bone marrow that might be producing these excess lichens and ultimately the amyloidosis.

The other type of amyloidosis that we commonly see is the ATTR amyloidosis, which occurs off a defect in the transthyretin protein that is being produced by the liver. Patients who have ATTR amyloidosis could either be patients who have developed this type of amyloidosis because of old age or this could also be the type of amyloidosis that runs in the family.

So if we are suspecting a patient with ATTR amyloidosis, and we suspect that they have some cardiac damage from it, there is a nuclear scan of the heart that can help us identify this type of amyloidosis. This scan is called as the PYP scan. Patients who have a more genetic form of ATTR amyloidosis, we have genetic testing that can be done either through a swab or a blood test that can help us identify the hereditary type of ATTR amyloidosis.

Interviewer: How reliable are these tests?

Dr. Godara: When patients undergo evaluation for amyloidosis, the blood and the urine testing usually helps indicate whether or not there is any damage that's occurring to the different organs in the body that we would suspect in a patient with amyloidosis. So they only tell us to a certain extent.

Ultimately, patients would require either a tissue biopsy or an organ biopsy to see that amyloid accumulation happening in that organ to have a confirmation of this type of diagnosis.

Interviewer: Many patients find information on the internet when it comes to this disease that can cause anxiety and apprehension. Why is that?

Dr. Godara: I think the answer to that lies in the complexity of the disease. When patients look up amyloidosis, one thing that they might not know at that time is the type of amyloidosis that we are suspecting that they have.

The workup for amyloidosis, the treatment for amyloidosis, and the prognosis of amyloidosis depends a lot on the type of amyloidosis that they have. So the information on the internet might not be very accurate to the fact to the type of amyloidosis that these patients have. And the generalized information can create a lot of confusion and apprehension.

Interviewer: So somebody could find out they have amyloidosis but not exactly know what kind, go to the internet, start doing some research, and then that can be scary place.

Dr. Godara: I think that's correct. When we see patients who are referred to us for amyloidosis, patients have very limited knowledge as to what this disease entails and why this diagnosis is being suspected. So my job for my patients is to explain to them why the suspicion exists, and what do we need to do to identify whether or not they have amyloidosis.

The information that's available for the patients before they have completed the evaluation could be very generalizable and might not be important to that type of amyloidosis that they have.

Interviewer: And let's talk about treatments for the condition. So you have a positive diagnosis, you know what kind it is, you know what it's impacting, I would imagine that the treatments that you would give depend a lot on the same kinds of things we've talked about up until this point.

Dr. Godara: So as there are so many types of amyloidosis that can inflict damage into the body, the treatment basically depends on the type of amyloidosis. So there have been a lot of developments and a lot of exciting work has been done for patients with amyloidosis in the last few years.

So when we see patients with lichen amyloidosis, just last year, we had a treatment that is specifically developed for patients with lichen amyloidosis that was approved by the FDA. This is a combination of four medications together that not only results in eradication of the clone that causes amyloidosis, but also helps improve the heart, kidneys, or any other organs that might have been damaged as a part of this condition.

So patients who have transthyretin amyloidosis have two different types of treatments available for them. One treatment focuses on stabilizing the transthyretin protein and preventing it from turning into amyloidosis. And the other type of treatment targets the liver and prevents it from producing the transthyretin protein, so that ultimately you cut out the source that would be causing amyloidosis.

So there's been a lot of progress and a lot of other new treatments that are in clinical trials for these two types of amyloidosis. For several other types of amyloidosis, we don't have any treatments available yet.

Interviewer: And for those patients, is it just managing the disease best you can, managing the symptoms? What's the strategy?

Dr. Godara: So patients who have types of amyloidosis that we don't have treatments for, our focus remains on the organs that are afflicted from this disease. We try to support the organs that are damaged as a part of amyloidosis, and sometimes these patients will end up receiving a kidney transplant, or a liver transplant, or a heart transplant depending on what type of organ was damaged, irrespective of whether or not we have any treatments available for that type of amyloidosis.

The first and the foremost thing for patients with amyloidosis is to identify these patients at the earliest, because the sooner we take to diagnose this condition, the sooner we can try to reverse this process.

Delays in diagnosis can ultimately hurt the patient, so we have to create awareness at all levels of our healthcare system to identify these patients who might or might not have amyloidosis so that they undergo the appropriate workup and have a confirmation on whether or not they have this condition.

So we need to create awareness not just at the level of the primary care doctor, but also the specialists that our patients see. And at the same time, we also have to increase the awareness about this rare disease with our patients, so that if they have one of the symptoms that we relate with this condition, our patients can come to us and be evaluated for the suspicion.

The one thing that patients with amyloidosis require is a comprehensive evaluation. So when we suspect amyloidosis in a patient, our patients require a multidisciplinary team to not just help identify whether or not they have amyloidosis, but also once the diagnosis has been confirmed, we can focus not just on the cause of what's causing the amyloidosis but also help support the organs that are damaged as a part of this disease.

So at the Amyloidosis Program at Huntsman Cancer Institute, our patients receive care under a team of specialists that includes representation from cardiology, nephrology, and neurology to provide the best possible care that our patients need.

Dr. Chan: What's it like moving from Boise, Idaho to Middlebury, Vermont? How can an outdoorsy lifestyle influence you to pursue a career in medicine? On this episode of "Talking U and Med Student Life," second-year med student, Joe, talks about rural medicine, why he ended up in Utah, and how to get started snowboarding in the great Utah mountains.

Welcome to another edition of "Talking U and Med Student Life." Fantastic guest today. Joe, how are you doing?

Joe: I am excellent. How are you?

Dr. Chan: I'm hanging in there, and we'll talk about that later. Living life in a pandemic. It's been interesting, difficult, and challenging, and beautiful all wrapped into one. All right, so Joe, what year are you now?

Joe: I am currently a second-year, MS2.

Dr. Chan: All right, second-year med student. And we're going to talk about what medical education looks like in a pandemic. But I want to go into a quick time machine. All right? So let's go in a time machine together and go back, back, back, back. So, Joe, what prompted you to become a doctor? What event in your life or were there a series of events, and how old were you? When did this start entering your brain?

Joe: Ah, sure. So I've always really been interested in science, and I sort of knew I wanted to do something in science probably starting in about third or fourth grade. But one of the real inciting events for me, and, you know, you read personal statements all day. And the thing that I talked about in my personal statement was, when I was 15, I was whitewater kayaking and a man dislocated his shoulder right in front of me. And one of the other members of our team was a wilderness first responder, and they kayaked over and reduced this man's dislocated shoulder while they were floating down the river next to each other. And so I immediately thought, "You know, that's a skill I want to have." And so I started with wilderness first responder as a wilderness EMT. I worked as an EMT. I did a bunch of wilderness sort of medicine-related things in college. And sort of every step of the way I wanted more and more knowledge, more and more skills. And fully pursuing medicine seemed like the perfect place for me.

Dr. Chan: Awesome. I mean, so a lot to unpack there. So this is back during high school, correct? You said you were 15?

Joe: Correct.

Dr. Chan: So college, where'd you end up, and how'd you pick that school?

Joe: Yeah. So I grew up in Boise, Idaho and I absolutely love Idaho, still go back every chance I can. But I wanted to try something a little different for college, and so I traveled out to New England, to Vermont, and I went to Middlebury College. And then while I was there, that afforded me a lot of opportunities to do some outdoor things, do a lot of wilderness, medicine-related stuff with teaching, with instructing rock climbing and kayaking, and things like that. And . . .

Dr. Chan: How was it going from Boise to Middlebury? That sounds like a big jump. Or wasn't that a big jump?

Joe: It was very different.

Dr. Chan: Yeah.

Joe: It was . . . Yeah. Yeah, I mean, it was interesting. I always say think of Boise as a pretty small town. I mean, I think currently it's about 200,000 people. The whole valley's got 500,000 or so. But Middlebury, Vermont, the college itself makes up about 3,000 humans and the town itself makes up about 6,000 humans. So it's the kind of place where the general store will say, "We close at around 5 p.m." or things like that. So you've got to come in a little early in case the owner is feeling like going home or you might not get your groceries.

Dr. Chan: Wow. And then, so when you went to Middlebury, was there like a premedical program, or did you start to waver, or like how did that go? How did your metamorphosis go during your undergraduate days?

Joe: Yeah, I started out as a physics major, but I knew that medicine was sort of my goal overall. We didn't have a premedicine, really, track. It was sort of you do whatever you're interested in, and as long as you check off enough of the boxes of which classes you need to take, then you were sort of granted the blessing of the premedical committee. And if you wanted to, you could do a committee letter or things like that. The University of Utah was at the top of my list when I was applying. And I knew that the University of Utah was not interested in committee letters. So it was nice that I had the option, but yeah, they had a group of people that could guide you if you needed assistance or needed direction. But I ended up graduating biochemistry major because it meshed a lot better with not only the premed requirements but of what I became interested in as I went through college.

Dr. Chan: How did you get all those necessary activities, like the research, like the community service? How did you do that at Middlebury?

Joe: Yeah. We had the distinct privilege of not having any graduate program, which sounds a little funny because I also did research at the U after my sophomore year working for a Ph.D. student in a chemistry lab. But being the only students on campus as undergraduates, it meant that when I pursued a research opportunity, I got to sort of be in charge of my own project working on Lyme disease. So they were all small labs, maybe three to five students. And it was 100% undergrad-driven. So it was a wonderful experience. I really loved it.

Dr. Chan: That's great. And then, you know, when you talk about Vermont, I also think about Ben & Jerry's ice cream. Do you have any stories to share? What is your favorite flavor?

Joe: Ooh, my favorite flavor of Ben & Jerry's is Half Baked. They were about, you know, 55 minutes north of us in Vermont, which means you had to pass by five or six creameries on your way there. But if anyone's from the East and they know of Maple Creemees, they'll know that that's really the best ice cream in Vermont. And we had it on tap at our college from 8 a.m. to 8 p.m. every day.

Dr. Chan: So I guess it was so common it wasn't that unique to you. To me, it's like very unique out here, but I guess back there it was just like water. Like it was everywhere, right?

Joe: Yeah, exactly. Yeah, you could hardly walk, you know, 100 yards without bumping into an ice cream dispensary.

Dr. Chan: Wow. And then, you know, you're hitting your senior year, you're looking at med schools. What was your strategy going in? What schools were you looking at, and how were you going to do that?

Joe: Sure, yeah. So being in Vermont and being sort of that . . . I guess about half of Middlebury students are from like the just outside of Boston, New York, Pennsylvania, that kind of area. And so all of my friends were really looking at schools in that area. And the few of us Westerners were sort of split up and didn't particularly know where to look. So I sort of looked all over the West, and being from Idaho without a program of our own when I was applying, I mean, Utah was by far the most attractive option. And mostly, I mean, from a financial perspective, from an outdoor-access perspective, Utah really checked all the boxes for me. But, you know, I applied everywhere and couldn't believe it when it worked out.

Dr. Chan: So Idaho technically does not have their own medical school. But University of Utah, University of Washington, through the WWAMI Program, do take Idaho residents. And we take 10 and they take 40. Did you apply to WWAMI? What were your thoughts about WWAMI? I mean, I'm just curious, Joe, like I've never had this conversation with you. How did you end up in Utah?

Joe: Yeah, absolutely. Yeah, so I definitely applied to WWAMI. And I have . . . I'm trying to think, I have at least four or five close friends who are at the WWAMI Program up in Moscow, Idaho. And yeah, I liked a lot of things about their program, but I think for me, the U is a more attractive option because it gave me a lot broader of options. I wasn't particularly sure of what kind of medicine I wanted to go into, whether it would be primary care or emergency. All I've done is emergency work in my life. And so I'm still leaning that direction.

But at the WWAMI Program, it felt a lot like they were University of Washington students who were sort of off on their own. It felt like they had a good strong sense of community with those, you know, 40 students living in and amongst each other in that same location. But it felt more like a satellite campus than a full-blown medical school the way that the University of Utah does, where it feels like we have all of these enormously beneficial resources right at our fingertips.

Dr. Chan: Yeah. I like how you said that, Joe. I think there's 125 medical students per class and there's 10 Idaho students. And I would argue the 10 of you are fully integrated into everything that the other students do to the point where I don't think people, unless you self-identify as from Idaho, people don't realize you're probably from Idaho unless you tell people, correct?

Joe: Exactly.

Dr. Chan: Yeah. And I think, yeah, we're a quaternary, tertiary care center and we just have a lot of opportunities. And our students get to have first access, first pass at all those activities. And yeah, I agree with you. Like I think WWAMI is a fantastic program. But they are based, the Idaho piece is based in Moscow. So yeah, I just think the two wonderful programs serving the state of Idaho. It's all good. So, all right.

So Joe, you get here, and then what was your impression? Because like let me frame this question. Like everyone has this conception of what med school is like, right? And I think that's born from the media or tales that are told around the dinner table. Everyone has an idea of what med school is like. But then you come here and then you start medical school. So what was that first semester like? Was it doable? Was it overwhelming? How would you describe your experience jumping from premed to med?

Joe: Sure. Yeah, so the sort of . . . the way that I like to think about it is there's all of the work that I did in undergrad where I was a biochemistry major, and so I was taking all of these biochemistry classes. And then I graduated, and I studied for the MCAT by doing a 10-week intensive course. And it felt like I was learning an entirely different side of medicine when I was studying for the MCAT. It felt like nothing I had actually learned in undergrad.

And then when I got to medical school, it felt like a whole other switch, where it felt like every time I had, you know, heard about some process when I was in undergrad or some process when I was studying for the MCAT, when I got to medical school and we approached those same topics, we would spend part of our time sort of getting everyone caught up on, oh, I don't know, like what the Krebs cycle is or something like that. But then we would always take it a step further, and you'd have to really, really be familiar with every single aspect of what was going into every single process we were learning about, even when we were doing that Foundations of Medicine, first six months to catch everyone up.

And I was mostly surprised at just how cursory of an understanding I actually had about so many topics before going to medical school and how much sort of work I had to put in to really understanding the nuances. But I felt personally like the first six months were difficult but doable. I had a strong group of people around me that I could study with and we could bounce ideas off of each other. But we could also, you know, really get outside, or exercise, or in some form almost every single day during my first year of medical school. So I was surprised at how much outdoor activity I was able to get in while simultaneously studying.

Dr. Chan: Was it hard, Joe, going from . . . And I'm just going to put my own projection out there. You're kind of big fish in little pond Middlebury because just being kind of at the top and just doing so well, and then you come to medical school and then everyone just knows . . . so smart, knows what they're doing. Was that a transition for you, or you felt you did that pretty well?

Joe: I think that when I was at Middlebury I was very much a small fish in a big pond as well.

Dr. Chan: Okay, okay. I'm just trying to use outdoor analogies.

Joe: Yeah, oh, absolutely. So I felt like when I got to the University of Utah that that sort of imposter syndrome really carried nicely through and I got to maintain my sensation of imposter syndrome through undergrad all the way into medical school. I'm constantly astounded at the students I get to spend time with.

Dr. Chan: How would you describe your imposter syndrome? Because it has different definitions depending on who you are. So how would you describe it?

Joe: Sure. So I feel like when you first get into any program, and I'd be fascinated to ask this question to a current MS1 because they're all seeing each other simply over Zoom, and it's a less personable space. But for me, when I arrived here, a lot of it was, holy cow, what did this person sitting next to me do in undergrad? Or realizing that they're, you know, 4 or 5 years older than me and have 17 more publications than I do and things like that.

So for me, it's the, when you get into Foundations of Medicine, you get into that first six-month course. Everyone's starting from a very different place, and we all had to, you know, be our own interesting person. But when you first arrive, it's really astounding to see how impressive sort of the accolades of your peers are. And then sort of as I've moved through, now as a second year, and especially with COVID when a lot of our opportunities that were, you know, in-person were shut down, or moved off, or things like that, and we're already starting to feel the pressure of taking Step 1, and thinking about our CVs, and our applications to residencies. It's seeing just how much your fellow students can be learning and also, you know, participating in their extracurricular activities while they're here, while they're in their second year.

Dr. Chan: Joe, you mentioned maintaining outdoor activities, or learning, or growing. And it sounds like you've struck a pretty good balance with, you know, life, and wellness, and academics, and personal time. What was your secret? How did you do that? Did you like map it out ahead of time? I mean, did you put it down on your schedule, or was it more spontaneous, you know, a couple of hours here and there? Like how did you do that?

Joe: Yeah, so one of my favorite expressions I ever heard in undergrad . . . And I've been so extremely privileged in where I've gone to school because I've always had outdoor access so immediately close by. But the sentiment that stuck with me most from a professor was, "If you do not have 30 minutes per day or in your day to do something for yourself, either physically outside or for your mental-emotional health, if you don't have 30 minutes in a day where you can sit down and do that, you need to take 60 minutes that day to do it."

And so there's sort of a point of diminishing marginal returns on studying for a lot of us. And I found pretty early on that if I got, you know, seven or eight hours of sleep every night, and I spent at least, you know, 30 minutes to an hour either walking or hiking in the foothills that come straight out of the medical school, or going to the climbing gym nearby, or things like that, if I took that time, I performed better and better than if I spent that hour, you know, re-reviewing notes from a lecture or something like that. I didn't actually perform better and I didn't retain anything better.

So I've tried to keep a really strong crew of people where we can sort of spontaneously say, "Hey, does anyone want to go, you know, climb in Big Cottonwood Canyon at 5 p.m. today?" And you'll always find one or two people who are willing to do that. I wish I was a more organized person who kept a tight-knit schedule to include that, but I absolutely know students who write in one-hour run at 4 p.m. and when their calendar goes off, they put on their shoes and go out.

Dr. Chan: Wow. Joe, that's fantastic. And I also know that, you know, like you mentioned, hiking, and walking, and I think you said rock climbing, I think you also have the skill of ski and snowboarding. So I'm curious, how long have you been a skier or a snowboarder?

Joe: Sure.

Dr. Chan: And yeah, just like what's your favorite resort here? And I think another great selling point of Utah, just access to a lot of different areas where you can do that.

Joe: Yeah. I don't know that I can say that the University of Utah has the best skiing of any medical school in the world because I don't know enough about the world, but in the United States, I think you'd be hard-pressed to make an argument that there's better skiing anywhere else. Yeah, so I started skiing when I was two years old. And in my family, it wasn't really an option. You were a skier, and you were a skier at age 2. And so I grew up racing a little bit, and when I was 15, or I guess, yeah, right when I was about 15, I was diagnosed with osteochondritis dissecans, which is a bone disorder. And we'll get to learn all about it in a couple of months here in skin, muscle, bone, and joint. But basically, I had to take about five years off of skiing, almost six years off of skiing because I was getting several knee surgeries to sort of reconstruct the bone at the end of my femur. And then luckily, about halfway through college I got to get back into it.

And yeah, so my favorite resorts here in Utah, this year we keep an Excel doc, a Google Excel doc called the All-Class Shredders List. And it's everyone who's interested in skiing writes in their phone number, they write in their email, and they write in what pass they're getting. So I know that last year it was about 70% Ikon Pass and, boy, about 30% split amongst the Epic Pass, and things like that. I was in Ikon Pass last year, and I think as of either later today or tomorrow I'm going to be buying my Ikon Pass as well. But for the University of Utah students, the price is marked down from $1,200 to $400. So it's hard to not take advantage of that. But in terms of favorites, I don't think I can confidently choose a favorite. I got unlimited days of solitude last year through the Ikon, so I certainly went there the most but . . .

Dr. Chan: So Joe, I don't even know what they call them, are you like a quadruple, Olympic, black diamond skier? Is that your level? Is that your . . .

Joe: I will say that I am very comfortable on black diamonds and comfortable on double black diamonds. But that being said, I am maybe the 15th best skier in the MS2 class. So there's a . . .

Dr. Chan: I love how you phrase it, yes. You cannot humblebrag, I will humblebrag for you. All right? That's awesome, Joe. So what if . . .

Joe: There are . . .

Dr. Chan: What if you're a brand-new . . . you know, what if there's a med student listening and they want to get interested in skiing. Like what would be some good, you know, equipment and maybe a good place to start out?

Joe: Yeah.

Dr. Chan: Obviously, our time machine isn't real. We can't go back to when they are two years old to get that experience you got. Like so how would like a 20-something-year-old start?

Joe: Sure, absolutely. So yeah, we have . . . I can't remember what the actual number is, but I think we have 60 students or something in our class, the MS2 class on the All-Class Shredders List who do ski already or snowboard already. But we had about five or six students who started skiing last year. And all of them, they skied together in a group, and they would ski with their more experienced friends and get their lessons that way. But we had a lot of students who went from either never having skied before or not having skied in 10 years to being really confident skiers on, you know, the intermediate and advanced ski terrain.

One of the things I love about the University of Utah is the rec center has gear rentals. And so you can rent skis from either the University of Utah rec center for a day or a weekend. And I think it's $25 for a day and $40 for a weekend for the ski boot, pole setup. So if you're interested in learning and you have some fellow MS1 students who come in with you and, you know, they're your good friends that you've already made and you want to run flashcards on the chairlift, which is absolutely a thing I recommend doing with your friends, then yeah, it's about $25.

And lessons, you can get access to professional lessons through Solitude. I was looking into this recently for a different friend, and it was $75 a day for college students on top of the pass for the day, which I think is in the $75 to $100-range. So skiing has always been a very expensive and exclusive sport. And I think that having the $25 rentals through the University of Utah makes it a little more accessible to people than having to do, you know, the $125 rentals from the resort.

But yeah, there's a few different options for renting equipment at the U for pretty reasonable prices. You can do seasonal rentals as well. There's a couple of companies in town that do seasonal rentals on skis. So yeah. My biggest recommendation is if you've got that study group and you've got some experienced skiers in your group, and they're willing to teach you, then I can't recommend enough that you reach out to them and reach out to your whole class and see who else is new to skiing and try and get a little . . . a crew together. It's a great community, and it'll be interesting to see what COVID does this year. We're all on the edge of our seats on that.

Dr. Chan: I love how you mentioned doing Anki cards on the ski lift. I did not know that was a thing, but my hats off to all of you who are doing that. That's like combining a lot of . . . Your generation, the ability that you guys have to multitask, it's amazing. So that's so cool.

And then, Joe, do you have like a favorite memory or a memorable time when you were skiing or boarding? Like something that just stood out to you, like this crystallized beautiful moment where it was like epiphanous and you hit nirvana or a scary situation where it got resolved. I'm just curious, because you've been in the backcountry doing all sorts of difficult hills, and yeah, so I'm just curious like if you have any memories you can share.

Joe: Oh, man. There's two moments that come to mind. One is more on the idea of Anki and studying, but it was, I was up with two fellow students [Stany and Alli 00:25:07] and we were sitting on the chairlift in between runs. And it was, you know, a Sunday before a Monday exam. And we couldn't resist, because I think we'd gotten 60 inches of snow that week or something like that. And so we had to go out even though we had a test on Monday. And we talked through questions on the chairlift of what we thought we were going to get quizzed on and what we thought we needed to understand, and filled in the memory gaps. And the next day during the test, there was somewhere between 6 and 10 questions that were exactly covering the topics we talked about on the chair. But I think the more salient moment, like one of the happiest skiing moments I've ever had was last year at the end of the year, at the end of the first semester, this is obviously pre-COVID, we had 31 of us MS1s go down to Jackson Hole, Wyoming. And Jackson Hole is on the Ikon Pass. So we just rounded up 31 students who had the Ikon Pass. We rented three houses in Jackson Hole. And I think everyone, overall, for lodging and food, we cooked all of our meals together for five days. I think the average . . . I think the price that every student paid was $105 for 5 days' worth of skiing, food, lodging in Jackson Hole. But there was one day where we had all 30 of us out on the slopes together riding as one giant group, and it was one of the coolest things I've ever seen, to see, you know, these 30 students that were sort of struggling together through academics but then also getting to get out and ski together.

Dr. Chan: Joe, that's beautiful. I love that image. Maybe when we post this pod, we can like throw up an image. I want to throw up an image of that, and then maybe you and your awesome beer that you're rocking.

Dr. Chan: All right, last question, Joe, we've talked a little bit about it, but pandemic, like because it was at the very end of first year, right? And then things started to kind of go . . . you know, the announcement came out. Like how was it from your perspective as a med student? And as a follow-up, like what's it like to be a med student during a pandemic, and what does your day look like? So I'm just going to throw that out there. I want to hear your perspective.

Joe: Yeah. It's been very interesting. And it's been varied as well, which has been sort of one of the things that we, as students, do talk about is how different units feel different. I think that when you're in Foundations of Medicine, it's all about getting as much time talking between students to make sure that everybody's on the same page of how well you need to understand something, how in-depth, and what nuances you think the professors care about or things like that, things you think you should care about.

And then once you move into the second semester of your first year, which is when COVID hit for us, you're in the host and defense. We were in what's called host and defense, which is the bugs and drugs course. And that one is just so much more memorizing that it felt more like an individual course. So it felt more like, you know, you're watching your videos, you're watching these things. You're running your hundreds of cards a day to try to get all of these little facts, you know, nailed into your brain. So there's a little bit less of a student community during that.

But when COVID hit, it was, you know, March 13th. That Friday, the 13th, I actually had a hernia repair that day, and I was completely laid up for about six weeks after it. So that was the first day we also shut down classes, which was, you know, perfect because I didn't have to come into school but also very socially isolating. But when we switched, the Monday after they shut down classes unexpectedly, we had . . . I think we missed out on one hour's worth of lecture. And the professors seamlessly transitioned to Zoom. I was really, really impressed. We basically lost zero time, we lost zero material with host and defense. When we finished this summer and we came back, it felt a little bit like there was still so much hope that we would be able to be in person that the course wasn't as well established for the second-years to be ready for online. So it was a little grating for the first couple of weeks to try and suss out exactly how we were going to be maneuvering through COVID and our second year of med school.

And I think a lot of us felt really isolated from a summer apart and not feeling comfortable getting together with our big study groups that we did previously. And then sort of as this second year has gone on, we've sort of come to accept more and more and more that it's most important to stay distant, to stay online. But yeah, it was interesting that the spring when that massive change happened it wasn't that bad, but then I think a lot of us, really mentally and emotionally, struggled. I know personally, I mentally and emotionally struggled with the fall semester more than the spring. Yeah.

Dr. Chan: And then, is it every single day Zoom? Or like what does a typical week look like now in the middle of a pandemic for a second-year med student?

Joe: Yeah. So right now we have asynchronous and we have synchronous. So it's usually, for this current unit, we're currently in CR and R, which is like the circulation and renal and respiratory. And that has mostly, most of the days has been asynchronous. So, you know, you just click on and watch the prerecorded lecture whenever you're interested. But then maybe two or three days a week we're in-person. We're digitally, you know, synchronous, where we'll all Zoom in at the same time and we'll have a team-based learning or a case-based learning. And they'll break us up into small groups and things like that. So that's usually like Wednesday mornings, Fridays. And then actual in-person activities when we're learning our clinical skills on Wednesday afternoons. We've been in-person probably just over 50% of the time. So that's from maybe 1 p.m. to 5 p.m. on Wednesdays every other week for the last, you know, four months we've been in-person. But everything else is Zoom. And for . . . Yeah.

Dr. Chan: Oh, go on. Sorry.

Joe: Oh, I was going to say for a person like me who, you know, I've got, I certainly have some attention deficit problems. And sitting in front of a computer for hours a day is sort of the antithesis to the way that I like to learn. But I found ways to, you know, set my computer up on a dresser or a desk or something like that and, you know, jump around my apartment, my living room, and try and run cards, and things like that, keeping my body moving. But yeah, I am ready to be back in person when that day arises.

Dr. Chan: Do you like the synchronous or asynchronous model better, Joe?

Joe: I think the asynchronous model works better for me because if I'm sitting in front of a computer for eight hours a day watching a lecture, probably about every 15 minutes my brain will wander off. And if it's a synchronous session and I just missed, you know, 20 seconds of material, then I desperately am lost or I don't know exactly what I needed to know from that. But if it's asynchronous, I can pause. I can back it up 30 seconds, and I can restart, or I can pause, stand up, get a drink of water, back it up 30 seconds, and restart. So, for me, the asynchronous works much better because I can pause, I can make sure I'm really understanding what they're saying. Sometimes I have to repeat a section four or five times just to figure out what the professor is trying to emphasize there.

Dr. Chan: Joe, I love it. It sounds like you're adaptable, resilient. And I think you, the faculty, the students, I think everyone's trying to do the very best job they can in really extraordinary, challenging, unprecedented circumstances. And it sounds like it's coming together.

Joe: Yeah.

Dr. Chan: Fits and starts though, fits and starts.

Joe: Yeah, absolutely.

Dr. Chan: Joe, we're almost out of time. I guess my last question is what advice do you have for anyone listening out there who is thinking of applying to medical school? What would you say to them? What counsel would you give them?

Joe: Yeah. I think the most important thing for me is to take your time. I took two years off after graduating and I absolutely loved it. I spent time working. And actually, I was talking to a professor yesterday during a small synchronous session. He shot me a message in the Zoom Chat privately asking what my prior experience with that topic was because we were talking about pulmonary embolisms. And I was an emergency department scribe for almost two years. And things like that, things that are extremely clinically relevant to scribing, you just excel at when you're an actual medical student. And so I can't recommend to people enough that they, you know, take a breather after undergrad, work a job, you know, build up some money, and be able to have a ski pass, be able to do things like that. Be able to have some sort of different nonacademic life experiences before you get here. And if you have the opportunity to scribe, that was the most helpful preparation for medical school I've ever had.

Dr. Chan: Great. Joe, well, I appreciate coming on the pod. We'll have to have you come back and share more of your adventures as you continue to go through our medical school. It sounds like you're doing really, really well.

Joe: Oh, absolutely. It was wonderful to talk to you.

Dr. Chan: All right. Thanks, Joe.

Joe: Hey, have a good day.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Dr. John Barrett is a family physician and the Executive Medical Director of the Community Physician Group for University of Utah Health. He reached his own health turning point over a decade ago.

Dr. Barrett found himself giving in to the anger and frustration that comes with being a physician. Like many men, this stress and frustration was actually a sign of depression. He was able to identify the symptoms in himself and seek help.

After reaching out to loved ones and working with professionals, Dr. Barrett was able to work through his mental disorder. It took over a year of talk therapy and medication to get his mental health back to a place where he could thrive.

"Down south I was what we would call 'a mess,'" says Barrett.

These days, Dr. Barrett is always on the lookout for signs of his own mental health. Whenever he notices a warning sign he focuses on self-care, focusing on his physical health, and reaching out to professional help before things get worse.

Like most health concerns, Barrett's mental health is something he's continually working on, but he feels more in control of his own mental health and wellbeing today than he did a decade ago. Telehealth: More Options for Medical Access

Dr. Barrett works with the Telehealth group at University of Utah Health, and he's seen first hand some of the applications emerging technology can have in the healthcare space. But first, what exactly is telemedicine.

Telemedicine is the means of providing healthcare access from a patient to a health professional using digital means like text or video chat through a computer or smartphone.

At University of Utah Health, in-state patients can call in via an app or web portal to speak directly to a general practitioner through a video call. For University of Utah employees and patients with a University of Utah Health insurance plan, these video calls are covered by insurance. For other patients in Utah, there's a flat $49 fee that will be refunded if the call is escalated to an in-person visit. What Can a Doctor Do Over Video Chat?

According to Dr. Barrett, the best way to think of a telehealth video call is like "virtual urgent care." Half of the patients calling in are given advice and counsel about whether or not they need to see a doctor in person. The other half are given a diagnosis of a relatively minor medical condition. And a very small percentage of patients contact telemedicine services with a concern that needs to be escalated to emergency care.

When a physician diagnoses a condition over a virtual visit, they can prescribe medications necessary for treatment. Dr. Barrett shares a story of a woman who was out on a camping trip in the Wasatch Mountains. After suspecting she had a urinary tract infection, she drove her car back down far enough to get cell reception. She was able to call a physician, get a diagnosis, and a prescription for an antibiotic right over the phone.

A large portion of the phone calls the telehealth team receives is from young new parents. When your kid is sick, it can be stressful. It can be difficult to determine if it's an emergency or if you can wait to seek help the following day. A quick video call to a physician can help to diagnose most pediatric concerns and help put a parent's mind to rest.

Other growing telemedicine fields include dermatology, where specialists can diagnose rashes and moles with pictures or videos. New services are also developing ways for people to access mental health services through text and chat. How Can I Access Telemedicine?

For Utahns, you can use the digital health services at University of Utah Health through the MyChart app if available, or visit healthcare.utah.edu/telehealth for more information. ER or Not: Broken Nose

Scot recently came across a skateboarder on campus whose face was covered in blood. There were no signs of a head injury, but the kid had broken his nose. Scot tried to help but he wasn't sure where to send him. Urgent care or ER?

According to Troy, a broken nose is no reason to go to an emergency room or an urgent.

As long as the person with the broken nose has not been knocked out, nor are dealing with a head injury, a broken nose is nothing serious. These days, if a patient comes to the ER with a broken nose, there's not much they can do to treat it. No big tubes of cotton stuck up the nose. No "setting of the broken nose." Nothing.

In most cases of a broken nose, the amount of swelling present limits the options doctors have for any type of treatment. The swelling must go down before any corrective measures can be taken.

Troy suggests that if you have a broken nose, wait a week for the swelling to go down, then go visit an ear, nose, and through (ENT) specialist. They will be able to better assess the damage and create a treatment plan after the swelling has gone down.

There is one caveat to this advice. If you look in the mirror up your nose and there's something on your septum that looks like a grape, you may need to go to the ER. This type of growth is called a nasal septal hematoma. It's essentially a big sac of blood that forms after an injury. When one of these hematomas grows in the nose, it can potentially erode the septum leading to potential structural problems. These hematomas are rare, but need immediate treatment if found. Housekeeping - We Have a Winner!

We announce the winner of the Who Cares About Their DNA Giveaway. For the last 6 weeks the guys at the Who Cares Podcast have been looking into the complicated issue of at-home genetics testing and calling for submissions for people interested in winning one of these kits and the opportunity to be on the show.

Our winner is listener Matt. Matt is thirty years old and he says this about wanting the test:

"I want to know more about my body, based on the things that are out of my control. A genetics test can help me understand what chances I have of developing certain disorders or what ones I could pass on to my children."

We'll be reaching out to Matt to speak with him about the aspects of these tests we've been exploring and have him on the show.

Thank you to everyone who participated! Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot has made a serious caffeine mistake. Troy muses about the first dog in space. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Chan: What's it like being a first-generation college student and choosing to chase your career in medicine while combating self-doubt? How do you flawlessly perform a scene from "The Sound of Music" in front of your new classmates during your medical school orientation? How does one go about deciding what to pursue their residency program in, particularly anesthesia?

Today, on "Talking Admissions and Med Student Life," I interview Max, 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, welcome to another edition of "Talking Admissions and Med Student Life." Max, finally, we meet.

Max: Finally.

Dr. Chan: Since you've been gone for so long. Fourth-year student.

Max: Yes.

Dr. Chan: And we're going to wait until the end to talk about what you chose.

Max: Okay.

Dr. Chan: So let's go back to the beginning, man. When did you decide to become a doctor?

Max: So, for me, it was one of these things where I always revered doctors. I thought they were cool. I have an uncle who did family medicine and he did a ton of humanitarian work. He would go to Africa and come back and show these slideshows and I'd be like, "Yeah. That's something I want to do."

Service has been a big part of what brings me joy and I thought if I could pick a career where service is a huge component of it. You have a very steady life as well. You're not going to lose your job as a doctor. And it helps that I really like science. But all those things combined together led me here. I had a lot of doubt as to whether I could do it, but pushed through that and we're here.

Dr. Chan: Where did the doubt come from?

Max: In my immediate family, both of my parents did a little bit of college. Neither of them graduated. I have a twin brother who went to some college but didn't graduate. Older brother, same story. And so, for me, I was like, "Can I do this?"

I remember getting to . . . I started undergrad at The U. I remember getting up here having to fill out all the financial aid stuff and I was like, "You know what? Maybe I should just stay home." It was overwhelming.

Dr. Chan: It's daunting. Yeah.

Max: Yeah. I come from a pretty small hometown, Spanish Fork. It's getting way bigger, but it's pretty sleepy. A lot of people stay around there. And so I think when I got here, I had . . . My first semester, I remember thinking it was going to be like high school and it wasn't. You actually have to write papers and do stuff. So that was a little bit of an adjustment.

But once I hit my stride in college, I started realizing, "Oh, I can do this." General chemistry isn't the most impossible thing. Organic chemistry still is, but I made it through.

Dr. Chan: Okay. Well, let's back up a bit. How did you wind up at The U to start? Walk me through the decision-making process. So you grew up and went to Spanish Fork High?

Max: Went to Spanish Fork High.

Dr. Chan: Okay.

Max: Most people in Spanish Fork, if they go to college . . . I feel like a decent amount do. They'll just go to UVU. It's 20 minutes away. Pretty much if you have a heartbeat, they'll accept you. And a lot of people do trades as well. And for me, I was like, "I want to be a little different." And so I was like, "All right. I'll go 20 minutes further to Salt Lake City."

Dr. Chan: Did you live at home and commute or did you live in the dorms?

Max: So, starting out, I lived in the dorms and I have many dorm stories to pull from there. So, yeah, I lived in the dorms. That was part of the reason why I think I had some freshman struggles with classes. I had a lot of fun.

And I started out wanting to do exercise physiology, and partway through that, they actually just got rid of the degree. And so, eventually, I did about two years here, went on an LDS mission.

Dr. Chan: Where'd you go?

Max: I went to Japan, south of Japan, and . . .

Dr. Chan: Could you speak Japanese before?

Max: I took a class in high school.

Dr. Chan: But that was enough for them to say, "Oh, Max, you need to go here."

Max: Yeah. They're like, "He's interested? All right. Here you go." But that class was mostly like the teacher would bring in Japanese treats and show us cool shows from Japan and I . . .

Dr. Chan: Anime and manga?

Max: Yeah. Exactly. So, yeah, the learning . . . I thought I'd be set to go. And day one of trying to learn the language, I was already way over my head.

Dr. Chan: Wow. So you're at The U. Were you doing pre-med stuff before you left for your mission?

Max: I was, but I didn't have much direction. I just took classes because you needed to have so many credits. But yeah, it was always on my mind. Medicine was the ultimate goal. So did that, did the mission, came back. Since the degree was gone . . . I had a really cool physiology professor who taught some neuroscience within that class. I was like, "This is pretty cool."

Dr. Chan: I want to hear about a story about you in Japan because I just have this image of you running around the country doing your thing.

Max: Yeah.

Dr. Chan: And Japanese is a fairly hard language to master.

Max: Yeah. I feel like I really just dove in. Once I was there, I tried not to speak English as much as possible. I was about six inches taller than the average Japanese person, blonde hair, blue eyes, and so I stood out. A lot of people, I'd be riding my bike by and they'd say, "Oh, doitsunin," like, "That's a German. That's a German man." I have no German ancestry, but to them, they thought I was German.

So everywhere I went, I was either scaring people when they'd open their door because I'm like this big looming figure. But the younger generation of Japanese girls tended to gravitate toward Americans. And so it would be fun because we'd be riding our bikes, we rode bikes everywhere, and there'd be a little gaggle of high school girls who had been paying attention and they'd be talking to each other. And then I'd go say something to them in Japanese and they're like, "Oh, no. He understands.' But yeah, I scared a lot of people when they opened their door, hit my head on a lot of doorways.

Dr. Chan: Yeah. The apartments there . . . I just imagine you're on the 95th floor and they're like a cubicle and that's how you sleep.

Max: And pretty much everywhere, you sleep on the floor, and you have just this big blanket. They called it a futon. And that was a little bit of an adjustment. The food was . . . I learned to love it. There are some pretty gross things out there as well that as a point of pride . . .

Dr. Chan: So it was not just sushi for two years?

Max: No. I wish. But the gross stuff, even Japanese people don't like it. There's this one food called natto. It's fermented soybeans and you put a little soy sauce in, but when you mix it up, it almost becomes mucus-y and it's repulsing to most people. But there are the little old grandpas, they're like, "No. It's great for your heart. It's great for all these things." So I was like, "Okay. By the end of this, I'm going to love it." And so what I'll do is I'll buy it sometimes and make my American friends try it out.

Dr. Chan: Were you doing any community service in Japan? Were you teaching English or working in hospitals or doing anything like that?

Max: So I was there when the tsunami happened.

Dr. Chan: Oh, okay.

Max: I think it was 2009, and so we had a ton of service opportunities.

Dr. Chan: Did you hear about that? How did you learn about that happening? Were just people talking about it? You're not allowed to watch the news, right?

Max: Yeah, not much. And you sneak it on the . . . you're getting a haircut, you sneak some news. So I was actually on a train in the very south of Japan and we were headed to an area, and mid-train ride, they just stopped the train and they said, "Tsunami alert." And where I was, was almost as far away from the tsunami as you could get, but still, that far south, since we were close to the water, they stopped the train.

Dr. Chan: This never happens, right? People were freaking out on the train?

Max: Yeah. People were freaking out and they stopped the train and they're like, "There's a tsunami up near Sendai.' Everybody gets off. So we stayed in this random town. I have no idea where it was. Middle of the night. But we had a lot of other missionaries come from those areas and it was a ton of service.

We were able to go up there, help clean up. The hospital situation . . . I mean, everywhere was just over-flooded. And so me having no real medical training, we were just there to try to help direct people, help clean up, whatever we could do, but it showed me if this earthquake that's supposed to be coming to Utah eventually happens, there's a lot of work that we could do to prepare.

Dr. Chan: Yes. Walk a lot. Okay. So you're on your mission, and then I think you make a big decision during your mission. Walk me through that. Because you end up transferring, right?

Max: I did. So mission was nice because, for two years, you didn't really have to think that much about . . .

Dr. Chan: Life.

Max: Yeah. Exactly. It's like you just have a purpose and you go do it. So I had a lot of people who were like, "BYU is pretty good. It's cheap. They have good professors there. A lot of research opportunities." And for me, they have a neuroscience degree that I was really excited about. And so, during that time, I think I had companions and probably half of them were BYU students, so they were in my ear telling me it was a good choice.

Utah for undergrad, I'm sure I'd have been plenty happy staying up here as well, but yeah, for those reasons, I was going to save a lot of money down at The Y as well. I decided to transfer down there.

Dr. Chan: And so, after your mission, you went straight to BYU?

Max: Yes.

Dr. Chan: Okay. How was the jump from The U to BYU? Night and day? A lot more praying, a lot more scriptures?

Max: Oh, yeah. I remember getting in . . . it was like a class of 300, 350 people. Huge science, entry-level class for all the pre-med people. And they started out with a spiritual thought and a scripture and then a prayer. And I was like,"Can they do that?"

Dr. Chan: It's very embedded down there. It's kind of the way of life.

Max: Yeah. Exactly. So that was different. I remember my first three classes as well were in the oldest building on BYU campus. It felt like it was crumbling. And I remember walking in that morning and thinking, "What have I done?"

Dr. Chan: "What is this place? Why does it look like this?"

Max: Exactly. But no, eventually, I loved it. I had great research opportunity. I was able to teach, at the missionary training center, Japanese for three, almost four years. So it was an awesome experience.

Dr. Chan: And is that where you first saw me? Because I think I talked to . . . is that that class?

Max: Yeah.

Dr. Chan: Okay. Tell me about it.

Max: I remember . . . so, Dr. Chan, to those who haven't met him, he's very friendly and a very inviting person. But just knowing . . .

Dr. Chan: Thank you.

Max: Yeah. Just knowing that he's the Dean of Admissions was terrifying.

Dr. Chan: In a class of 350, I was terrifying?

Max: I was on the second row.

Dr. Chan: Did I call on you?

Max: You might have. I would have had no idea what I would have said.

Dr. Chan: Oh, my goodness. This just makes me laugh.

Max: So you walk in and I remember just thinking, "This is the man standing in the way."

Dr. Chan: Yes, it's me. It's the committee. It's not me. All right. So you're at BYU. How is it being a pre-med at BYU? Because there are a lot of pre-meds that come out of BYU.

Max: Tons.

Dr. Chan: Is it overtly competitive? Is it subtle?

Max: I feel like if you find a good group of people you can study with and get in with, it's not too bad of an experience. But yeah, there, it's very much . . . there are some people in the classes that are like . . . you know, they'll call out the professor because they want to make sure that their grade is high enough.

I think that's everywhere, but at BYU I think we had 300 in my class who were going into pre-med. And once I found out I got into The U, there were people who came up to me and they're like, "Oh, you got into The U?" I was like, "What?"

Dr. Chan: "You're the one."

Max: Yeah.

Dr. Chan: All right. So walk me through the application process. How many schools did you apply to? What was your strategy?

Max: So, for me, I think I applied to between 30 and 40. I just shotgunned to places that sounded fun living. I went through it with my wife and we thought, "Where would be fun? Where would be reasonable? And what are some schools that would actually be interested in taking me?" And so I applied to probably 25 MD, 30 MD, and then a handful of DO schools, because I did not want to reapply.

And most of the interviews that I got were in the West. So University of Colorado, University of Arizona, a couple of DO schools in the area as well, University of Utah. Went to all those interviews and I think it was pretty clear that we wanted to stay in the West after doing those. Well, I also got an interview at the Uniformed Health Sciences.

Dr. Chan: Oh, okay. Back in D.C.?

Max: Yeah. And that's like the military route, and I really thought about that one, but through some conversation, we decided I'd rather not have a military career. It has its pros, it has its cons, but for our family, we decided to do something else.

So, for me, it was ultimately between Utah, Colorado, Arizona. Once we got that beautiful call from you . . .

Dr. Chan: Yeah. I remember calling you. You were very excited. You were a little stunned at the beginning, but you were very excited.

Max: I was taking an exercise class. I'm not a runner, so I think I had just finished running two miles, which is pretty good for me. I was walking up a big staircase and I got the call from you, so I'm sure I was out of breath. I was stunned.

Dr. Chan: Was it an immediate yes or did you have to talk to your wife, or what was kind of the internal discussion?

Max: From the very beginning, my wife, she was so confident that I would get into The U. And I think we had just found out that she was pregnant with my son. He's 3 now.

Dr. Chan: I remember that. Yes.

Max: Yeah. So we just found out . . .

Dr. Chan: I met her at White Coat.

Max: Yeah, so we had just found out she was pregnant. Both of our families were here, a time of transition. So Utah just made sense. So once we found out, I was able to cancel a handful of other interviews. We knew we wanted to be here.

Dr. Chan: Okay. So there's a perception of med school. You can't really fully understand med school. I'm trying to do that with the podcast, but in a way, you have to actually be in med school to understand it. What was the biggest surprise to you? Because people have this notion med school is going to be X, but then you came, you started, and it turned out to be X, but maybe some Y. What were your thoughts? Was it a surprise? Was that a hard jump to go from undergrad to grad school like this?

Max: I think so. During undergrad, you're doing a lot of things to make yourself competitive. So I was working a job. I was doing all this volunteer stuff. I volunteered with hospice, so I was spending a significant amount of time doing that and other activities.

I was surprised that once I got to med school . . . I mean, it took time to figure out how to study and whatnot. I actually had more free time.

Dr. Chan: Really? Okay.

Max: Yeah. I had some more free time. You hear from everybody, "Oh, med school is going to kill you. It's going to be the hardest thing ever." And so I went in expecting that and it was a lot better.

Dr. Chan: So what were you doing with your free time?

Max: Golfing.

Dr. Chan: Preparing for the life.

Max: Yeah, exactly.

Dr. Chan: So it wasn't hard?

Max: There were things that were challenging about it. I think figuring out the best way to study . . . it's just so much more information. I remember we had our first lecture. It was Dr. Formosa, who's a big name in biochemistry, cell biology, microbiology stuff. And he did his lecture and it was so esoteric and the stuff he'd been researching for 20 years. I remember thinking, "Yeah, I'm never going to learn this."

Dr. Chan: Too much detail.

Max: Yeah. So I had a panic moment maybe the first week. I was like, "I don't know." But then I looked around and everyone else was panicked and it was like, "Well, there are 100 of us and we've got to get through it somehow." And I think safety in numbers, kind of this "we're all going through it together" helped through that initial shock phase. But once I figured out a way to study, figured out a way to prioritize my time, it was pretty smooth.

Dr. Chan: And then you were in my CMC, my Clinical Method Curriculum group.

Max: Yes.

Dr. Chan: So how was that? I'm just curious. I love asking this. What was your perception? When you found out I was going to be your CMC preceptor, did that freak you out or did that make you happy?

Max: Once I was in and had a couple of conversations with you, I was like, "Oh, Dr. Chan is awesome." You went from the gatekeeper to just an awesome mentor. And so I loved that. And I actually took Step 2 CS last week.

Dr. Chan: Oh, you did?

Max: Yes.

Dr. Chan: Okay.

Max: And then one of my patient encounters . . . I did JVD, jugular venous distention, and I recalled clear back to when you were teaching us JVD.

Dr. Chan: Oh, wow.

Max: Yeah. So it was a positive experience.

Dr. Chan: I would like to think that you used that often during your last two years, but I doubt . . . were you doing JVD in a lot of your patients?

Max: No. But you do it for show on CS.

Dr. Chan: Yeah. You do for OSCEs. You do it for clinical skills and CS.

Max: Exactly.

Dr. Chan: Okay. Yeah, and I remember that. You were like this big, burly, happy guy. I remember we could talk about the interesting fact about you. I remember at orientation, Dr. Stevenson called you out in front of the entire class for "The Sound of Music." Explain that to people.

Max: So I had never seen the movie, "The Sound of Music." My wife's family was super into it and the "Hills Are Alive, all of that. So once we got married . . . well, I guess as long as I can remember, people were like, "Oh, you're Friedrich from The Sound of Music. You look so much like him. And I was like, "Okay. Cool." And I eventually watched the movie. I was like, "Oh, I look a lot like that guy." It's weird. I had this weird out-of-body thing where I was like . . . Even his mannerisms are super similar.

Dr. Chan: Did you ever dress up for Halloween?

Max: No. I didn't want to do that to myself.

Dr. Chan: Okay. Maybe down the road.

Max: So, yeah, we have this lookbook for the entering class, and in it, it says, "Say something interesting about yourself." And I think I mentioned that I have a twin brother and that people mistake me for Friedrich from "The Sound of Music."

And at the orientation, Dr. Stevenson, who ran the whole thing, was talking about people's different interesting things they brought up. He called my name out and I thought it'd be a couple of questions about my "Sound of Music" experience, and it definitely wasn't. He was like, "Let's have you come forward." And he played one of the songs from "The Sound of Music."

Dr. Chan: Yeah. He went all-in on the audiovisual.

Max: Yeah. And so I did a very poor job of singing and dancing along.

Dr. Chan: Yeah. You danced. I remember that. In front of the entire . . . you just met these people. Oh, my goodness.

Max: Yeah. And one of my classmates', Jabber, he's awesome. I played basketball with him. He's hilarious. He, for the first six months of med school, thought that I was in the movie. He looked at me and he's like, "Bro, I can't believe you were in movies and stuff." And I was like, "That movie was made 60 years ago."

Dr. Chan: Okay. So, during the first two years, Max, what were you thinking of becoming? I think surgery was up there, wasn't it?

Max: Surgery was up there.

Dr. Chan: Emergency medicine maybe.

Max: Emergency, ophthalmology.

Dr. Chan: Okay.

Max: I had shadowed people in nearly every specialty, and I'm one of those people that you could pick for me and I would probably have a happy career. And that's a good thing, I think, because it helped me know that medicine was the right choice. But when it came time to actually choosing, I think . . .

Dr. Chan: So don't say it. So the future is wide open, a lot of different ideas. How did third-year start? How did you start ruling in, ruling out different fields? What was third-year like for you?

Max: So I think the big one that most people experience is medicine versus surgery. That's the big breakpoint. And I started with medicine and I liked it. I really liked my attendings. It was nice. But once I moved to surgery next, I thought, "Oh, rounding is not really my thing." There were some days where you would round for four hours before lunch, go get lunch, and then round for four more hours.

Dr. Chan: A lot of talking. A lot of thinking.

Max: Yeah, exactly. And my attention span, I'm good for a couple of hours and then my mind just starts to wander to the pain in my feet as I'm standing there.

Dr. Chan: Trying to look interested.

Max: Yeah, exactly. And so, once I moved to surgery, the hours are longer, you can have some attendings that are a little more intense, but I loved being in the OR. There's a problem right in front of you and you're there to fix it. I like the kind of immediate gratification that comes from that. So surgery was definitely high on the list.

I have people I know that have done emergency medicine, which is pretty high on the list as well. But then ophthalmology was up there as well. I had a cool mentor in undergrad, so I liked aspects of pretty much everything.

Dr. Chan: So how did you make your decision then if you'd liked everything? Walk me through that.

Max: So, for me, it was as I experienced it, I would talk a lot with my wife, talk with friends. I'd ask her, "What was I like coming home from surgery?" or, "What was I like coming home from this emergency medicine?"

Dr. Chan: So you would ask Kelsey, "Did you like ophthalmology Max or internal medicine Max or family medicine Max?"

Max: Exactly. And that was helpful. And I think one thing I really noticed was how I felt going in for shifts as well. Going in for surgery, I was always tired, but I was excited.

Dr. Chan: Yeah. The hours can be daunting. Waking up at, what, 3:00 or 4:00, going into the hospital.

Max: Yeah. So that was . . . you kind of get in the groove, but there are times where I was like, "I don't know if I could do this for 30, 40 years." But once I was there, it was really exciting.

So you have to choose to do an emergency medicine elective. And another one I was interested in was anesthesia because you're in the OR, but I had never rotated on it. And so, at the end of third year, it's coming that time where you have to pick and I was still thinking, "Okay. Emergency medicine."

So those that don't know, Dr. Chan does psychiatry.

Dr. Chan: Yep.

Max: Child and adolescent psychiatry. I had rotated through UNI up here and thought, "Oh, I could definitely do some child and adolescent as well." There's a program where you do . . . it's called triple board where you're peds, adult psychiatry, child psychiatry. So there was a month period where I thought, "Oh, that's something I want to do as well." So I was all over the board. I loved it all. I thought I could do it all.

Dr. Chan: What did you do for your elective time during third year?

Max: Yeah. So I did emergency.

Dr. Chan: Oh, okay.

Max: I did emergency. Well, I did research. It was my proper elective time, and that was in ophthalmology. And I figured out that the lifestyle is great, a lot of people really like it, but it wasn't a perfect fit for me. And then the rest of that time, I did emergency medicine, and then I stacked anesthesia right after that. That was the deciding point for me.

Dr. Chan: So why anesthesia?

Max: That's what I chose.

Dr. Chan: Yeah. Why?

Max: So anesthesia, for me, they felt like my people. Was just the very most basic. I would go into the OR. Generally, really chill people tend to calm the seas. They're somebody who you really advocate for one person at a time, which I loved.

The chair here at The U, Dr. Egan, he says that in anesthesia you have the mind of an internist, the technical orientation of a surgeon, and the heart of a psychiatrist. I mean, you don't dive in as deep into any of those, but you get to have pieces of different specialties, which I loved.

I could still work with my hands. You still use all that physiology and pharmacology that you pound into your head during med school. And a lot of times, you're meeting someone on the scariest day of their life. They're about to . . .

Dr. Chan: A lot of anxiety.

Max: Yeah. A lot of anxiety. A lot of times, they're leaving that surgery with a very different life than they went in. And as the anesthesiologist, you get to meet them, you get to greet them, you get to calm their nerves, and you're this advocate for them throughout this procedure. The surgeon does their thing. They fix it. You're the one who keeps them going throughout that whole thing. And I love the opportunity to be . . . one person at one time, you are 100% their advocate.

Dr. Chan: I love your eyes just light up when you're talking about it. So did Kelsey see that too?

Max: Absolutely. Yeah. So I did emergency medicine for a month, and then right after I did anesthesia. I wanted to see how the two compared, and I would come home from emergency medicine shifts and even though the hours aren't as long, I was tired.

And they generally funnel the cool stuff to med students, you know, suturing, iliac repairs, different things like that. And I started noticing before I'd go in, I have a pit in my stomach, and coming home, I was pretty tired. And so I thought, "Well, if it's not emergency, I really hope it's anesthesia because I've got to pick soon." And day one or two of anesthesia, I was in the operating room. They let me do some intubation and talk with patients before. I knew it was the one for me.

Dr. Chan: So what does anesthesiology residency look like? How long is it and what kind of rotations are there on it?

Max: Yeah. So it's four years.

Dr. Chan: Okay.

Max: Your first year is an intern year. You can choose between . . . there are basically three options. You can do a prelim year in medicine. So you're rounding, doing all of . . . you're basically an internal medicine resident intern for a year. You can do surgery where it's the same deal but for surgery, and then you can do something called a transitional year. And those are a blend of the two. There are some transitional years that have a reputation for being super chill. There's one in Santa Barbara where I think you work 30 hours a week. So everybody applies to that.

So you have your first year. It can vary widely. And then three years of anesthesia training. You spend . . . do you want me to keep going on?

Dr. Chan: Sure. Keep going on. Yeah.

Max: Yeah. So first year is just getting used to the OR. They'll rotate. The big disciplines within anesthesia are obviously OR, just general anesthesia. You can do regional where you're doing blocks, nerve blocks before surgery. A lot of times on the burn unit, they have a lot of pain, so you'll go in and do a nerve block to take away the pain.

Dr. Chan: Like for laceration repairs.

Max: Yeah, exactly.

Dr. Chan: Okay.

Max: OB is a big part of it where you go and you're doing epidurals. You're helping with pain management there. And then there's chronic pain, which is people with back pain, nerve pain. You're managing them long term.

Dr. Chan: Yeah. That's fascinating because when I think of anesthesia, you do have this image of they provide general anesthesia, they knock the patients out, bring them back to life. But yeah, you've talked about there's also this clinic component where you're treating people who have chronic pain. Yeah, I can see psychiatry being a huge part of that, like motivational interviewing and helping people. That's a fascinating dynamic when you think about it. I don't think too many people think of anesthesiologists like that.

Max: Absolutely. And I didn't know much about what else you did. There's a perception of people that go into anesthesia. When my non-medicine friends hear that I'm doing anesthesia, they're like, "Oh, you're going for the big bucks," or, "You want an easy job."

But when you're in the OR, it's not easy and it can be really scary at times. You are breathing for that person. You are making sure their heart is beating normally. You're the one making sure their brain is getting blood flow and you have to act quick. And I like that component. There's kind of the emergency medicine acuity there, but in a very set environment.

Dr. Chan: So what is or what was your strategy for applying to anesthesiology programs? How many are there? How many did you decide to apply to? How did you determine if you're a competitive person for these programs?

Max: Yeah. So I followed a rule where you apply to 60% of schools that you think you're a really good fit for, 20% that are fallback schools where you're like, "Eh, I'll go there," and then 20% that are reach.

Board scores is a big part of deciding where you fit well. I was pretty happy with how I did on my boards. I felt like I did well with clinical grades, and so there were definitely plenty of reach scores. Most of the schools in the middle, I felt if they're interested in me, I'd be a really good applicant. So we went about it like that.

There's a big list. Doximity does a list of ranking according to reputation, research output. You could spend months looking up all these schools. So I spent a good amount of time looking at how these schools rank up. And then location is another big one. I'm married. I have a 3-year-old son. We're from Utah. Utah is comfortable. The West is comfortable.

Dr. Chan: It's home.

Max: Exactly. And so somewhere in the West we thought would be ideal, but I still applied to programs on the East Coast and have loved those interviews as well.

Dr. Chan: So how many total did you apply to?

Max: So I applied to, all together, about I think 50.

Dr. Chan: Fifty? Okay. Wow.

Max: And that includes intern year applications as well.

Dr. Chan: Okay.

Max: So you have to apply to those separately.

Dr. Chan: Fun.

Max: Yeah. More money.

Dr. Chan: There are no programs that are combined?

Max: There are plenty of programs that are combined, but there are also a bunch where it's not combined. And if you end up getting in there, you have to find your own intern year.

Dr. Chan: So you have to go out and interview for these intern years?

Max: Yeah.

Dr. Chan: And kind of do the whole process?

Max: Yeah, exactly.

Dr. Chan: Wow.

Max: And it's a different feel. They're really nice. I did mostly medicine the intern years. They're super nice, but they also know you're only going to be there for a year.

Dr. Chan: Yeah. You're a hired gun for them.

Max: Yeah, exactly.

Dr. Chan: when you go on these anesthesiology interviews, do they ever test you for your skills? Do they say, "Oh, start an IV or intubate," or they don't do that? It's all just talking.

Max: So that's one thing. Another confirmation to why anesthesia has been great for me is it's just talking.

Dr. Chan: Okay. All right. No . . .

Max: No surgery.

Dr. Chan: They're not like, "Okay, IV. Do it. Go"?

Max: Yeah. And most of it has been super chill, super laid back. Depending on the program you're at, you can have anywhere from a 10-minute interview to a half an hour, which can be daunting because you're like, "What am I going to talk about for a half hour?" But people in anesthesia are generally laid back and those 30 minutes fly by.

Dr. Chan: Okay. This is fascinating, Max. That's why I love talking to you. What's the perception of nurse anesthesia? Does that get talked about in interview days or is that . . . I'm just curious what you guys learn about that.

Max: Sure. That was something I considered before choosing the field. Everyone thinks, "Oh, nurse anesthesia, they're taking over all the anesthesiologist jobs. It's cheaper." Every nurse anesthetist I've worked with has been excellent. They're wonderful.

And generally, in residency, the things I've looked for are, "Are you working to relieve nurse anesthetists? So are you going in to make sure the nurse anesthetists get home, or is it vice versa?" And if you're a resident who's relieving nurse anesthesia, you're probably going to work a lot more. You're maybe more of a workhorse in that environment, whereas vice versa, the program is prioritizing your time, your own study.

Dr. Chan: Your education.

Max: Yeah. But a lot of people in anesthesia in general, there's a concern that "Are there going to be less jobs because nurse anesthesia, they can do very similar things, more routine cases?" They can step in and . . .

Dr. Chan: And that leaves the complex cases for the anesthesiologists, which have inherently more risk. And then you talk about insurance coverage. It's hugely controversial. It's one of these things that I don't think there's an answer. It's just how the system has evolved.

Max: Right.

Dr. Chan: But I do know to get a bunch of anesthesiologists go and just talk, like, "Oh, what do you think about nurse anesthesia?" and then they go, "Oh . . ." and everyone has opinions on this.

Max: And most people I've talked to in anesthesia who've done it forever, they're not super concerned about it taking jobs away or killing their pay, anything like that. It more has turned into rather than doing one patient at a time . . . if it's at a surgery center where the acuity is lower, they'll just observe two or three rooms. And nurse anesthetists will be in those rooms. And if anything happens, you step in and can help.

So I would love to do one patient at a time all the time, but it's nice to have those skills to manage multiple rooms as well.

Dr. Chan: Yeah. It sounds like the field is evolving, like all fields do.

Max: Yeah.

Dr. Chan: All right. And so, going into your decision, because you have to make a rank list, wasn't it due in a couple of months?

Max: Yeah. I think it's due February or so.

Dr. Chan: So do you have some sort of really complicated Excel spreadsheet at home, or is this just by your gut, or is Kelsey in charge of your rank list and you just give her the password and she's just going to do what she does?

Max: I think it'll be an amalgamation of all of those. I'll say, "Honey, how do you feel? Where do you want to live?" But I'm very much a go-by-gut feel. I've done about eight or nine interviews at this point. The magic number to match almost 100% possibility of matching if you do about 12 interviews.

Dr. Chan: Okay.

Max: I'll probably do 10 or 11, but going into it, it's very much been a gut feel. The programs I leave where I was like, "Yeah, I really got along with the residents. I really like the area," those are the places that I tend to think about more.

Dr. Chan: All right. This has been great, Max. So, looking back, what advice would you give anyone who's listening out there who might be struggling with the idea of going to med school or unsure if they can do it or maybe has that doubt or doesn't come from a background in medicine? What would you say to them?

Max: I'd say medicine isn't for everybody and there are definitely those who get into medicine . . . their whole life, they were like, "Medicine or bust," and they get into it and they're disappointed. But if you know that it's something you're really interested in, give it a shot.

I had a lot of self-doubt, like I said before, but once I got in, once I put the time in . . . I think some people, they really want to do something, but sitting down and actually putting the time in, showing that dedication is another thing entirely.

So, for me, once I sat down, I was like, "Okay. I'm really going to study for this organic chemistry test. I'm really going to get through and do the hard stuff." That's where I gained some confidence.

And so you'll have hard classes. You'll have moments where you think, "Maybe it's not worth it." Just buckle down, get through that obstacle, and you'll have confidence coming out the other end.

Dr. Chan: Awesome. Well, we should have you come back, Max, after the match because I'm very curious to see where you end up.

Max: I'm curious to see where I end up as well.

Dr. Chan: It's been fantastic having you in the CMC group, but also just being part of our school and just part of our community. And everyone loves you and Charlie and Kelsey. Just keep on . . . I'm just so proud of you.

Max: Thank you.

Dr. Chan: All right. Thanks, Max.

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 is Anki? Is it a powerful study tool? What makes a good or bad flash card? What's the best thing about using this AnkiApp? Today, I'm talking admissions and med student life. I interview Nick, a first-year medical student here at the University 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 Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." I'm with a great, great guest today, Nick, how are you doing?

Nick: I'm good.

Dr. Chan: First-year med student?

Nick: Yeah.

Dr. Chan: All right. We have much to talk about. But I like to start in the beginning. All right. So Nick, how did you know you wanted to be a doctor? What is your origin superhero story?

Nick: Well, it's in my journal when I was five-years-old. It was doctor or policeman. So that's where it started.

Dr. Chan: So you were competing with the police academy on some level.

Nick: That's right, yeah.

Dr. Chan: All right.

Nick: But honestly, like I always wanted to be a doctor. My dad's a doctor. And when I really sat down and started thinking about it, my dad played devil's advocate and told me, you know, "It's awful. You're not going to see your family. You're going to have to give up a lot." And so I started looking at, I went through the majors list at BYU, you know, what else could I do. And I found like finance things, I really like finance.

Dr. Chan: So how old were you when you have this conversation with your dad? Was it kind of a more of an ongoing kind of . . .

Nick: So this was . . . I was actually on a mission. So he was signing up for classes for me because I couldn't do it. So I was 21 at the time, almost, and . . .

Dr. Chan: Where were you on your mission?

Nick: I was in Taiwan.

Dr. Chan: Okay. Not a lot of internet there I bet, or is it against the rules . . .

Nick: There's the internet, yeah, just against the rules.

Dr. Chan: Against the rules? You can't sign up for BYU classes on the internet?

Nick: You can email your parents once a week. That was all I got to do.

Dr. Chan: Oh my goodness, okay.

Nick: So, anyway, I emailing him.

Dr. Chan: So you got a good relationship with your dad. He wasn't signing you up for joke classes.

Nick: Yeah.

Dr. Chan: Kind of messed with your life a bit.

Nick: Exactly.

Dr. Chan: Okay. All right.

Nick: So yeah, he just playing devil's advocate. So finally, I'm looking, do I want to do business or finance? I just could not justify making money for the sake of making money. I wanted to do something where I could actually, like, help somebody with the skills I learned and just nothing felt right. And now that I'm here in medical school, like everything feels right. I love it.

Dr. Chan: It's all clicking.

Nick: Yeah.

Dr. Chan: All right. So you come back from your mission. Talk to me about BYU pre-med life. Like, how competitive is it? Because I know there's a lot of you. Like how was that? How did you navigate that? How did you set yourself apart?

Nick: It was competitive, no doubt. Yeah, getting an "A" was not easy. I think medical school is less stressful in that regard. But it was less busy and I had fun. People told me, you know, you can try and do things for your application or you can just do the things you love, and then when you get to the application, you just make it work. And that's what I did. And it worked.

Dr. Chan: What kind of things were you doing? How did you prepare for the application, medical school?

Nick: Yeah, I did a lot of humanitarian stuff, because that's just, that's my thing. That's what I love. So I did stuff in Africa, Nepal, and I loved that. And then I worked with Boys & Girls Club a lot, and then I was in a singing and dancing group.

Dr. Chan: Okay. Let's break that down. I love breaking this down. Okay, so Africa, did you do that through BYU, or did you do that on your own efforts? Or like how did that come about? Yeah.

Nick: My dad has done a ton of stuff, like he was on the relief troop that went to Haiti and Philippines after the earthquake. So he kind of gets involved in this, and he started sponsoring people in Africa and just wanted to go. So it was just he and I, and we set up this medical trip. And I did eye exams, and blood pressure, and vitals, and stuff, and he did bigger physical exams and we worked with a bunch of girls that were orphans, and normally they'll go into prostitution, that's the only way they can survive. And so our neighbor had set up a big school there to help them learn, and we went and helped with the health part of it.

Dr. Chan: Wow, that's amazing. And then you mentioned the Boys & Girls Club?

Nick: Yeah.

Dr. Chan: What was that about?

Nick: I would just go volunteer after school. I mean, it was nothing big. It's just that, typically, the kids in Boys & Girls Club their parents are still working after. So they're kind of from lower-income families and I would just go to school and read with them.

Dr. Chan: So kind of like a mentor tutoring kind of thing?

Nick: Yeah. And I found out halfway through doing that, that they had a Chinese immersion program at one of these schools, so I went and helped them with their Chinese homework. And that was tons of fun.

Dr. Chan: Wow, that's amazing. And then you mentioned, what was that last thing you mentioned? You said three things.

Nick: Oh, yeah, Boys & Girls. Oh, singing and dancing.

Dr. Chan: Singing and dancing. Oh, let's focus on that. Okay. Again, BYU is known for this. Were you on the team?

Nick: I wasn't. This is actually totally different. It's called Clayton Productions. It's in Sandy. So I commuted up to do it. And I just, I did it all through high school and then I did that, and we actually went on tour to Taiwan and performed all over.

Dr. Chan: What kind of singing and dancing are we talking about here?

Nick: Everything. Just depending on the music we were doing . . .

Dr. Chan: Country, rap?

Nick: Yeah, we did country. We did Michael Jackson. We did hip hop, everything.

Dr. Chan: Okay, you know how to moonwalk?

Nick: So, not quite. But yeah, it was fun.

Dr. Chan: Okay. All right. All right. So you're doing all these activities. You're going to class, you're studying hard. And, you know, for those that are listening, like because I know you applied to a lot of schools. I know you got into a lot of schools. Like what was your process? How did you know which schools to apply to, and, you know, just kind of walk us through that?

Nick: Yeah, somebody told me, which I thought was great advice, to take the MCAT a couple months earlier, so that I could apply to Texas. And they have cheap schools and they're good schools. So that's something I would definitely recommend to everybody.

Dr. Chan: Because they have a separate application system. Texas does its own thing.

Nick: Yeah, they do their own thing. And it's earlier too, and then kind of for out-of-staters, it's kind of a first come, first served sort of deal. But for other schools, I just kind of looked at what based off what my MCAT was, what I could get into. And then I had a few reach schools and I had a few safety schools And I think I ended up applying to almost 20 schools.

Dr. Chan: Twenty schools?

Nick: People had recommended.

Dr. Chan: Okay, and how many interview offers did you get?

Nick: I think I went to 10.

Dr. Chan: Okay. All right. That's good. Good. Feeling good about things. What was your experience interviewing at all these schools? Like different kinds of . . . I assume different atmospheres.

Nick: Yeah, totally different.

Dr. Chan: Different cultures.

Nick: Totally different interviews. Everything is totally different. And then you realize too after the first one, that the curriculums of every med school is different, and the way they actually do med school is different. So, yeah, they're all totally unique.

Dr. Chan: How'd you find which one . . . I mean, like how do you learn about that as someone who's there for like less than a day? I mean, were you doing like a lot of research on the internet? Or do they have a lot of students come in? Or was there like an alumni network you kind of reached out to? Like how did you gather information?

Nick: Yeah, that's a good question. I think the biggest thing for me was I stayed with somebody every night in the school. I always signed up for that "stay with a med student" thing and talking with them the night before, and then I would always keep their phone number too. And once I got accepted, I'd ask them more questions. But that was the biggest thing for me, because you're hearing it from somebody who's there. Now, the admissions committee kind of shows you like the glamour, but the students can tell you the real deal. And so if it matches up, then you know it's a good school. And if they tell you something different, then, you know, you really need to ask a few more questions, what's going on.

Dr. Chan: And were you married by this time?

Nick: I was, yeah.

Dr. Chan: Okay. So did your wife go out with you to these schools?

Nick: She went to one with me.

Dr. Chan: Okay. Was that helpful or not helpful? Because again, she was part of this decision, right?

Nick: Yeah.

Dr. Chan: It's complicated kind of process. So.

Nick: So we went out like just because her friend lived out there in Dallas, and I loved UT Southwestern. I thought it was an amazing school. She hated Dallas.

Dr. Chan: Did she know that before she got there?

Nick: No, she went and spent all day in Dallas with her friend while I was interviewing. When we were done she's like, "I can't live here."

Dr. Chan: All right. All right. So you got an interview, you learned about the different cultures, different curriculums, or like, what are some of the . . . I mean, again, it's hard for people who are not in medicine. What, like you don't have to name names, like what are some of the differences in the curriculums that you saw? I mean, what did you appreciate at that level?

Nick: One of the schools I almost went to, their curriculum, they do all their book work in a year and then they jump straight in the clinicals. Whereas other schools, like The U, is two years, and others were a year and a half, and some of them will do a year and a half, and then take the boards and some would do a year and a half, and then a year of clinicals and then take the boards. So all totally different methods. And then some of them were organ systems. And some of them were more like class-based, like you'd have a genetics class. So totally different.

Dr. Chan: Okay. Did you go to different second look days?

Nick: I went to, I think I actually just went to The U's. At that point, I was more like committed.

Dr. Chan: That helped seal the deal. I assume it was a good experience.

Nick: It was. Yeah, it was a good experience.

Dr. Chan: Okay. So again, kind of again, how did you end up choosing? I mean, what was the kind of, what were some of the criteria that you were looking for that helped you decide to stay here?

Nick: I'd say the biggest one was my wife, staying here in Utah. Both of our families are from here. But beyond that, location, price and curriculum, that was my three things. And I realized the interview days they'd show you the flashy things, like The U has an anatomy table, but I haven't touched it since I got here. You know, it's flashy, but . . . and then some schools have awesome anatomy labs, and The U's is really old, but it didn't bother me at all.

Dr. Chan: It's over in Research Park, yeah.

Nick: Didn't bother me at all. Once you got in there like all you needed was a cadaver and a scalpel. And so I realized later into the process that it was the curriculum and the price and the location. Did I want to live there for four years? Did I like the people that were there, and was the cost not outrageous?

Dr. Chan: Okay, all right. Fair enough. And so you matriculate here to The U, and before I turned on the pod you were telling me that you had quite the commute.

Nick: It was.

Dr. Chan: So let's talk about that. I think it's the furthest I've ever heard of anyone living. So were you just locked into a rental agreement you couldn't get out of, or you just love what Mapleton has to offer?

Nick: We were living in my wife's parents' house because they're on a mission. So we were there for almost free basically, which was nice. And she was at BYU doing a lot of credits, trying to finish everything up before she student teached, so she was almost as busy as I was. And first years here, told me I can do it, second look thing.

Dr. Chan: It was a lie.

Nick: And I did it, honestly. It wasn't the easiest thing. I didn't get into the social life and stuff because I'd go right home and it would take two hours.

Dr. Chan: Yeah, how far away is Mapleton? And we're talking driving or . . .

Nick: If we're driving, it's about an hour and 10 minutes, but I took . . . yeah,. I would drive to the station, which would take like 15 minutes. I'd get on FrontRunner and then take a bus to The U. The whole thing took about two hours.

Dr. Chan: I'd assume that's the southern-most FrontRunner station.

Nick: Southernmost is Provo. And then you go drive 15 minutes south of it to Mapleton.

Dr. Chan: Okay. All right. Good studying time or?

Nick: Yeah, it wasn't terrible, because I did Anki flashcards on the way up.

Dr. Chan: Which we were talking about. Oh, I'm excited. Okay. This all segues together here.

Nick: So I just did my flashcards on the way up, and then on the way home I would download the lectures, and then I would watch them on the way home, and it worked out okay.

Dr. Chan: So did her parents get back from the mission? What was the tipping point? Why did you guys move out?

Nick: Well, she only has two classes this semester. And I said, "I'm done. We're moving." So we're up here now.

Dr. Chan: Okay. So you live up in Salt Lake?

Nick: Yeah.

Dr. Chan: Okay. All right.

Nick: Much better.

Dr. Chan: Very cool. All right. So first semester under your belt.

Nick: Yep.

Dr. Chan: Did it go as you thought it would go, a little bit harder, a little easier? Like what was your experience, first semester?

Nick: First semester, honestly, I felt like it was a little bit easier. The second semester now that we're really getting into things is more what I expected. Because the first year we kind of covered physiology stuff that I already sort of had a basis for, but I mean, it wasn't awful.

Dr. Chan: Okay. So doable? Manageable?

Nick: Very doable. I think I studied Monday through Friday. I usually caught the first bus at 7 a.m. and I'd be home by 6 p.m. or 7 p.m. And I didn't study on the weekend.

Dr. Chan: And how do you feel about like, you know, the different teaching methods? Because I know, we have CBL, TBL, what are your thoughts about those?

Nick: It's nice to have a mix. The TBLs are fun.

Dr. Chan: Team-based learning. Yeah.

Nick: Because you get to kind of synthesize all these ideas and you have questions that are, honestly, way harder than they should. But it's good because it forces you to think. And then the CBLs are great because you're thinking this is a real case. You're trying to think of a real person. I think it really helps with the thought process developing.

Dr. Chan: Because of the commute, have you had time to get engaged in like different student interest groups or clubs or?

Nick: Not a ton. I kind of held off on that. I did a little bit . . . I volunteered once for a street clinic, but I have no time just because I was living so far down there.

Dr. Chan: Okay. What's been the biggest drawback, other than the commute?

Nick: Of?

Dr. Chan: Med school.

Nick: Of med school in general?

Dr. Chan: Living in Salt Lake City life? I don't know.

Nick: Yeah. I think med school's busy. You have to sacrifice things. Like I was doing flashcards on Christmas.

Dr. Chan: That doesn't sound like a good Christmas morning. Yeah.

Nick: It was only about 20 minutes. So it wasn't terrible. But I mean, there are sacrifices that have to be made. Honestly, I've loved pretty much everything in medical school at this point.

Dr. Chan: So great lectures, great material, classmates, everything's going well.

Nick: Yeah, I mean, sometimes it's frustrating trying to navigate like what am I actually supposed to know, because it is never-ending. You could keep studying forever.

Dr. Chan: Yeah, keep on going down the rabbit hole.

Nick: Yeah.

Dr. Chan: I mean, you can keep on going further and further and further.

Nick: I mean, the doctors teaching us don't even know. So, yeah.

Dr. Chan: What are you on right now? What's, the lecture?

Nick: We're doing, well, MCC is a molecule cells in cancer and we're doing kind of the cancer unit now, oncology drugs.

Dr. Chan: All right. And I know like, did they do blood cancers earlier?

Nick: Yes. We just kind of finished the white blood cells stuff.

Dr. Chan: Okay, again. I heard there was an epic slide deck, 150 slides like . . .

Nick: So much information. It's like straight nonsense. Like this type of leukemia, you're testing for CD15 and CD30. Like there's no magic way to remember that, you've just got to remember it.

Dr. Chan: Yeah. I remember, yeah, like anytime I get, I'm just, I mean, I'm almost an AVI Nick, because like you guys are learning all this up-to-date, current information, and I'm like much more on the clinical side, and I'm a child psychiatrist. I don't deal with blood cancers and stuff. And I just remember I was talking to some of the med students and I said, you know, "Like what happens if like the white blood cells are elevated?" And like the students, bless their hearts, they started to give me all these very kind of zebra-like answers. Well, two things guys, it's probably just an infection.

Nick: "It's cancer."

Dr. Chan: Yeah, they go right there, you know, like horses, like [we're confident 00: 14: 39]. Or, you know, it could mean it's not that elevated, you just recheck it. So just draw the blood again. It's very fascinating because I think medical education is really predicated on studying these very, you know, interesting diseases because it kind of checks all the boxes that you kind of learn these different principles associated with diseases, but a lot of these diseases are very rare, they're very, very rare. And we call those zebras, you know, like, and I feel sometimes we teach students to look for zebras when, in essence, they're just like regular horses, you know, it's just an infection.

All right. Flashcards. Let's talk about this. So what is this program or I don't know, an app or?

Nick: Yeah, it's an app. It's online. It's free on the computer.

Dr. Chan: How'd you discover this?

Nick: So it was actually a second look day.

Dr. Chan: Okay. All right.

Nick: Yeah. One of the one of the second years told me. He said, "Med school is really not that bad. I'm just doing this app. And I do like three hours of flashcards a day. And that's it. And I'm doing awesome. And somebody already made all these flashcards pre-made for you." I was like, "This is awesome. That sounds really nice. I could do that." Because I learn well with flashcards.

Dr. Chan: So Anki?

Nick: Yeah.

Dr. Chan: All right. So you hear about . . . so as far as you know, is not used on the undergrad level or?

Nick: Well, I was kind of introduced to it when I was studying for the MCAT, and I hated it because it's so . . . it's not user-friendly at all. But when somebody told me, you know, there was pre-made cards as opposed to you have to make your own, I was a little more convinced that would save a lot of time. And as I've gotten to use it more I realized it's actually really powerful. It's just that it's built so that you can change it. It's kind of like the Apple vs. Windows comparison, you know, Apple is really user-friendly but you can't change it very much.

Dr. Chan: Okay, so heard about it second look day, and then school starts. And I think there was a group of you that kind of started working together, or just walk me through this, how this developed.

Nick: Yeah. Well, so Anki is a spaced repetition flashcard app, right? So you see a flashcard today, then you'll see it tomorrow, then you'll see it in three days and then in seven days and onwards, unless you get it wrong. Then maybe it'll come back, you know, so you can review it more. And so a couple of friends and I decided we want to get into more difficult specialty surgical stuff, so we're going to dedicate to this app, because the same kid I met on second look day told me he scored a phenomenal step one score. So I was convinced at that point, and so we started trying to learn how to do it.

And I think it took the entire first semester before we had a grip on what we were really doing. But by the end of that semester, you're seeing flashcards that you'd made three or four months ago, and you realize what makes a good flashcard, what makes a bad flashcard. But I also realized I wasn't studying for quizzes and all my peers were cramming. And I didn't study for the final at all and I did really well. And so that's when I started to be really convinced, you know, this is really powerful and now I'm loving it.

Dr. Chan: Okay. So how much time a day are we talking about? I mean, how much do . . . I mean what, is there a recommended time or like?

Nick: No, it's just kind of whatever you wake up in the morning and it says you got to do, you got to do this. I woke up this morning, I think I had 400 flashcards and I just do them first thing in the morning. Usually takes me one or two hours, depending on how many reviews it says I need to do. And then I'll learn material and add flashcards depending on what I've learned for the day.

Dr. Chan: So it sounds like Anki really kind of comes up with almost a schedule for you.

Nick: Yeah, it totally does.

Dr. Chan: And based on your responses, you know, maybe a flashcard is added later, or they kind of start clustering and then it kind of focuses more on this subject if you're struggling.

Nick: Yeah, but it's still reviewing. So like, you know, this morning I'm doing my white blood cell cards and stuff that I was learning from last week, but I also was reviewing some of the kidney stuff and some of the cardio stuff that we've done, you know, last semester. So it does give you a good schedule. And the best thing about Anki is that you study every day. It forces you, you got to do your reviews every day. The worst thing about Anki is you got to study every day.

Dr. Chan: Yeah, yeah, cool.

Nick: On Christmas, I was doing it. I only had like 50 flashcards, but you still got to do them. So.

Dr. Chan: Then how much time does it take you to program, or I don't know what the verb is, but to upload the information to create new flashcards?

Nick: Yeah, so making a new flashcard . . .

Dr. Chan: Is that kind of a rate limiting step would you say or?

Nick: Making new flashcards for sure, it takes a while, just because you got to type it out. It's just like if you were using Quizlet or hand-making any flashcards it takes a long time. And that's what's so nice for medical school, is that, you know, it's totally pre-made for you. And just recently I saw somebody just released an MCAT one, and I think the NCLEX one is starting to come out too. So people are starting to upload their decks just on Reddit or something like, "Hey, I made these flashcards. Use them for free." I downloaded a medical Chinese deck just so I can start doing it. And somebody else made it. I'm learning how to do stuff. You know, it's nice because you can share around with everybody. I'll make cards for class and share them with our class, and everybody else can use it.

Dr. Chan: Okay, so that's my . . . kind of my next question, Nick. It sounds almost like a little bit like a religion. Is it kind of growing, do you have more and more believers?

Nick: From what I understand . . .

Dr. Chan: Do you have disciples and followers?

Nick: From what I understand, like four or five years ago at The U, there was one guy that did Anki. He was kind of the one that started it, and he got a phenomenal board score. And so the next year there was a few more, and the next year a few more. And I think a lot of our classes used it, and from what the faculty has been saying our test scores have been higher than any of the averages. I know last year's board scores were The U's highest ever.

Dr. Chan: Yeah, it's trending in a great direction. Yeah.

Nick: So I think you could probably attribute some of that to using a spaced repetition. And there's other companies, like Firecracker or the First Aid has even come out with spaced repetition flashcards. So I think everyone is starting to realize this is a superior method of study.

Dr. Chan: And do you still get to enjoy like lectures, or are people making flashcards in real time, or, you know, I'm just again, I'm just going to put on my medical educator administrator hat. Like does this in any way detract from like what you're supposed to be getting out of med school? Like the professionalism and the peer and the teamwork and that type stuff, or do you feel this enhances it and just makes it better?

Nick: So I think I would say it enhances it, in that there's just a ton you have to memorize for medical school. It's not quite so much like undergraduate where it's more understanding. It's just straight, like I said, CD15 and CD30 is this cancer, you just got to memorize that or memorizing names of drugs. And so it really helps that and it makes that part faster. And you can spend more time on the actual clinical stuff I think that matters more.

Dr. Chan: So there's the doctoring course, there's clinical method curriculum. Is Anki used for that, or is that . . .

Nick: Like a tiny, tiny bit, because we have a little bit of a . . .

Dr. Chan: Because that's more like muscle memory, and, you know, kind of, you know, inner professional communication skills.

Nick: Exactly. You actually got to go practice those skills with . . . and I do it with a friend. You know, we'll go practice doing the hard exam on each other. So, yeah.

Dr. Chan: Okay, good, good. And now, I think this has gotten so important and so useful, such a great tool that you were mentioning, like there's a YouTube channel?

Nick: Yeah.

Dr. Chan: Can you talk a little bit about that?

Nick: Yeah, so we found, I mean, like I said, it took us almost the whole semester before we got a grip on it. And we decided there's no one place you can go to learn everything. Plus, all of my peers were asking me like, "Hey, how do you do this on Anki? How do you do this?" And it was taking a lot of my time. So we just decided, let's make a whole video series and how to use it. So we just we did, we made a whole YouTube channel that goes step-by-step from beginning to more advanced skills, and you could probably watch the whole thing on two times speed in like an hour.

Dr. Chan: Okay. And what's the YouTube channel called?

Nick: It's called "The Anking," like Anking.

Dr. Chan: So can you spell it for people? Well, we'll have a link in the little ditties.

Nick: So A-N-K-I-N-G.

Dr. Chan: Okay. All right. So I get the sense, again, I don't know too much about this. I'm very envious of your generation, because like, you know, people mention Anki, and I don't know, I just hear, like over the years I've heard about so many kinds of apps and programs. What I'm understanding though, is like maybe a flashcard you built for yourself might not work so well for someone right next to you, but they will have the ability to maybe go in and then create one that's a little better. Does that make sense?

Nick: Totally.

Dr. Chan: So it sounds like it's like even though it seems . . . it sounds like it helps people's individual learning style.

Nick: Yeah, absolutely.

Dr. Chan: Okay. Would that be a fair statement? Like flashcards that may work for you may not work for someone else?

Nick: Yeah. Yeah. Well, like, I downloaded this deck of, I think it's 25,000 cards. And every day when I'm going through them to unlock the ones that I'm learning, I'll add to them too. You know, the first aid book comes out every year and there's updates. And so I'll read through that and if there's something different in the flashcard or I can do the screenshot, a screen, and put it into the flashcards just if I want to. So I update the cards regularly. I add things to them all the time.

Dr. Chan: That's great. Then you don't have to pay Anki?

Nick: It's free. The iPhone app is $25, the Android's free. The computer one, which is the main one, is free.

Dr. Chan: So other than helping students get that warm fuzzy feeling, what do they get out of it? I mean, it's just open source. I mean, yeah, okay.

Nick: Yeah. I think the guy that made it makes his money off of the iPhone app. And that's about it.

Dr. Chan: Okay, so the feeling is like people create this using their laptop or desktop, but they mostly kind of use it on their iPhone.

Nick: No, I do my cards on the computer a lot, but I have it on my phone just, you know, if you're waiting for a bus or whatever, you can do 20 flashcards.

Dr. Chan: So yeah, it's like the convenience factor, you know, it's right at your fingers.

Nick: Yeah, exactly.

Dr. Chan: I'm starting to get it. You make me feel old. Oh my gosh, this is fascinating. Okay, last few minutes. I always ask, I love asking this. I'm not going to hold you to it.

Nick: Yeah.

Dr. Chan: But as of today what kind of doctor do you want to be?

Nick: Oh, that's a good question, especially because I've been shadowing all sorts of things and I love everything. I think I'm leaning more dermatology. That's what my dad is and I like that field, but pretty close up on that list I just shadowed ocular plastics, which sounds fascinating. ENT and urology are on that list for sure.

Dr. Chan: So definitely, I'm hearing surgery.

Nick: Surgery for sure.

Dr. Chan: Surgical subspecialties, using your hands.

Nick: Yeah. The more fine technical stuff. I like the artistic component of plastic surgery. So something in that area.

Dr. Chan: All right. And then my last question, Nick, what advice do you have for those out there who are thinking about med school? Or maybe aren't sure of, you know, what path is right for them, what would you say to those people?

Nick: I would say, go spend some time in a hospital. And if you're shadowing a doctor or a nurse or whatever, it doesn't matter, you'll see everybody that's in the hospital. And I think people know pretty quick whether or not they like health care as a field. And then from that point, you just got to figure out where you want to go. Do you want to go nursing? Do you want to go medicine? Do you want to go dentistry? But first figure out, do you like health care? Do you like working with people and blood and that kind of stuff?

Dr. Chan: Okay. Awesome. Well, Nick, this has been great. I'll have you come back on a little bit later. Maybe even get updates about how Anki is going, especially into the step one mega test in a little over a year, I guess.

Nick: Yeah.

Dr. Chan: Feels like that's fast. Cool. Well, thanks, Nick.

Nick: Yeah.

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 is systems biology? How does presenting at a conference make one decide to pursue becoming at doctor? What's it like to have a husband in the Air Force and trying to match his order options with medical school applications? How does learning how to learn apply to nontraditional students? Today, on Talking Admissions and Med Student Life I interview Kristen, a second-year medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of 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 a great guest today, first-year, Kristen. How are you doing?

Kristen: I am doing great, thank you.

Dr. Chan: Fantastic. All right. Let's start in the beginning. Where along your path did you decide to go to medical school?

Kristen: Well, I was one of those kids that I think always wanted to be doctor. Growing up, I loved superhero movies and a lot of superhero origin stories involve science and medicine, so I really liked that. But I kind of fell in love with engineering when I was in my undergrad and I didn't always love memorization so I decided I wanted to pursue engineering. I was actually planning on doing my Ph.D. in biomedical engineering.

Dr. Chan: And this is back in Ohio, right?

Kristen: Yeah, yeah.

Dr. Chan: Case Western.

Kristen: Case Western, yep, doing systems biology, which is a really cool program, which is kind of interdisciplinary between biology and computer science and math. I decided I just wanted to go kind of more the engineering route. I kind of fell into this opportunity, though, that I couldn't pass up, which was taking a job at Microsoft as a technical program manager, which I really loved. So that was a great opportunity.

Dr. Chan: So, I remember in my undergrad days that they would have these job fairs. Did Microsoft have a booth? How did you get into Microsoft? Correct me if I'm wrong, but I don't think they have a big presence in Ohio?

Kristen: No, no office is in Cleveland. No, Cleveland's great. Microsoft wants to go to Cleveland. No, I had already gotten into the Ph.D. program that I really liked and Microsoft, though, they had a booth at the career fair and they had water bottles. I really wanted a water bottle so I wound up giving a rÈsumÈ and did an interview. If you do well in the interview they actually send you out to Seattle. I'd never been to Seattle so I was like, "Oh, free trip to Seattle." Then that kind of turned into a job that I really, really loved, so I got really . . . it sounds weird to say "lucky," but I got really lucky. It was a great opportunity for me at the time and moved out to Seattle. It just gave me the opportunity to kind of live as an adult.

Dr. Chan: Is the Microsoft campus kind of like . . . I have this image in my mind where there's free smoothie bars and there's these little pods you sleep in, anything you want they just do because you've really got to focus. Is that an accurate description? Masseuses everywhere.

Kristen: I did not see any masseuses when I was there. They did have a 100 flavors of pop machine. That was really great.

Dr. Chan: Wow.

Kristen: Yeah. Coffee and just they had beverages and stuff. They did have great parties. Whenever we'd launch a product they would have amazing launch parties. It's just one of those places where also the people that you work with are really great, so there's just this exciting atmosphere there because everyone's just really excited to be there and do great things.

Dr. Chan: Seattle's a cool city.

Kristen: Oh, Seattle's amazing, yeah.

Dr. Chan: So you're working at Microsoft and then were you also still going to school through your Ph.D. or how did that work out?

Kristen: No, I actually declined the Ph.D. program after I got the offer at Microsoft. I was continuing to work on my master's thesis. That's kind of a long story as well, but I kind of started with a B.S./M.S. program, doing my master's in systems and control engineering. I tried to work on that part-time while working. Actually, for anyone listening out there, that's not a great plan. If you're going to do something, just do it. It'll be much faster and cheaper to just get it done.

Dr. Chan: Very true. Very true. All right. So you're working at Microsoft, cutting edge of technology. You probably had really great . . . I bet your Excel spreadsheet skills and your Microsoft Word skills and Outlook skills are just amazing. So you're kind of plugging along and then what was the next kind of pivot point or decision point?

Kristen: Yeah. Well, I had been dating this fantastic guy for some time. We were engaged and I decided that the commute between Seattle and Texas, where he lived, was getting a bit too long for me. My now husband is a pilot in the Air Force, so he was stationed down in Texas and I decided to try to find something that was a little bit more flexible that would allow me to do the things that I really enjoyed doing, so do something that was really intellectually stimulating and challenging and, I guess, fulfilling in a career kind of sense. So I found a position in big data development to do consulting and move down to Wichita Falls, Texas, which is the next stop on that journey.

Dr. Chan: So how long were you in Seattle for?

Kristen: I think about a year and a half to two years, somewhere in there.

Dr. Chan: And then did you meet your future husband back in Ohio?

Kristen: Yeah, we actually interned together back at NASA Glenn Research Center in Cleveland, Ohio. He's from Cleveland too.

Dr. Chen: Fantastic. Go Cavs, right?

Kristen: Oh, love the Cavs.

Dr. Chen: All right. So he's Air Force, he's flying jets and all sorts of planes, so he's down in Texas. So you were in Seattle for how long?

Kristen: A year and a half to two years, somewhere in there.

Dr. Chen: Then you make the jump. Help people understand, where's Wichita Falls, Texas?

Kristen: So I like to say sometimes it's . . . there's not a lot around Wichita Falls. I would say it's about halfway between Oklahoma City and Dallas.

Dr. Chen: Prairies. Ranches.

Kristen: Prairies and ranches. Really, really good steaks. If you like steak, go to Wichita Falls. You will get the best steak of your life. It's great.

Dr. Chen: So you set up shop in Wichita Falls and you do big data consulting. So for those people that don't know, what's big data? What does that mean?

Kristen: Basically any time you interact with a retailer or something that has an online presence, pretty much anything you can think of will have a digital touch point. So if you make a phone call, if you send a text message, if you're at the supermarket and you give them your phone number so you can use your reward points, those are all touch points. Those are all being collected by companies.

Companies have all this information but they're not always sure quite what to do with it because they have different goals. Maybe they want to retain customers or maybe they want to sell you more stuff. Or sometimes maybe they just want to make a better experience. Maybe they have a website and they want to see, hey, how can people use this website better so that they're not banging their head against a wall trying to buy something on our site.

They would hire people like me to come in and say, "Hey, you can use these mathematical methods to kind of figure out where are people getting stuck. How can we improve your process? How can we understand the results of this clinical trial?&" or kind of things like that? It's really broad but it was a great experience because you get to use these kind of cutting edge mathematical methods on problems that are super interdisciplinary.

For example, I did some work at a financial company understanding personal networks and then you can use that same kind of network theory in a hospital system to understand how people move between providers. So it's really interesting to kind of take techniques from one field and move it to another field where it can be applied. But basically big data is just big, big, big data that you have to kind of use sophisticated techniques to understand and you have to be able to use technologies that can scale to actually process all of that data.

Dr. Chan: So it sounds like it could be something as mundane -- because I've read a little bit about this -- as that when you go into . . . I'm just going to pick on Amazon. You go into Amazon, there's a reason why the buttons are where they are, because it is shown that people are more likely to click on the button if it's at that point on the screen. Right?

Kristen: Oh yeah.

Dr. Chan: Or it can be more higher up, like how do we drive traffic here? Kind of like you said. Am I kind of conceptualizing that?

Kristen: Yeah, exactly. Actually, one example that I can't talk about, most of my stuff is NDA so I can't go into too much detail.

Dr. Chan: Nondisclosure.

Kristen: Nondisclosure. Sorry. Nondisclosure agreement.

Dr. Chan: I love it. I feel like I'm in the know. I love this stuff. Okay.

Kristen: But one I can't talk about I presented at a conference, and they wanted to know how they could reduce the time to go see a provider. So they had people coming in and they just wanted to give patients a better experience and figure out where are the bottlenecks here? If I'm coming into the system and I need to go see a specialist, what was taking so long to go see a specialist, how can we reduce those wait times, are there particular areas where people are getting stuck. So we use this type of graph model. So a graph is basically . . . Sorry, I didn't realize how much I relied on drawing stuff. Usually I normally draw stuff at this point.

Dr. Chan: All our listeners have really active imaginations. You're doing a good job.

Kristen: You can think about each appointment as being a point on a map. I'm starting out with my general practitioner. My general practitioner is going to refer me to get an X-ray and that person, from there, they're also going to refer me to go see an orthopedic surgeon and from there I'm going to go and I'm going to have this path where I might pick up pharmaceuticals. There are even various stops on this journey, each particular event. If I fall and I break my leg, that's going to start one particular path along this map. If I fall and break my arm, I'm very unlucky but I'm going to start on a different place in that map and I'm going to kind of navigate that system.

You can kind of superimpose all of those paths to find patterns. So what are the places with the highest traffic? You might imagine general practice to the pharmacy might be a very common path or general practice to getting X-rays, that might be a very common path as well. So we kind of want to understand how people are moving through the system and also how that varied for different age groups and for different regions, so just taking different slices of the population and saying, "How are people using these services? How are they moving through and what's the interplay between that and what their wait times are?"

People might get stuck in certain points and maybe bottlenecked. So if your general practitioner's only referring to one particular orthopedic surgeon, that person's going to be way too busy, so you might want to have more orthopedic surgeons in that particular area, that sort of thing. That's kind of how we . . .

Dr. Chan: So it's almost like tracking the data then. Here's a great question I've thought about. As you've interacted with different companies, different entities, organizations, you have all this data. Would you get sometimes people just pushing back, like they just didn't believe the date? Like, you do all this analysis and then they just don't believe it.

Kristen: I would say sometimes people can be surprised by things. What's kind of hard is you don't want to go in with too many assumptions about what you're going to get out of it. I don't think I've ever had anyone say like, "No, there's no way that can be true." But I think a healthy degree of skepticism is always a good thing because it forces you to kind of evaluate and say like, "Am I really doing this the right way? Is everything right? Is my code right?" Sometimes you make a mistake, and then if something is wrong, you look back and you're like, "Oh, actually, I definitely should have added here when I subtracted," or something like that.

Dr. Chan:I think I see powerful corollaries in medicine. I think sometimes doctors and patients are confronted with pretty strong evidence that either a treatment works or a medication works, but because of emotion or anecdotal past history they kind of push back against it. I don't know if you ever thought about it like that.

Kristen: Yeah. Actually, that's something that I really . . . I'm actually really glad you brought that up because we have an evidence-based medicine kind of section in our curriculum and what I've kind of been thinking about a lot is choosing the right numbers to describe a situation. So something that's really important is averages.

Everyone's like, "Oh, what's my average chance of surviving this?" Averages are not actually a great . . . at least I've found that averages aren't great for actually giving you information because, you know, we talked about people making appointments, some people are going to be really on it. They're going to make their appointments right away. Then some people might just forget. They might put it on their calendar and maybe they feel better, they don't want to make that appointment again, so your average time might be somewhere in the middle when, really, you have this bimodal distribution.

You have a peak of these people who are really overachievers. You have these people who kind of fall off the end. But the average doesn't really tell you that much. It's all really more about distributions. Even there, probabilities don't always help your understanding.

It's hard because when people do take numbers really personally, it only helps if you're in that number, right? If only 0.001% of the population gets hit by a bus, you're pretty safe. But if you're that person that's hit by a bus, that was not a very helpful number for you.

Dr. Chan: Yes. It makes it real.

Kristen: Yeah. I think that's just the hard thing is it's a lot of large numbers. Especially in medicine you see these weird conditions come up that we learn about. Not these weird conditions, I guess that's not very nice. You hear about these really unusual conditions and you're like, "Wow, that's really, really unlucky." But there are a lot of people in the world, which means that there will be some unlucky people. I think that's just the hard thing about probabilities is that you try to use these as guidelines, how should I make my decisions. But without knowing what population you're in, which you have no way of knowing, it's tough.

Dr. Chan: Yeah, I agree with you. I don't think doctors are really that great at math. I don't know if you've seen that already with evidence-based medicine, but with your background you should be, like . . . it should come a little bit easier to you than others. That's what I'm saying.

Kristen: It's kind of a different perspective, though, which is interesting. Kind of the way that you look at problems from an evidence-based medicine perspective versus from a data science perspective, it's really, I think, kind of the opposite. For a lot of data science you use really new methods. You might use text mining or you might use graph analysis. Evidence-based medicine is a lot more like we're looking at P values and we're looking at odds ratios, which actually I don't love odds ratios but odds ratios are everywhere in medicine. I think that's been kind of challenging in some ways because I was really ready to kind of bring my perspective in but I kind of have to learn what is accepted here.

Dr. Chan: A different language almost.

Kristen: Yeah, exactly.

Dr. Chan: Was all of your consulting with healthcare kind of entities or not really?

Kristen: I did some stuff with healthcare. I did work with LLT Finance, transportation, insurance. I did, actually, a bit with insurance, and then, yeah, some with healthcare, some with pharmaceuticals.

Dr. Chan: And would that kind of, "Oh, yeah, I need to go to medical school"? Walk me through that. What was going on?

Kristen: Yeah. I actually had one particular moment that it was really clear that . . . I really started to think about it seriously. It's hard, changing careers and saying, "I have this thing and it's going really well and it's solid."

Dr. Chan: Yeah, you're good, you're moving up the ladder, you're flying around the world, doing all this cool stuff, you're just immersed in data.

Kristen: Exactly. It actually was for a pharmaceutical company. I was working for them and I was presenting, I think it was some sort of information on a clinical trial and I was presenting these numbers. I must have been pretty blasÈ about it, which I kind of regret now. This clinician who was sitting in and watching these results, she just interrupted me and she's like, "You're presenting these but you don't know what these numbers mean because you don't have to sit across from someone and explain these numbers to them. You don't have to take ownership of their care based on these numbers."

I thought about that and I was like, "I was a pre-med." That was kind of my first instinct. "I was a pre-med. I understand health stuff." Then I thought about it for a second longer and I was like, "I have no idea. I have absolutely no idea." She was completely right. For me, it was numbers. It was all just these are numbers that are in this table that's sitting in some data center somewhere.

I don't know, maybe that person was a marathon runner or has kids. They weren't people to me and that was kind of like a weird, sad realization. I had a conversation with my husband when we were traveling and I just kind of brought it up. I'm like, "This has been really great. I've been really fortunate in my career and I've had really great people I've worked with, really amazing experiences, but I kind of feel like I want to do more. I want to know what those numbers mean. I want to have that impact on people." That's when I started looking into medical schools and applying.

Dr. Chan: So you were looking for more meaning, in a way, behind the numbers.

Kristen: Yeah, and I just wanted to be able to do more good too because if you're good at numbers, you're good at numbers, but you don't always know the right questions to ask. I feel like that's sometimes a disconnect. A lot of people in medicine have great questions but it's hard to answer the questions without the mathematical skill set necessary. But I have the mathematical skill set but I didn't know what the right questions were. So I kind of wanted to bridge that gap and I thought I might be able to do that. So that's kind of one of my goals. We'll see how it goes.

Dr. Chan: Yeah, that's cool. I really hope we get you there. So you told your husband you were thinking about med school. I assume supportive?

Kristen: Yeah. Oh my gosh, he's amazing. My husband is absolutely amazing and I'll be honest, I don't know if I would have done it if he wouldn't have been so supportive because military, I mean, we've moved around a lot. Even when I was applying to schools I kind of kept it on the down low, if you will, when I was applying because every time I'd bring it up people were like, "Oh, what's going to happen if you don't get into med school where he is?" I was like, "Well, I guess we'll just see if that happens."

But he was really great because it's a decision you have to make . . . if you're married, you have to make that decision as a couple. Like, "Hey, I have this job and I'm going to not be having income for awhile," or, "I'm going to have a really busy schedule for a while. It's going to put a little bit more on you for some time." Yeah, I just feel really fortunate there.

Dr. Chan: So very supportive. Was your work supportive or did you kind of tell them at the very end?

Kristen: My management and my whole team, really great. I can't overstate how lucky I was to have those particular people.

Dr. Chan: "Come back and work for us after you've got your M.D."

Kristen: Well, they were really amazing. They actually let me do a short educational leave, so I was able to do some of my post-bacc because I didn't do my prerequisites or I didn't have all the prerequisites.

Dr. Chan: I remember that. Wichita Falls Community College or something, right?

Kristen: I had, let's see, Midwestern State, I had Kansas State. I have Estrella Mountain down in Arizona.

Dr. Chan: Yeah, I remember when your transfers came in, like, "Oh, this is an impressive array of places you take your classes."

Kristen: Yeah. Well, every time we moved I had to find . . . there was one I did online. You just do them when you can. My management was really supportive. I was able to take time and do some shadowing and study for the MCAT. I think the hardest thing there was just being a nontraditional student, trying to figure out where to start. If you're kind of doing the traditional path from undergrad, you have resources that are available for you.

I reached out and the pre-med advisors at both Case and Midwestern State were great. But it's kind of hard when you don't have longitudinal support. The Case meetings I had to do remotely and then at Midwestern I just wasn't there for very long. What was good was I was able to say, "Here's my transcript. If you could just take a look and let me know what my chances are, kind of what I need to aim for with my MCAT, or where I'm missing things in my application." So I was kind of able to get a high level road map of where I needed to go.

I would say the rest of my information I got through online sources. I kind of lived on the Premedit, they call it.

Dr. Chan: I know that very well, yes. I dabble there every once in a while.

Kristen: They have a lot of good information there about how to navigate MMIs and applications and essays and things like that.

Dr. Chan: Do you feel there was kind of a corner just for nontraditional students in a way or it was just more vague, more general than that?

Kristen: Yeah, I would say it was pretty general. I did try to look . . . I was nervous because it's hard kind of being . . . you feel like, oh, you're way older than everyone. I was out for five years. You're just coming from a different place. I was actually trying to figure out, oh, are there schools that are more nontraditional friendly? Which was one of the challenges I had with figuring out where to apply.

Dr. Chan: Okay, so let's break this down.

Kristen: I'm sorry. There are a lot of pieces.

Dr. Chan: I know, it's beautiful. It's life. It's complex. It's like the data. Everyone thinks I retain everything but my brain doesn't retain everything. Did your husband kind of go through the Air Force to kind of figure out where he was going to be for some stability or did you kind of take the lead on that? I know that was kind of the decision, I got the sense.

Kristen: It was actually kind of crazy how it worked out. I was actually planning on applying a year later because I was like, "I don't have a lot of shadowing hours." I kind of thought I needed a bit more clinical experience but I decided to apply a little early. But the crazy thing about the timing is that my husband was figuring out what plane he was going to be flying. He was an instructor pilot flying T-6s and from there he had a plane that he was going to get as his main . . . I'm completely blanking out on the word for this plane.

Dr. Chan: His baby.

Kristen: Yeah. His main big plane that's very powerful.

Dr. Chan: Yes, the very fast one. But he wasn't sure because there are a few different options for what he could get and each of those options had several locations so we had a list of here are the 20 different places that he could go. Then for me the next step was, okay, let me see what medical schools are around those areas. So I kind of applied. Hill and Utah, that's a big one so I applied here, some places in Arizona. I think I applied in the Carolinas. I have family in Ohio so I applied in Ohio. I was also a resident of Texas so I applied to Texas and there are a lot of Air Force bases in Texas as well. I think I applied to 25 schools kind of all over the place.

The great thing is I actually . . . I really liked the schools that I applied to so there are a lot of great programs out there. Then kind of as we went through, as time passed, we kind of had an idea . . . I think in the summer we found out, okay, he's going to be flying the F-35. Then from there they're like, the few locations. I think we had some kind of general idea but we weren't quite sure where he was going to go.

Dr. Chan: Again, it's very different. I realize all the military branches are different but did he have a lot of voice in this? I know at the end of the day they just kind of tell you, "You will go here and you will do this." But I assume he got to have some voice in it.

Kristen: It's kind of like a ranking thing. Actually, it's a lot like the match. He has his packet or whatever he put in and I think he had to rank the planes he wanted or rank the location, something like that. Anthony, if you're listening, I'm sorry that I don't . . .

Dr. Chan: She's been paying attention all the time.

Kristen: It was a very stressful time. Yeah, then from there he had to put his options and then -- I forgot about this -- he actually had to go through another program to figure out if he was going to be flying the F-16 or the F-35 and that was in November, December, somewhere around there. So there was just a lot of decision points for him as to where he could go. So for me it was just filling out secondaries and trying to go through the process. Actually, my mother passed away during secondaries and that was really tough as well. I was far away from everyone and my husband was actually away doing training at the time so I was going back to Ohio, filling out applications, trying to figure out where life was going, so it was crazy times.

I think I've heard someone else say this on one of your podcasts before, which is that the time's going to pass no matter what happens. When things happen that are really hard things in your life, you just want to make sure your life's already kind of going in the direction that you want because it'll . . . you know, that's how the time is passing.

Sorry. I thought this would be more eloquent but now that I'm saying it . . .

Dr. Chan: No, it's beautiful, beautiful. It sounds really stressful. A lot of stuff's going on.

Kristen: Yeah.

Dr. Chan: So I get the sense that your husband found out Hill Air Force Base was his destination.

Kristen: Yeah, and I forgot exactly when that was. I think it was actually . . . I think it was in 2017 is he got the final thing. But what was hard was there was a point then where . . . so I'm nontraditional but I was out of state applying to Utah and the stats are kind of sobering.

Dr. Chan: Yeah, we have a lot of people apply from out of state.

Kristen: Yeah, yeah. The numbers are . . .

Dr. Chan: Against the math.

Kristen: Yeah. You want the odds to be in your favor but I actually . . . I didn't hear back from Utah for awhile so I was kind of looking at my other options and kind of figuring out . . . I think there was really one other school that I really, really was feeling strongly for so it was kind of a hard decision in the end but I was also really glad to hear from Utah. I don't know. I still can't believe we pulled it off. My husband's here, I'm here.

Dr. Chan: He's flying around the country doing stuff.

Kristen: Yeah.

Dr. Chan: All right. With being a nontraditional student, how did your first year go? I mean, how would you describe it? We kind of talked before I turned on the podcast but you said something that I thought was fascinating. You're learning how to learn. You said something like that.

Kristen: Yeah, yeah, learning how to learn. In engineering you really don't have to memorize very much because it's mostly about problem solving. So you learn different ways to solve these problems and you can kind of apply these to different things. But in medical school it's a lot of memorization.

In anatomy, if you forget what a structure is, you cannot logic out what that structure is. You can logic out maybe what it does, like, okay, it's connected to this and therefore it does this and if it's injured then this will happen. You can use that kind of process-based logic. But some of these things have really bizarre names. You are not going to guess those names. You're not going to logic your way out of it.

Dr. Chan: A lot of historical, a lot of people in Greece and Rome, other things.

Kristen: Yeah. So I think it was more just trying to learn how to memorize, learn kind of memory tricks, and actually just get back into the study habits. I was just working for a long time and I worked jobs that could be very demanding but it's different having a job and having projects that you're working on with set deadlines and then you have to do a little bit more self-starting, I think, in medical school. No one is going to make sure that you're doing your tasks except for you. So as far as accountability goes, you kind of have to be your own accountability.

For me, that involved really setting deadlines for, "Okay, I'm going to watch these recordings. I'm going to watch these external resources. I'm going to kind of bring these things together." I would say I'm still learning how to do that. I think it's still a challenge for me sometimes because it is just so different and there are some things that you can apply. I would say a lot of medicine, at least in the beginning, it seems like it's first principles.

In engineering and physics you try to boil everything down to first principles, so is this true with the laws of nature as we know them, and then from there use that to solve your problem. In medicine the base knowledge that you have to have is just so much wider, so much broader, there's just a lot of memorization that you could do before you start getting into the deep problem-solving.

Dr. Chan: Excellent. Going back to being nontraditional, have you found the other students . . . I would argue . . . at least my perspective is that our medical school has more nontraditional students than others because people tend to be a little bit older, they've switched careers, they've had families. Does that match with your experience?

Kristen: Yeah, definitely. I actually think Utah has turned out to be really great for me from the nontraditional route too because I was worried about that. I'm coming in at least five years out of school and married and there are different stages of life, I think, and I was a little bit worried. I guess you prioritize different things in some ways if you've been out in the world for a little while. I settled down a bit, I think, a few years out of school.

I think a lot of people here, like you said, have taken time off, have taken time with their families. I think Utah in general is more family-oriented than a lot of places as well. Yeah, so I'm kind of trying to figure out where I want to go.

Dr. Chan: I assume a lot of your peers, your friends you've made have also kind of been married and are a little bit further out from school as well?

Kristen: Yeah, yeah, definitely. I think it's actually really great because a lot of people are . . . they have really great stories. I think that's something I've really enjoyed hearing.

Dr. Chan: Well, this story's pretty great. I love your story.

Kristen: Thanks. Well, it's kind of incredible, though. We have people who have been really competitive athletes and musicians and people have traveled all over the place. I think almost everyone in our class speaks at least two languages. It's really, really incredible. I remember during the transition to medical school, kind of like the orientation program, there was a point where it was like, "Okay, raise your hand if you've been to at least 10 countries," or something and a bunch of people raised their hand and you're like, "Wow, this is kind of amazing."

Dr. Chan: Cool. Well, Kristen, I appreciate you coming on the pod. I guess the last question is what advice would you give someone? Someone's listening right now and they're in a job that they like but they've always kind of had that little feeling in the back of their head like, "Oh, I want to go to medical school," what advice would you give that person?

Kristen: I would say do some introspection. Really think about what it is that you want to do and where you want to go, and then just make sure that your decisions are in alignment with where you want to go. You never know how much time you have or when something might happen that might completely wreck your perspective, so just make sure when those things happen that your life is going in a direction that you feel comfortable with.

As long as you, at any given time, are comfortable with where you're going, where you are and what your motivations are for doing those things, I think you will be happy, whether that's staying at your job, whether that's kind of embarking on a new journey. I think there are a lot of great options out there, so just be comfortable with what you want and try to just understand where you want to go.

Dr. Chan: Fantastic. And last question -- I'm not going to hold you to this -- what kind of doctor do you want to be?

Kristen: Oh, I don't know. I don't know. I'm kind of like a dog from Up the Squirrel.

Dr. Chan: So a cardiologist comes in and talks to you, you think cardiology. The next day, pathologist, you switch.

Kristen: I'm all over the place. When I first came in, I was like surgery, because I had chatted a lot in surgery and I shadowed a lot of plastics procedures, and I just thought, "Wow, this is like a puzzle. It's like a body puzzle, which is very cool." Kind of got that spatial reasoning part of my brain really excited. I was like, "Oh, this will be really cool." But then hematology was really interesting as well and nephrology has some really cool kind of mathematical things you have to understand. Gosh, there are just a lot of great options. I don't know. You'll have to see, you'll have to see. I think it'll probably be some kind of surgical area but time will tell.

Dr. Chan: Time will tell. Cool. Well, thanks, Kristen, I appreciate you coming on.

Kristen: 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.