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Mitch: You are listening to The Scope, on the floor of the AAMC Learn Serve Lead 2022 conference, where we are having conversations with the movers and shakers in academic medicine who are looking to kind of change the way we do things from the ground up.

And today, we're going to be having a couple of people on to kind of talk to us about how we can kind of maybe change the health of the nation if we change the way we educate in medicine. And the idea that if we can expand access to people who have typically not had it, the way we do it is by reaching them where they are already at.

To discuss this, we are joined by Dr. Pedro Greer. He is the Dean of the Roseman University College of Medicine, as well as Dr. Lu Brewster, who is the Senior Executive Dean for Community Health Innovation at Roseman University College of Medicine, as well as Dr. Jose Rodriguez, who will be leading the conversation today, who is the Associate Vice President of Equity, Diversity, and Inclusion for University of Utah Health.

So let's start with you, Dr. Rodriguez. How do we change the health of the nation by changing medical education?

Dr. Rodriguez: Well, I am very lucky to be here with Dr. Greer and Dr. Brewster. All three of us lived in Miami, and previously, before being at Roseman, they were at FIU College of Medicine. And so what I'd like to hear about is some of the stuff that you're doing at Roseman and the stuff that you did in Miami to kind of address this issue of bringing health to the people.

Dr. Greer: Well, actually, let me start off. The architect of what we're going to be talking about is Dr. Lu Brewster, and the question that was asked was, "How do we get to the poorest patient before they show up at the clinic?" And so that was put in front of us.

And the answer to something like that does not come from MDs. It comes from a collection of individuals that actually understand community and understand society. We understand science and disease, but we need individuals that actually this is where not only they're trained, but where their mission lies. And with that, I'm going to stop talking and I'm going to hand it over to Lu.

Dr. Brewster: Well, I would say one of the big things is that we do need MDs. We need MDs to change the definition of what is leadership in medicine. And that means, like Dr. Greer was saying, that we have to empower all members of the interprofessional team to play a valuable role in addressing some of the change that's needed.

The reality is that medicine and health have become a lot more social and a lot more reliant on the activities and the context that people live in every day. And those are things that sadly are outside of the purview and the expertise many times of clinicians.

That does not mean that clinicians are marginalized in that process. It just means that there are others that they can draw expertise from. No different than their reliance on data analytics and data scientists or individuals who have expertise in nursing or any other skill set needed.

But at the core of it is reducing the distance between the patient and their provider. When you get closer to the people that you are supposed to serve, exciting things, great things, and spectacular things occur. And so by having physicians as they're training visit the homes of the individuals that they're caring for, you now have a shared existence with them, even for a brief time.

If they have an infestation in their home, you now are in that infestation. If they have a leaky roof, the water is now dripping on your head as well. And so you have a heightened motivation to do something about it when you know that you have to go back to that home in a month's time.

And so that's really what Joe kind of challenged all of us to do, was to just try to get medical students to learn empathy through lived experiences.

Dr. Greer: And let me just add something on there too. This is going up against established academic medicine, which just to put it very clearly, structurally we are racist, we are sexist, we are xenophobic, and we are elitist. The average income of an American medical student's family in 2020 was two to three times that of the national average. But on graduation, we are required to take care of an entire population without really understanding it.

And one of the most amazing things that Lu has done . . . Because when we take the student into the household, you change the power differential. You're no longer coming to the ivory tower. You're entering somebody's home. And Lu made a requirement that the student, the medical student, was never allowed to ask, "How do you feel?" The question had to be, "What is your most urgent need?"

And so all of a sudden the student now understands the reality. The student then understands also that the doctor is not always the king or the queen. The doctor sometimes has to be just a member of the team and sometimes probably the member that can contribute the least. You have to admit that, and that's the truth.

Dr. Brewster: That's a humble approach to care.

Dr. Rodriguez: And that's wonderful. Now, if I remember correctly, this program that you guys ran wasn't just once a month for one year?

Dr. Brewster: No.

Dr. Rodriguez: It was for . . .

Dr. Brewster:All four years.

Dr. Rodriguez: All four years.

Dr. Brewster: And it could be . . . it was a minimum of one visit per month. We had some students who were doing visits multiple times a month. But also keep in mind we had a full-time team of lay health workers who were recruiting, supporting the students along the way.

So even when visits weren't being performed by the students, we had enough commitment to the community to hire a team, that quite honestly has never really had a role in medical education, to manage and support the students when they are taking exams and doing the things that students have to do. The household is not left in a lurch. They actually still have support. They still have someone to contact them.

And the beauty of it is that we preferentially hired individuals from the community that we were doing home visits in, and we looked for individuals who didn't have a college degree.

Because the reality is this: Everything that we did, we embedded the same philosophy in. We didn't want to be the medical school that was good at helping students and good at creating good experiences for students, but then neglecting and avoiding the societal ails that were broadly impacting the work that we were doing.

When we go in these communities, people need jobs, so why not hire them? Oftentimes medical schools don't even purchase . . . their procurement excludes these communities. They have things to sell. We would buy from those communities. We would take individuals who didn't have a college degree, bring them in, and get them college degrees.

Dr. Greer: Over half of those ended up with college degrees. One, by the way . . .

Dr. Rodriguez: That's spectacular.

Dr. Greer: . . . is now getting her Ph.D. in Policy Analysis at the RAND Corporation.

Dr. Rodriguez: And these are community health workers you're talking about?

Dr. Brewster: These are community health workers, but we didn't call them community health workers. Just to tell you how the system is so screwed up . . . Because if we called them community health workers without the certification from the state, then they wouldn't be recognized. So we purposefully called them outreach workers, neglected to do the outreach training.

But you know what? That was a benefit. They did us a favor, because by creating our own training modules, we were able to put people on a path. What we learned was the retention for community health workers in other programs was terrible, but we kept our people. Why? Because we didn't train them with the expectation that they were going to do this job the rest of their lives.

We gave them transferable skills, got them degrees so that they can enjoy and pursue the careers they wanted to pursue. You learn by serving and then you go on and you enjoy the prosperity that everyone else has.

Dr. Greer: And the other lesson that became very important is called Social Accountability, to be responsible for what is going on in your community. It's by looking at it not from, "How do I train my medical student?" but, "How do I prepare the future physician to really serve our country and improve the health of our nation?"

For example, if it was just the student, we wouldn't care about the community. The community sees that that becomes vitally important.

And some of the students upon graduation, the saddest part was they had to leave their family. But the other aspect from a medical education perspective, what other course gives you four years of longitudinal care of the same household? Which is what you're going to be doing in a true medical practice.

I'm a gastroenterologist/hepatologist, and students are always shocked that when they ask, "What is your most urgent need?" medical never comes up.

Dr. Rodriguez: Interesting.

Dr. Greer: And I've been in practice over 45 years, and as a gastroenterologist asking the question, nobody has ever said colonoscopy is their most urgent need.

Dr. Brewster: Because at the end of the day, people want to address their basic needs first.

Dr. Rodriguez: Absolutely.

Dr. Brewster: "I want to feed my family first." Right? And we've all know the story of people who will give up everything to make sure their children are fed.

Dr. Rodriguez: Absolutely.

Dr. Brewster: They will limp into an emergency department after they fed their family. And so what we did was we made a conscious effort to not go to healthcare providers to recruit households. We went to non-health-providing non-profits that were seeing these individuals first, trained them on how to identify them, and then referred them to us.

By the last number I saw to date, we've serviced 14,000 households in South Florida, okay? Fourteen thousand.

Dr. Rodriguez: Fourteen thousand?

Dr. Brewster: Fourteen thousand uninsured, low-income households in . . . And we're not even there anymore. So now we're bringing this to Southern Nevada, to Las Vegas, implementing this. We've already started it. In South Florida, it was called Neighborhood Help. In Las Vegas, we call it Genesis.

Dr. Greer: And we've taken it a step further. Tell them about the cars.

Dr. Brewster: Oh, it's incredible. So now always being responsive, the first intervention is always right outside our office door. So one of the things that Dr. Greer gave us the ability to do was to purchase electric vehicles for our staff. And that's because I didn't want the burden on their cars, right? I didn't want you to have to own a vehicle to work for me, right? And so now you can go and serve your community, work for us, and drive the vehicles that we have.

But the second part to that is that low-income communities are always the last to receive innovation. I'm amazed that there were no electric vehicle chargers in these communities before we got there. But now since we're doing it, we can basically say, "If you want these services in your community, then you've got to put chargers, because my cars need to be charged so that we can continue to do the work." So now there's a backend motivation or incentive to bring technology to these communities.

The next element, our goal is to create what's called Genesis Zone, six of them. Six free Wi-Fi-enabled areas that . . . Yes, every household that is in our area will have free Wi-Fi, and being able to provide care digitally and offline, high-touch services in their home.

Dr. Rodriguez: This is a spectacular revolution.

Dr. Greer: And not only that, what comes out really important for the students is they do a lot of reflective writings and narrative writings. Now, why does that become important? Because if we're training the future workforce to be leaders, if they can't tell a story, they cannot make a change.

Dr. Brewster: Exactly. Because what does Joe tell me? "Facts tell, stories sell."

Dr. Rodriguez: All right. Can I steal that? Because I'm putting that in my leadership . . .

Dr. Brewster: Joe told me that all the time. "Facts tell, stories sell." And at the end of the day, we can dress it up all we want, but you have to sell healthcare to individuals in this day and age. There are too many competing narratives. There are too many competing priorities. You have to sell it. You have to find a way to make people do something they don't want to do and love it. That's true medical leadership, finding a way to get them to do something they don't want to do and love.

We have a mascot for Genesis. It's called the Apple Cone. And so the reason we have it is that people want ice cream, but we need them to have apples. So we have an actual design of an apple cone. I'll send it to you. It's an apple on top of an ice cream cone. And that's to remind the staff, remind the community that we're going to meet you where you are. I know you want ice cream, but we want you to have an apple. So how would we find a middle ground?

Dr. Greer: And we told them we have enough patients for the dental school.

Dr. Rodriguez: What an incredible story. This is the kind of thing that needs to happen everywhere.

Dr. Brewster: Exactly.

Dr. Rodriguez: And bringing this to the community. It's revolutionary what you've guys have done in both places that you've been. Having a medical student . . . having one class for four years is miraculous to begin with. Then to have them have a relationship with families for four years? They're people who won't stay in the same job for four years in their entire career, and you've given them a gift for their entire career.

Dr. Brewster: And can I give you some retention rates?

Dr. Rodriguez: Oh, please share.

Dr. Brewster: So, in South Florida, our 12-month retention rate for households was 83%.

Dr. Rodriguez: Oh my gosh.

Dr. Greer: Unfunded.

Dr. Brewster: Our 24-month retention rate was 77%. That's with no incentives for anyone. Not the organizations, not the families, no one. No money is exchanged anywhere in that system.

Dr. Greer: Let me tell you how successful . . . We were in all parts of South Florida, south to north. But in the northern part of the county when we were there, I think it was either Opa-Locka or Miami Gardens, we took care of a family. The family wanted to know if we could take care of their family that was in Homestead. We explained we were not in Homestead.

Dr. Rodriguez: It's a long drive.

Dr. Greer:The next visit, they had the family from Homestead move into their house.

Dr. Rodriguez: Oh my gosh.

Dr. Greer: So that way, we could take care of them. I mean, that's how successful it was.

Mitch:I know I'm the layperson here hopping in, but at The Scope, we've done 2,000, 3,000 interviews. I've edited almost all of them, and I hear about results that people get awards for and stand up and clap, and they have full funding. Say that one more time, the retention rate of these participants.

Dr. Brewster: So the retention rate of a population of low-income, undocumented oftentimes, and all uninsured was, for 12 months, 83%, and 24 months, 77%.

Dr. Greer: And the other thing that becomes very important is because we're putting students in these communities and in these households, they learn, and also because of the mentorship of the faculty, the virtues that we don't have in medicine: humility, empathy, compassion. These are the type of things that are really, really missing.

If you look up the definition of wisdom, humility is the first thing that comes up. So, apparently, there are not a lot of wise people in my profession. So it becomes important that we bring these out and we point these out, and we say, "We need to change our structural way of doing medicine." Not just the reasons I had outlined, but also because it becomes a very toxic environment.

I mean, I'm a physician. I've been a physician my entire professional life. It's about me and climbing and how many titles I have. Whereas it's supposed to be we're here about service. We're supposed to improve the health of individuals.

And as a medical school and as an educator, it becomes our responsibility not just to produce a future workforce, but to improve the health of the community that we're working in. Because things become very regional.

Dr. Rodriguez: Absolutely.

Dr. Greer: But the most important aspect of all this is that we go into these communities and we build trust. Why is that important? Let's just look at COVID where the black and brown communities sacrifice illness and death more so than anybody else, and why would they trust us?

And everybody is just saying how incredible this telemedicine is. "This is great technology." Well, that was originally developed for rural and very poor communities. What happened during COVID? Well, since we hadn't allowed them into the health system, they had no physician or nurse. So, at telemedicine, you have a patient on one end and a health professional at the other. Well, guess what? Only the insured got to take advantage of telemedicine.

Dr. Rodriguez: Only the people who already had access. You're absolutely right. But what a great story. I'm delighted that you guys are in Las Vegas. Las Vegas is only five and a half hours away from Salt Lake. So I hope we can get you up to visit us in Salt Lake City . . .

Dr. Brewster: Absolutely.

Dr. Rodriguez: . . . as we try to make things happen the way you have. This is really a miraculous change in how we see medicine.

And what you were sharing, Dr. Greer and Dr. Brewster, we believe that. Not just the entire physician core or the faculty, I think that we believe that in our deepest personal convictions. But what happens is the pressures on the outside push into that, "How many titles can I have?" and, "How much work am I going to do in administration and these things?" when what really matters is fixing the problems for the least of us.

Dr. Brewster: Yeah, we have to place impact over success.

Dr. Rodriguez: Absolutely.

Dr. Brewster: I meet students all the time and they tell me that something was successful because they received an award or they got an acknowledgment. Well, that's great, but what did you change? What did you impact?

I can't get off without underscoring the value of a dean like Joe Greer. All the other deans have the same opportunity to do what he's doing, right?

Dr. Rodriguez: That's true.

Dr. Brewster: We can never lose sight of that, right? Everybody has the opportunity to do this. They all have the opportunity to mobilize the team that he did, but they did not.

And so my sense, and the sense of many who have worked for him, is that he basically is putting his career on the line for each and every household we go into. And so he should be commended for that.

And when you look at it in the long term, no matter what happens, there'll be a number of young people who come through the programs who can now never say that it can't be done.

Dr. Rodriguez: That's right.

Dr. Brewster: That's the most powerful piece of this whole thing.

Dr. Greer: And when they see what we're doing, they can also say, "Maybe I can do it better."

Dr. Rodriguez: Oh, beautiful.

Dr. Greer: We're producing that future workforce. And Lu and I have the advantage of going to Catholic school, so we learned very, very early that it's easier to ask for forgiveness than it is for permission.

Dr. Brewster: Exactly. And all that time in the principal's office and talking to Brother Paul really does pay off at the end.

Dr. Greer: You had a Brother Paul too?

Dr. Brewster: Of course. Who didn't have a Brother Paul?

Dr. Greer: Okay, I'm sorry. [inaudible 00:18:58].

Dr. Rodriguez: Look at that.

Dr. Brewster: Everybody has a Brother Paul, and I'm sure that Brother Paul is somewhere probably talking to my son.

Dr. Greer: That's right. Exactly.

Dr. Brewster: Telling him, "I'm worried about you."

Dr. Rodriguez: How many times have we heard that?

Dr. Greer: That's right. How many windows have I cleaned at the high school?

Dr. Rodriguez: Oh my gosh.

Dr. Brewster: Exactly.

Dr. Rodriguez: Well, this has been just completely inspiring. Thank you for your absolutely spectacular work and for your wonderful presentation of it. And I am looking forward to meeting more with you as time goes on at University of Utah Health.

Dr. Brewster: Come to the school. Come see us.

Dr. Greer: That's right.

Dr. Rodriguez: Oh, I go to Vegas all the time.

Dr. Brewster: Yeah, come see us.

Dr. Greer: Come see us. And by the way, thank you for the work you're doing.

Dr. Rodriguez: Oh.

Dr. Greer: Because that is, I think, essential for improving the health of this country. It is essential. And the more we diversify medical school, the better our profession becomes, period. There's no question about it. We've seen it in business.

Dr. Rodriguez: Of course.

Dr. Greer: We've seen it in everything. I mean, there's no reason not to. And we also have to really consider and re-look at what are pre-med requirements.

Dr. Rodriguez: Oh, absolutely.

Dr. Greer: I mean, how great would it be to have a student that understands the world and not just science, and then can apply science to that world? Understands cultures, understands how to be tolerant and accepting. It has to come from the top down. I think we have the most diverse senior faculty that you're going to find in this country.

Dr. Rodriguez: That's wonderful.

Dr. Greer: And diverse not just in race, ethnicity, and gender, but diverse in your past education.

Dr. Rodriguez: Oh, wow.

Dr. Greer: So MDs aren't going to resolve this problem because we're not trained for it.

Dr. Brewster: Tell them who created Uber. Who created Amazon?

Dr. Greer: Right. It wasn't a cab driver that created Uber. It was not a retailer that created Amazon. So unless you bring ideas from the outside and say . . . And the first question we have to ask as medical educators is, "What are we doing wrong to get us to this point?" Not, "What did they do wrong?" And how can we change our behavior and what we do?

Dr. Rodriguez: Absolutely. I think introspection is key to changing how we do business. But honestly, this has been one of the best conversations I've ever had. I look forward to going there and I look forward to seeing you guys up in Utah.

Dr. Brewster: Thank you.

Dr. Greer: Come on down, because we want to change, "What happens in Vegas stays in Vegas." We want it to be, "What happens in Vegas, the world knows."

Dr. Rodriguez: Absolutely. At the very least . . .

Dr. Greer: And it's not because of iPhones.

Dr. Rodriguez: Okay. You got it. Thank you.

Dr. Greer: Thank you.

Dr. Brewster: Thank you.

Mitch: Again, we are at The Scope. We are here at the AAMC Learn Serve Lead 2022 conference, and having conversations about how we can change medicine from the ground up.

Dr. Greer, Dr. Brewster, and Dr. Rodriguez, thank you so much for joining us here on the exhibit floor to have this conversation.

If you are listening right now and you love this conversation, would like to hear more, we have plenty that we've gotten here at the event. You can hear those at uofuhealth.org/aamc22.

And if you're interested in any other health-related podcasts, talk shows, basic information, you can also hear more of me at thescoperadio.com.

Interviewer: Can you believe that there's a school actually called Headache School? And if you have headaches, you might want to go to this school. So we're going to talk to Dr. Jared Bartell. He's assistant professor in neurology. He's a doctor, but he's also an expert in headache. He did his fellowship in headache medicine, they call it and today we're going to find out more about the University of Utah Health Headache School, why you have one, what it is, and who can benefit. So Dr. Bartell, thank you for being on the show today. I do appreciate it very much.

Dr. Bartell: Thanks, Scot. Happy to be here.

Interviewer: Yeah. So tell me a little bit briefly, I just I'm curious. So headache medicine is what it's called, that you do. Explain the additional training you've had and what that means?

Dr. Bartell: Yeah. So I finished my neurology residency at the University of Wisconsin. And in neurology, you learn about all aspects of epilepsy, multiple sclerosis, stroke, various things that affect the central nervous system and the peripheral nerves too. But headache is certainly within that and we learn a lot about headache in residency. For those people that want to do more outpatient neurology, headache is really a big part of that.

So I spent this last year doing headache fellowship at University of Utah training with the guys there at the university. I learned about various procedures to use for headache, things like Botox, nerve blocks, the different types of medicines that you can use, both for prevention and for rescue of headaches. The nice thing about headache medicine these days is that there really are a lot of new treatments available within the last even couple of years there have been a number of new medicines that are all fairly expensive right now. Insurance tends to pay for them as long as you've tried a few other medicines first, but it's definitely an exciting time to be in the field as a provider of headache medicine, and it's been a great opportunity for me to help patients as well.

Interviewer: Yeah. That's pretty cool. I know headaches can really be debilitating to some people. It can really just really affect the quality of their life, their ability to enjoy life, their ability to do what they have to do. Headache School. So what is Headache School?

Dr. Bartell: So Headache School is a program that we are offering at the University of Utah, and in collaboration with Danielle Henry Foundation to educate patients and their loved ones about headache in terms of treatment and what causes them and just every aspect of headache.

Interviewer: And it's virtual and online, and you can find back episodes on YouTube. So there are a lot of different kinds of headaches. Why would somebody with a headache want to come to the Headache School or watch some of these videos? Why wouldn't they just say, "Just give me some aspirin. Tell me what it is I need to do to solve my headache"? Why are you finding people who are finding this interesting, and coming and showing up?

Dr. Bartell: So they're really a lot of headaches that . . . So you can think about just little everyday headaches that most people get as being responsive to an over-the-counter medicine like aspirin or ibuprofen or Tylenol. But unfortunately, a lot of people have much more severe headaches that really don't respond to those types of medicines. And that actually can get worse with chronic use of things like aspirin or Tylenol. And it can actually cause something called a rebound headache or a medication overuse headache. For people that have chronic migraine or chronic tension type headache or various other types of even more unusual headaches, those types of over-the-counter medicines aren't as helpful. And so educating patients on the different types of treatments, whether that's medicines or non-medication therapies can be really helpful in treating their headache condition overall.

Interviewer: Talked to one of your colleagues, Dr. Pippitt, and she is an expert with headaches as well. And she says that for the most part, a primary care physician can take care of most people's headaches. So it sounds like Headache School is for somebody who has really struggled and hasn't found that answer to their headache because they do have more of an unusual headache and this gives them access to some experts that might just specialize in that particular type of headache. Is that correct?

Dr. Bartell: Yeah. I think so. I think that's a good way of thinking about it. Most primary care providers are excellent in treating headaches. Sometimes it takes 2, 3, 4, or 5, 10 medicines until you really find the right medication fit for that person's headache. Everybody's headaches are a little bit different. Even if you have migraine, for instance, you can have 10 migraine patients lined up and all of their headaches are a little bit different. And the physiology of their migraine can all be a little bit different such that different medicines work for some people and not for others.

Interviewer: So somebody that might have gone through the process of trying to find some satisfaction or some treatment for their headache really could benefit from Headache School. I'm looking at, man, you've got so many episodes already. Just to cover some of them, the cognitive behavioral therapy treatment for headaches, yoga, for headache and migraine, contraception options in migraine, headache, the basics, acupuncture self-care for a headache, pathophysiology of migraine. Sounds like you cover a lot of ground. And what benefit does this help with somebody then if they hear the lecture? What does that information usually do? How does that impact somebody?

Dr. Bartell: So, in Headache School, we have the benefit of having a number of different speakers coming from different backgrounds talking about their view of what headaches are, how to treat them, we have a pharmacist that has given us several talks, we have multiple different providers that treat patients clinically that have their own medical background to provide. You could do a bunch of your own personal research online, which you might find various blogs and find anecdotal ideas as to what to do and what your headaches are caused by and different things you can try. But really looping into how doctors think about your headaches and how a pharmacist might think and how a psychologist might think about headaches can really be helpful in better managing your headaches.

There have been many years, decades and decades of research into headaches and it's not all intuitive. So you might think that you can treat all of your headaches with Tylenol, you take Tylenol three times a day. And this seems to knock down your headache just a little bit. But as it turns out, somewhat counter-intuitively, that can worsen your headaches. It can cause rebound headaches, it can cause some other problems, it can cause liver problems. Different medicines can do things like that, but it's really helpful just to touch base with the headache medical establishment to know what Western medicine thinks about headaches. We do try to incorporate alternative ideas too, and there are many talks on not just true Western medications and that type of thing, but also these alternative therapies that are available.

Interviewer: I love that you have all sorts of experts. I never really thought of that as an advantage, I just thought, "Well, you go to a doctor." Maybe you go to a doctor who's an expert with headache. But as you said, you've got pharmacists, you've got people like psychiatrists or people that can help teach you a cognitive behavioral therapy, or you have people that know about how exercise impacts headaches. So just a lot of different opinions on how to maybe reduce the impact of your headache or the frequency of your headache. So that's pretty awesome.

It's also pretty awesome too because many people they don't live in Salt Lake City, they don't have access to one of these specialists. They can just make an appointment, but they can go to the Headache School and they can watch the lectures and it sounds like they can interact with that individual. At the end, it's not recorded, they could ask them questions and boy, just really making yourself available.

Dr. Bartell: It's true. We see our clinic, especially now more than ever, patients from all across the region. We see people in Nevada and Wyoming, Montana, Colorado. And this resource especially it's on YouTube, so anyone can see it. You could live in a different country and you have all of the videos available for free at your own pace. One thing that you may not realize is that with YouTube videos, you can actually adjust the speed of them too.

Interviewer: Yeah. It gives you access to these experts. It gives you access to this great expert information. Briefly, I want to hit on the skill building session. So you say you have some skill building sessions. What do those look like on Headache School? I get a lecture, what's the skill building session?

Dr. Bartell: So we have a number of talks on various issues, things like progressive muscle relaxation, breathing exercise, guided relaxation. As of today, those are the most recent talks, but there are a number of courses that talk about these non-medicine options to treat headaches that you can just do on your own. You could do these multiple times a day, depending on what they are. And they can really help to have some synergy with the rest of the treatment that you're undergoing. It's one thing just to take a pill every day, but it's another thing to change your lifestyle in certain ways to really help to solidify the changes that your brain is undergoing as you're treating these headaches.

Interviewer: Headache school, it sounds like such a great resource and we will put a link to the University of Utah Health Headache School in the description for this particular podcast episode. Dr. Bartell, thank you very much for telling us a little bit more about Headache School. It's a great resource. Appreciate it.

Dr. Bartell: Thanks, Scot. Happy to be here. Appreciate it.

Dr. Chan: What's it like to move from the East Coast to the stunning Rocky Mountains of Utah? How does one decide to become a pediatric endocrinologist? Why is there such a demand for creating exceptional learning experiences and excellent educators in medicine? What is the Bills Mafia, and how does one associate with the Bills Mafia? Today on "Talking Admissions and Med Student Life," I interview Dr. Kathleen Timme, an attending physician in pediatric endocrinology here at the University of Utah School of Medicine.

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

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." I've got Dr. Timme. How are you doing, Dr. Timme?

Dr. Timme: Great. Good to be here.

Dr. Chan: And so you're actually an attending physician, and what field are you in?

Dr. Timme: I'm a pediatric endocrinologist.

Dr. Chan: So take us back to medical school. How did you end up becoming a pediatric endocrinologist? What did that look like? What was your decision-making process?

Dr. Timme: So I actually was exposed to endocrine in undergrad. I took a bio-elective in endocrinology, and I thought it was one of the most interesting things I had learned about. I think the hormone pathways are really intuitive and just kind of fascinating with all these feedback loops. So I was exposed to the content kind of early on. And then at my medical school, our pediatrics department chair was an endocrinologist, and I really admired her and was able to spend some time with her in clinic and just liked that you could be a subspecialist but also have really good continuity and good relationships with your patients. For me, I see most of the kids that I treat every, you know, three to six months, so sometimes even more often than their general pediatrician. And I like being a subspecialist. I like knowing a lot about a more narrow arena but still feeling like I treat a lot of different conditions. I see a good variety of patients, so it keeps it really interesting.

Dr. Chan: When you mentioned the hormone pathways, I barely remember those. I remember there was a lot of arrows, you know, like TSH, you know, a lot of feedback loops and things like that. So you felt that came just naturally to you during school?

Dr. Timme: Yeah. I just thought it was really fascinating how the body works with these feedback systems and kind of keeping everything in checks and balances, and I thought it was really intuitive.

Dr. Chan: Now you went to med school back East. Where were you at?

Dr. Timme: I was at the University of Buffalo.

Dr. Chan: Okay.

Dr. Timme: And I'm from Buffalo, so that was my hometown school.

Dr. Chan: And then as you started looking at residency programs in pediatrics, how did you wind up in Utah? I mean, like, walk us through that. What was that like?

Dr. Timme: Yeah, so I made a stop in Connecticut before coming to Utah. I was in Buffalo both for undergrad and medical school, grew up in Buffalo, so really thought that it was time to, you know, experience living somewhere else. And I was looking for, you know, a medium-sized program that was close-knit, with great academic opportunities and ended up really falling in love with the program at Yale. So I went there for a pediatrics residency and started some really interesting projects in medical education that I wanted to see through during fellowship, and ended up staying there for endocrine fellowship as well.

And then after that, I realized I've only lived in the Northeast, and I really only knew Yale's way of practicing pediatrics and endocrine. And I always admired physicians who had kind of diversity in their training, experienced, you know, different ways of practicing, and I wanted that for myself. I didn't want to just stay in one institution. I wanted to kind of, you know, expand my horizons, see what else was out there, and also just personally experience living in another part of the country. By that point, I had met my husband who lived in Colorado during grad school and Arizona and New Mexico before we met in Connecticut, and he was really itching to come back to these mountains and it just took, you know, an interview trip out here to see what he meant by that. And I think Utah fits us really well in terms of our hobbies and hiking, camping, running and being able to be outside all parts of the year.

Dr. Chan: So you did all of your training back East and then you moved out West to become an attending physician.

Dr. Timme: I did.

Dr. Chan: Wow. It's a huge jump. Yeah.

Dr. Timme: So my first job after training was here. So it was a big move. I didn't really know much about Utah, Salt Lake, and, you know, I just kind of sent a cold email out this way, seeing if there was any opportunities available. And then, as I got further into the process, I realized I had a lot of, you know, mutual colleagues with some of the people here, and it's been a really nice fit so far.

Dr. Chan: And your passion for education, what I heard is that it started in med school, but also continued throughout your residency training.

Dr. Timme: Yeah.

Dr. Chan: What kind of opportunities did you have as a resident to be involved in teaching and education?

Dr. Timme: So I've always really loved teaching. I grew up in a dance studio. I loved kind of teaching the younger dancers, and there were even points where I thought that I might become a teacher instead of a physician. But in residency, my favorite part of interning was always having a medical student on the team because I felt like I finally had a piece of knowledge to share, and it was just really exciting to be able to share that and also for, you know, the few students that ended up going into pediatrics after rotating with us, it was just a really neat experience to watch somebody go through that process. So during residency, I got involved in the GME. I sat on a subcommittee for the executive subcommittees, so I got to see a little bit about what happens behind the scenes in curriculum development and program structure, which I thought was really interesting.

Dr. Chan: And GME is Graduate Medical Education?

Dr. Timme: Graduate Medical Education.

Dr. Chan: So UME is Undergraduate Medical Education, that's like medical school, and GME is like the residency afterwards? Okay.

Dr. Timme: Yeah. And then through networking, I was able to sit on the LCME faculty subcommittee later on in residency and just kind of see what process was like to review a medical school curriculum, which was really neat. And I just always connected with the people who were in education. I thought they were enthusiastic about the same kind of things that I was. And, you know, it just kind of blossomed from there into a research project and fellowship, and then I decided to pursue my master's in education at that point.

Dr. Chan: Wow. So you were able to get a master's in education while back East or . . .

Dr. Timme: Yeah, so I'm in the process . . .

Dr. Chan: Oh, you're still in the process, okay.

Dr. Timme: Yeah, from doing the Cincinnati program, the online master's, and I have 2 more courses of 10 left. So I was able to start it in fellowship, and I'm still working through it.

Dr. Chan: Okay.

Dr. Timme: Yeah.

Dr. Chan: And then, Dr. Timme, like, because I think back to my, like, a lot of my peers, you know, we graduated med school, and, like, I had this core group of friends, I don't know, like all of us who just love kids, a core group of us went into pediatrics. I went into child psychiatry. But I remember very clearly that all my friends who went to pediatrics, they were very excited about doing a fellowship one day, and then bless their hearts, residency was just long, it was hard, and most of them decided not to do a fellowship. So did you ever waver in this endocrine dream, or were you ever tempted just to become a general pediatrician and just . . . Do you understand what I'm saying, like . . .

Dr. Timme: Yeah, I understand what you're saying.

Dr. Chan: Yeah, like, how did you weather that? How'd you get through that? Like, what did that look like for you?

Dr. Timme: I mean, I think the temptation is there to stop training and finally start your life, but I was just so enthusiastic about the topic and I liked endocrine so much I even thought about OB/GYN and reproductive endocrinology and infertility. So for me, that was as important as the pediatric side of things. And I also really enjoyed my residency training. So I, you know, enjoyed the relationships that I made. I loved being in New Haven. I loved learning and taking care of kids. So I think sometimes there's also a temptation in the other direction too, like I just want to keep being a trainee for a little while longer and then, you know, face the real world after that.

And I just . . . for me, I have a ton of respect for anybody who practices more general fields, general pediatrics, but I would have been very overwhelmed having to know a lot, you know, about everything. I feel like pediatricians are the great gatekeepers to everything else, and I think I would be afraid of missing something or, you know, not knowing enough about every system or every possible thing that a patient could come in with.

Dr. Chan: So the fellowship is it . . . How long is it?

Dr. Timme: Three years.

Dr. Chan: Three years. And it was it all clinical, or was there some research or some education time built in or . . . What did that look like at Yale?

Dr. Timme: Yeah, the first year typically is heavily clinical and then the last two are a little bit more research-focused. I was the only fellow my year, so I had a very heavy clinical first year and kind of a mix of both in my second year. But by the third year, it was more research-focused and just kind of keeping up with some clinical activities. So, actually, it was a pretty intense first year, but after that, I had a better work-life balance.

Dr. Chan: And then you kind of mentioned at the beginning about that when you came out here to Utah, I mean, when you . . . I mean, this is a great conversation, because I talk to students about this, like, when you signed your first contract, when you were able to kind of become an attending, when you had a, you know, a very clear voice in what your career was . . . what you wanted it to be, like, how did you negotiate that? I mean, what did you ask for? I mean, because I assume that you could ask for more inpatient time or more outpatient time. Or did you ask for, like, you know, if you felt affinity for like, more, like diabetes, as opposed to thyroid issues? I mean, what did that look like? I mean, how did you do that as a fellow coming out to a new area, a new program, and how did you negotiate what you wanted?

Dr. Timme: Yeah, it was definitely a very foreign skill set. I think we're not used to asking for anything other than admission and acceptance and . . .

Dr. Chan: Yeah. We're kind of coached just to take it.

Dr. Timme: . . . you know, "Please just let me come and join the team."

Dr. Chan: So I think a turning of the tables.

Dr. Timme: Yeah, it was a very interesting, you know, process interviewing. Definitely turns the tables and, you know, feeling like you're being recruited or that you're a value to a program rather than, you know, the other way around was really interesting. So for me, my number one priority was having some time to work on medical education-related projects, specifically on helping people develop teaching skills. So any program or any, you know, potential place that didn't offer me those kind of opportunities in the near future, I kind of shied away from. And so that's one of the main reasons why I came out here because there were some really interesting opportunities to get involved, both on the UME and GME side, around training people how to teach. So that was my number one priority.

And then I really liked doing both general endocrine and diabetes, and some endocrinologists or some institutions really divide the two. But especially early on, I didn't want to lose either skill set, so it was really important that I had clinics on both sides and I enjoyed both sides equally. And then also a good mix of, you know, inpatient and outpatient without too much inpatient time, because that can be pretty exhausting.

Dr. Chan: So you mentioned the teaching. So tell us about the Students as Teachers Pathway. Was that already kind of being formed before you got here, or were you kind of the original force behind it? Like, how did that work out? And like, you know, just help people understand what that is.

Dr. Timme: Yeah. So the Students as Teachers Pathway is a really unique longitudinal experience for medical students to be exposed to some of the skills involved in being a clinician-educator. So the idea is that after medical school and even during medical school, we're tasked with teaching our peers, patients, colleagues, and eventually trainee students without much formal training on how to do so. I think medical schools now are a lot more mindful to that. But the pathway is for students who have this particular interest. I think it attracts people who have had experience in teaching and really want that to be a part of their career.

So it's a four-year program. The first couple years are based in these workshops and sessions. There's four every semester. We try to keep them very interactive and help, you know, build a teaching skill set. We also have our students teach in front of a classroom and get some feedback on that. So it's a nice way to sort of practice those skills. And then, as of right now, we just have first years and second years because it started two years ago, but eventually, in the third year, we hope to do more experiential learning alongside the clerkships, and then everything will culminate in a capstone education project where students identify a mentor and are really just trying to create an educational intervention and assess its impact. Their projects are very interesting. I'm very impressed.

Dr. Chan: So could you give me an example what kind of projects they're working on?

Dr. Timme: Yeah, so I'm working with one of our students on evaluating what an exceptional learning environment is through focus groups with students. We have other students who are doing more community-based projects where they're, you know, interacting with students from high schools or elementary schools and people in the community trying to teach on different topics. And a lot of it is tailored to their own clinical interests. So if someone's interested in pediatrics, they might take more of a pediatrics sort of flavor.

At this point, our second years are mostly developing project ideas and identifying mentors, so I haven't seen any through to completion yet, but it's, you know, very interesting. And the pathway started . . . it was developed before I came here, so I co-lead it with a neurologist. And he was working with one of the pediatric chiefs to develop the program, and then she ended up going to another institution. So right around the time that she was leaving, I was coming in. And so I took on kind of the co-director position.

Dr. Chan: When I talk about admissions and talk about our med school a lot, I would say a lot of our applicants and a lot of our students are very interested in teaching in an academic health center, first of all, kind of a career, but also just becoming better teachers. And I've talked about the Students as Teachers Pathways, you know, like teaching is a skill, like you said, and can we teach the students to become better teachers. And it seems to be really popular, and the students, it seems to really resonate with them. And I feel the students have very strong opinions about the quality of their education and who's a good teacher, who's not a good teacher.

So I think that's an excellent opportunity to challenge them, "Okay, you're going to be in front of the class one day. You're going to be in charge of that small group one day. You're going to be leading the clinic and teaching in the clinic one day. How are you going to do it?" I think that's a great impetus for like, change, because I think the students are fairly opinionated about this stuff. Like, does that match with what you see on your end? Yeah.

Dr. Timme: Yeah, I mean, I think even on the GME side, too, there's just more and more interest in becoming good teachers. And I don't know if that stems from kind of who your role models are. So in medical school, we look up to, you know, really great teachers, and I think the same thing in residency training, we really admire the people who teach well and teach effectively and I think we try to model our careers after them. I think that's some of it, and then also, just trying to create some balance in life. So I think people recognize that having a career that's 100% clinical can be really tiring. And for me, I like that every single day is different. I like that I can come and be here with you and then go to clinic in the afternoon. It's just a really nice way to keep my days interesting and keep me motivated and excited on both fronts. And I think the students are seeing that too.

Dr. Chan: If you can identify one thing that students struggle with as they become teachers, what do you see as a common theme? What do they have to work on?

Dr. Timme: I think it's something that we all have to work on, but more of like imposter syndrome, like feeling as a learner, how do you have something to offer? How do you have something to teach a group, and realizing that we're all just acquiring these micro-skills as we go and we do have things to offer and things to teach and even just different ways of approaching things. So I think some of it is just having the confidence to realize that you have something to offer and being able to do that. So I hope that our pathway gives them a safe space to kind of practice some of those skills and receive feedback in a constructive and kind way, so that they feel even more confident when they have residents to teach.

Dr. Chan: Yeah. I love what you said, Dr. Timme, because when I think about it, you know, what do we do as doctors, I mean we teach our patients about their bodies. I mean, my own personal philosophy in a perfect world, you know, everyone would go to med school, everyone would learn about their bodies, and we would take care of our bodies and things like that. You know, it's obviously not set up that way. So a core group of people, you know, go on to health science careers, and to me, they educate, they teach people about their bodies. And to me, that's what you do when you go in to see the doctor. Oh, you learn about your body, and you learn what's working well or not so well. You learn about this medication or that procedure.

And to me, medicine, the health sciences, it's like an educational endeavor. And, you know, I teach in our med school, I can always become better, but I like what you said. It really resonated with me because when I interact with students, sometimes they have this, you know, imposter syndrome. They don't believe they should be here. And I challenge them, like, "Look, look how much you know compared to like a year ago" right? "Look how much you know compared to two years ago. You have so much knowledge. How do you communicate that? How do you share that with others?" So I just love what you're doing. I love this teaching pathway that you're creating. It's beautiful.

Dr. Timme: Yeah, it's really fun. It's, yeah, one of the most exciting things I do.

Dr. Chan: Okay. So a couple of questions before we wrap up. These are kind of fun and silly. So the silly one is anytime I meet someone from Buffalo, I just have to ask about the Bills. So how many games you've been to? Are you part of the Bills Mafia? Do you know what I'm talking about?

Dr. Timme: I do know what you're talking about. I hope nobody from Buffalo is listening because I will not do the city justice, but, I'm, you know, an associate of the Bills Mafia. I'm not really a football fan. I don't have cable. I don't really watch games on weekends. But my brother is definitely like a rank and file member of the Bills Mafia. He's had season tickets since high school. He lives in Minneapolis and flies home for games and . . .

Dr. Chan: Wow. And for people who don't know what the Bills Mafia is, can you explain it to them? Because I have this image, but I'm not sure this image is the correct image, so . . .

Dr. Timme: Yeah, I mean, it's just the cult that follows the Buffalo Bills, you know, rain or shine, good or bad. You won't find truer fans than Buffalo fans.

Dr. Chan: And also I get the sense just watching clips online, they tend to get really rowdy pre- and post-game to the point where like, they're intentionally, unintentionally hurting themselves because they jump into tables. That seems to be a thing.

Dr. Timme: Yeah, jumping on tables. I mean, the tailgate is, you know, even more important than the game, so it's just a full day.

Dr. Chan: Does your brother jump on the tables?

Dr. Timme: You know, he probably wouldn't be the one jumping on the table.

Dr. Chan: Because it seems really dangerous.

Dr. Timme: But he might be, like, videotaping people jumping . . .

Dr. Chan: Cheering it on.

Dr. Timme: Yeah. He definitely would be a part of it.

Dr. Chan: Okay. And then in a more serious question, like, talking about diabetes. I'm just curious, like, what do you see with kids and teenagers nowadays with their diet? Is it getting better? Is it getting worse? I read about these insulin shortages. I mean, what's your take on all this?

Dr. Timme: Yeah, that's a difficult question. So, you know, in terms of type 1 diabetes, I think things are headed in the right direction. So there's definitely a lot more technology for patients and families to take ownership of their condition. There's continuous glucose monitors now, whereas, you know, not that long ago, the only way we could check glucose was through urine test strips. So we have a lot more real-time data, which I think allows us as clinicians to make more informed choices about insulin dosing and make more meaningful changes. And then insulin pumps, I think it really revolutionized things where you're able to just take a little bit more control of the diabetes and also go about living your regular day-to-day life. So I think, in general, things are getting better. There's definitely an increase in type 2 diabetes, and I think that's related to the fact that kids are more sedentary than they've ever been, you know, spending more time in front of the TV and less time outside . . .

Dr. Chan: So you see more type 2 in kids?

Dr. Timme: More type 2. Yeah.

Dr. Chan: Okay.

Dr. Timme: And, you know, even a fair amount of it here in Utah, so . . .

Dr. Chan: Is that reversible if the children eat healthy and exercise and lose weight? Because I remember learning about that with adults that, you know, there's, again, I'm not an endocrinologist, so I use very poor terms, but like there's this zone, where it's kind of reversible, if there's some things that start happening and like, you know, you can take the Metformin, but then kind of back off before you're full-blown on insulin-dependent. Is there still, like, a zone or . . .

Dr. Timme: Yeah, with type 2, I mean, there's still hope in coming off of insulin. So by the time I see kids with type 2, we're probably having that conversation about starting insulin and doing full teaching on diabetes, but with lifestyle modifications, a little bit of weight loss, exercise, oftentimes they can come off of insulin and maybe just maintain things on Metformin, or, you know, completely off of everything. So, yeah, but doing that is easier said than done.

Dr. Chan: In the past when I've talked to you, I've made jokes because as a child psychiatrist, I manage kids' diabetes from time to time inside Uni when people get a med for more of a psychiatric reason. I think it's really hard. I mean, I've seen, you know, because when you think about teenage adolescence and wanting to be your own person and having control over your life, and not all teenagers, but there seems to be this core subset, where this control issue kind of spills over into diabetic food control. And I think it's really rough. It's really difficult growing up, and again, like, everyone, I mean, people making choices, some people are making bad choices, and then just throw in this pretty serious disease and this need for constant management, it could be really combustible at times. So I don't know if you've seen that on your side at all, like, this control issue where teenagers kind of get into it with their parents and the diabetes, then it's kind of on the table to kind of manipulate or argue or fight over. Have you seen that at all?

Dr. Timme: Absolutely. And I think that technology, you know, also plays in an interesting way. So some of the continuous glucose monitors parents often have a share app where they can see where is the blood sugar. So then you also have, you know, adolescents who are trying to be independent and responsible for their health care, who are maybe out at a friend's house and then their parents are texting or calling saying, "Hey, I see your blood sugar is high. Did you forget your insulin? What's going on?" So it just creates a very interesting dynamic.

Dr. Chan: Fascinating dynamic. So the parents not only are monitoring their kids kind of, like, you know, "What social media sites are you on?" but they're also monitoring your glucose levels. It's fascinating.

Dr. Timme: Yeah and, "Did you give your insulin?" so . . .

Dr. Chan: Wow. So what's your official position? Like, should parents have access to that information? Should they have the app? Or are you kind of agnostic when it comes to this or . . . Or is that a complicated question?

Dr. Timme: I think it's an individual decision. I think for younger kids, it's very helpful for families to have that share app both for their peace of mind and for safety. So in the middle of the night, if their blood sugar's headed low, you know, for a parent to know about that I think is really crucial. But then I think there has to be this thoughtful, letting go process that the endocrinologist should ideally be having conversations with the families about, where you're sort of giving the child more and more responsibility and you're doing less of kind of the hovering and watching over things, and maybe just using that for spot checks every once in a while to make sure that they're doing what they're supposed to do. And certainly, if things are headed in the wrong direction, and you know, when they go to the doctor's office and the A1C is high and we can see on their downloads, whether or not they're bolusing, giving their insulin, then maybe that's time to negotiate some closer supervision.

Dr. Chan: Dr. Timme, I'd love to talk about this. So my last question and like, so, you know, teenagers are very good at, you know, there's parental controls, right? And teenagers can kind of get around those to access websites they shouldn't or whatever. Have you ever seen a teenager, like, I use this word loosely, "hack" the app? Have they been able to manipulate the data in a way? Or is that . . .

Dr. Timme: No, I haven't seen that. So there's two versions of the app.

Dr. Chan: Okay. Interesting.

Dr. Timme: There's the app that the patient downloads, and then there's the share app that the families download, so they're separate and on separate devices. I haven't seen anybody go in and delete their parent's app or something, but I wouldn't be surprised if that happens.

Dr. Chan: Okay. Well, I hope we didn't give that idea to anyone out there. I'm just curious. Because the reason why . . . I'm bringing it all back. The reason why I love medicine is that it's like the intersection of really cool science with people. It's like humanities combined with the scientific knowledge. And, you know, diabetes, insulin, it sounds like it's grown by leaps and bounds, you know, a lot cooler technology, a lot more knowledge. But at the end of the day, you're still interacting with people. And then teenagers and families and dynamics and communication, expectations, things like that. So that's why I love being a doctor, because it kind of combines both those spheres. And that's what I'd like to teach the students because I think they get at times overly focused on the science and I, like, "Well, your science is only as good as people who take the medication or do these things. And there's still this free will and humanity aspect to it."

Dr. Timme: Right, I mean, even with all this technology, we're not making big strides in A1Cs or diabetes control because there is that human aspect to it, which is the most challenging part but also some of the most exciting to navigate.

Dr. Chan: Okay. Well, Dr. Timme, thank you so much for coming on the pod. I think we'll be talking to each other soon, maybe on a future podcast.

Dr. Timme: I hope so.

Dr. Chan: But this has been great. Thank you.

Dr. Timme: Thank you.

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

Dr. Chan: How does growing up close to nature inspire a love for science? How do you turn your talent in sports into college opportunity? How does one overcome discouraging feedback about being a woman in medicine? And what's it like to apply to 25 different schools and go on 13 different interviews?

Today, on "Talking Admissions and Med Student Life," I interview Kaitlyn, a first-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." I have Kaitlyn.

Kaitlyn: Hello, everybody.

Dr. Chan: Incoming student who is so excited who . . . we were just talking before I turned it on. Who just drove down here from Idaho.

So let's get in the time machine and go back to the beginning. So you grew up in Post Falls.

Kaitlyn: So Rathdrum, Idaho, actually, but I was in Post Falls, yes.

Dr. Chan: Okay. Educate people where that is.

Kaitlyn: So Rathdrum, little town, a little bit north of Coeur d'Alene. I think more people have heard of Coeur d'Alene than all of those other surrounding towns. But yes, little town of about 7,000 people, currently. It was a lot smaller when I was born a few years ago. But no, it's kind of nestled in the mountains and it's my home.

Dr. Chan: And then you grew up, up in Northwestern Idaho?

Kaitlyn: Yes. So born and raised.

Dr. Chan: And then did you have any early childhood experiences that led you to wanting to be a doctor? I mean, where did that idea come from? How did . . .

Kaitlyn: Of course, I've kind of gone back and looked at that as I've gone through the application process. But I feel like a lot of people had some sort of experience with being sick or having family members being sick, and I was thankful enough to not have that. But I think that it kind of just goes back to who I am.

So I'm a fairly ambitious person and I grew up surrounded by nature and everything, and I think that that really drew me towards science in general. As I started going through school, I started getting involved in sports and that kind of led me more to my interest in the human body.

Dr. Chan: Interesting. Okay. What was your sport?

Kaitlyn: So I did a few at first, mostly volleyball and track in the end. Of course, I'm tall. You can't see me now, but . . .

Dr. Chan: How tall are you? For the listeners.

Kaitlyn: I am six feet tall. And so I did play basketball for a little bit, but it wasn't really my jam. So volleyball and track is where I ended up. I just . . .

Dr. Chan: Were your parents tall?

Kaitlyn: Yeah. Yes.

Dr. Chan: Okay. Did they play sports too?

Kaitlyn: My dad did a little bit of track himself. My mom, not really, but they go to the gym together now.

Dr. Chan: Well, I think it's fascinating. I have little kids and, you know, there's this like kind of sports culture and I kind of struggle with how soon do you introduce them to sports and the camps?

Kaitlyn: Yes. That's a big conversation.

Dr. Chan: Because it's almost like a separate kind of . . . So how old were you when . . . I mean, did your parents actively say, "Oh, you know, you seem to be kind of really fast and natural with this"? How did they do that?

Kaitlyn: So where I live, we have mountains. My brothers and I were always kind of outside playing on the mountain and I guess being active outdoors. And then my mom was the one that suggested that I do a volleyball . . . like a club team and kind of start doing volleyball camps. I was probably in third or fourth grade when that happened and I started playing club volleyball in sixth grade.

Dr. Chan: Were just dominating?

Kaitlyn: No, I was actually . . . I'm a lot stronger than I was. I was kind of a little string bean. And so I actually remember not being able to serve over the net when I was in sixth grade, which is . . .

Dr. Chan: Was it the normal size nets or were they lower for the kids?

Kaitlyn: You know, I don't remember that. Either way, I was kind of a little string bean. So no, I wasn't very good at first. I don't think I was super coordinated, but it finally came after the past few years.

Dr. Chan: So you're doing sports, learning about the human body, and then were you doing club sports or were you doing varsity at your high school or?

Kaitlyn: Yeah. So I was doing club sports and then junior high and high school with school-organized sports was . . . you know, I started those then. Yeah, for the first . . . I was a three-sport athlete for the first two years of high school and then I had a choice between club volleyball and doing varsity basketball, and I chose club volleyball.

Dr. Chan: I would think volleyball would be easier on the body in certain ways, because I just look at basketball and so many people, you know, twist their ankles and knee problems and you get elbows to the face during rebounds.

Kaitlyn: Yeah. There is a net between you in volleyball, you and the other people, so that's generally helpful in that respect. But I mean, I was a front-row player and you do a lot of side-to-side movement, so you still get the knee problems. You're still jumping, and sometimes running into your teammates because as a middle, you're kind of like running around in circles.

But no, it is a little less physical. And I took to it more. I enjoyed it more. Club was really fun. I got to travel and experience other places, and so I just ended up picking that.

Dr. Chan: So doing volleyball and track?

Kaitlyn: Volleyball and track, yes.

Dr. Chan: And what was your event? Is that the right word?

Kaitlyn: Yeah ,event. So I pole-vaulted mainly and I did end up going on and doing that in college where I was then kind of thrown into the heptathlon, which was not super successful for me, but it was a really good experience. But pole-vaulting is what I mainly did. Yeah, it was fun.

Dr. Chan: And then during high school, were you thinking like, "Oh, I'm doing . . ." I mean, did you think, "Oh, I'm doing so well at these sports, I might be able to do these in college"? Was your mindset then . . . like, do you send out tapes or did people come and watch you and recruit you, or how did that work?

Kaitlyn: So for one, I think it's kind of funny. In retrospect, it's really easy to shine, I think, when you live in a small town and you go to a small high school. So I did well at least in high school, and then I got to college and I just kind of was middle of the pack with everybody.

But some people do send out tapes. I didn't have a lot of . . . I didn't have a lot of involvement in that, but there are a lot of college coaches at state meets and at club volleyball tournaments. And so I had some interest in doing club volleyball, but that was more at a junior college level and I knew that I wanted to go to a four-year university.

And then the opportunity arose at Idaho State University. Dave Nielsen, our head coach at the time, was at a couple of the state track meets and we ended up talking with him and that's kind of how I ended up down at ISU. And I had done a couple of track camps there in the past, so I was familiar with it.

Dr. Chan: So it wasn't totally unfamiliar going from Coeur d'Alene to Pocatello?

Kaitlyn: Yes. I think that's probably the big thing.

Dr. Chan: For people who aren't familiar with Idaho, that's like nine hours.

Kaitlyn: Yeah, eight or nine. Yeah, depending on traffic and construction, you know? Depending on how fast you're driving.

Dr. Chan: And during this time, you're taking science classes?

Kaitlyn: Yeah, so taking science classes and I was doing a little bit of volunteering. I had gotten into research my second or third year of college. I knew I was interested in medicine. I'm not really sure where the idea ended up coming from exactly, but I was drawn towards it because of, I guess, what it offered. I really was interested in science. It was the best place to learn about that stuff. And I like interacting with people. And so there was that.

I feel like it's kind of this cliché a little bit. You know, you're interested in science. You want to help people. I don't want to say it was a challenge and that's why I chose it, but it was a worthy enough career to go after in my mind.

And so I had been drawn to it. I was taking science classes, preparing, and I then started shadowing physicians and that's really when I decided, "Okay, this is what I want to do. This is awesome."

Dr. Chan:Were you doing this mostly in the Pocatello or were you kind of doing some . . .

Kaitlyn: A little bit of both, yeah.

Dr. Chan: . . . in Coeur d'Alene, kind of bouncing back and forth? Okay.

Kaitlyn: Yeah, a lot of it ended up being in the summer. I was very busy with track in school and research, and so the first person I shadowed was Dr. Cher Jacobsen up in Post Falls, Idaho, and I just wanted to be her. I thought she was just awesome.

Dr. Chan: What kind of doctor was she?

Kaitlyn: A family practice doc.

Dr. Chan:Okay.

Kaitlyn:Yep. And she just had such a good relationship with her patients and she was so competent and so caring and so on top of. And I just thought she was such a great role model to look up to.

There were a few bumps along the way. I think I had a lot of doubts. I shadowed with some other physicians who kind of cautioned me because I was a woman in medicine and they were, I think, a little old school and they were like, "It's going to be really hard for you. You are going to have other challenges if you want to have other things in your life."

Dr. Chan: So they overtly said that to you?

Kaitlyn: Yeah.

Dr. Chan:Interesting.

Kaitlyn:And it was brought up a few times and I had a few doubts, but I ended up shadowing another female physician who had . . . I mean, she had family and kids, just someone who had other obligations in their life and were balancing other things in their life. And that's when I knew I could do it, which is sort of silly, but, you know, it points I think to the importance of representation in medicine. Your mind is so moldable when you're young, you know? And you can really be affected by the role models that you see around you.

Dr. Chan: Yeah. Did you come from a family and medicine or . . .

Kaitlyn: No. You know, nobody . . .

Dr. Chan: Okay. So in a way, you're going out there trying to get these experiences and I would say mentorship, and it sounds like some of it was . . . most of it was positive, but there was some negative as well.

Kaitlyn: Yeah. I think it was well-intentioned. Like, I think it was trying to caution me to be realistic. And I don't think this person would probably . . . I don't know. They probably didn't know me or life of being a woman. So, you know, in retrospect, I think it's silly that I even doubted it. But it was good because it did challenge me to think about those things.

And like I said, I don't think it was really trying . . . I don't think they were trying to discourage me. I think they were just trying to encourage me to be realistic, which is fair. But I still . . . yeah, I look back and I'm like, "Really?"

Dr. Chan: Yeah. I think it's hard when you have a dream, you have a goal. And to use an analogy, and you may disagree with me with that, in track, in sports, it's kind of the same. You're working towards something. There are going to be setbacks. You know, you're not going to "win the gold medal" or win the tournament every time. But if you show perseverance, resiliency, hard work, eventually that will pay off.

Kaitlyn: Right. Exactly. And it has, so I'm very excited about that.

Dr. Chan: All right. So let's go back to undergrad. So I have other friends and colleagues who did sports as an undergrad and they have told me that it becomes almost like a job and it kind of weighs down . . . I mean, if you're very passionate about sports, that's great, but it also kind of weighs down the academics and it complicates schedules and life is very busy, very full. Does that resonate with you?

Kaitlyn: It does. I mean, it's absolutely true. I think that I was . . . how do I put this? So I applied three times to medical school before I got accepted and I really think that part of that was due to having such a busy schedule and being involved with that because it takes away time from other things that you can do to prepare for medical school.

With that said, I wouldn't do it any differently because I learned so much from the whole . . .

Dr. Chan:The application process.

Kaitlyn:Yeah. But it's true. It does kind of become like a job, and by the end of it, I was ready to be done. But still, there were so many lessons that I learned and I think that it really pushed me to manage my time well because I was doing the part-time research job and I was doing school full time and I was doing track full time. And I think that's going to be really helpful, you know? The tools that I used then are going to be very helpful for me in medical school and as a physician in the future with my goals of balancing multiple things in my life.

Dr. Chan: Okay. All right. Let's, again, go back in time. So the first year you applied, what was your strategy? How many schools did you apply to? Were you using the premed advisor up at Idaho State? What was going on back then?

Kaitlyn: So I was a little bit. I don't think that I was getting enough mentorship looking back now, which could have been a combination of my own fault and . . . I don't know. Just not finding somebody that was really great to mentor me.

I applied to . . . let's see. I think my first application cycle I applied to around 15 schools. Only applied MD. Just did the one application cycle or one application process. And I got one interview that season.

I also applied late. That's what happened. I applied late because I took my MCAT later and my scores didn't come in I think until September. So that was kind of . . . I think I had been warned not to do that and I kind of just had this mindset of, "Well, I'll just do it anyway."

Dr. Chan: Give it a shot.

Kaitlyn: Yeah. I was like, "You know, I'm going to make it. It's worked up until this point." Very naive of me. I had the one interview and then I didn't get accepted, and it was kind of this giant thing.

Dr. Chan: Okay. Was that with us?

Kaitlyn: No, it was . . . yeah, it was with the University of Washington, which was great, but I was also . . . I was studying abroad that semester, so I was writing secondary essays and studying abroad, which was just not a good combination.

Dr. Chan: Were you in this little internet café? Where were you?

Kaitlyn: I was in Spain, in Valencia.

Dr. Chan: Okay. In Spain in this little internet café.

Kaitlyn: Basically.

Dr. Chan: Hoping, you know, there's not a breakdown.

Kaitlyn: Right. And it was not a smart idea. I would not recommend that at all. I would recommend a gap year if that's what you're thinking of doing.

So there were a lot of mistakes I made that first application cycle, and I think it was very fair that I didn't get an acceptance. I just didn't have an idea about the whole process as a whole.

And the second time I applied was a little harder because I did feel like I had a better idea.

Dr. Chan: So in between the first year and second year, what did you do? You had kind of a gap year foisted upon you.

Kaitlyn: Sort of. So I . . .

Dr. Chan: Sort of. So what'd you do?

Kaitlyn: Let's see. So we're backing it up to during that first application cycle, I am studying abroad my first semester of my senior year, and then I came back and the application cycle is still going and I wasn't sure if I was going to reapply right away or not.

And so I didn't really know that I would be doing that, and I don't think I was preparing necessarily accordingly. I did do . . . let's see. I'm trying to remember. I shadowed a few more doctors in different specialties. I started volunteering. I think that's where I was more deficient, again, kind of back to the time commitment with track. So I did some more volunteer work.

Dr. Chan: What'd you do for volunteer work?

Kaitlyn: So I first . . . let's see. Two things. I volunteered at the animal shelter in Pocatello, which was great. I feel like it was not super applicable, and that's maybe where I went wrong. And then I really wanted to try to get in and do some volunteering in a medical setting, so I went and volunteered up at Portneuf in IV therapy at the hospital there. So that was fun and good.

I'm trying to remember. I got a job. That was a thing. Then I got a job working as a nanny for a disabled girl for a family that was in the area. And so those were main things I want to say that I did.

Dr. Chan: Sounds pretty busy.

Kaitlyn: Yeah. But then I applied immediately. And so not all those hours and all that time was on my application. And by the time I got to do an interview, I could speak to it, but . . .

Dr. Chan: Okay. So did you apply to more schools, or the same schools, or different schools, or what was your strategy the second year?

Kaitlyn: Yeah, so then I applied to . . . I want to say I applied to five more, so I think I did about 20, and I pre-wrote my secondary essays. That was a big thing because they come in, in waves.

Dr. Chan: Yeah, it's like a [inaudible 00:17:05].

Kaitlyn: It's madness, yeah. And so there's a little gap of time from when you submit your primary application and when you are able to get secondaries. And so I had been reading around, trying to gather some information, and I went ahead and pre-wrote my secondary essays based off of previous year's questions. Because a lot of the time, some of them will be the same. Not all of them. And that was definitely the case. And there might be nuances you might have to change, but then you have a basis to go off of and you can save yourself a lot of time, which is really important in the whole cycle.

Dr. Chan: So you sent about 20, and then how many interview offers did you get that round?

Kaitlyn: Two. And so that was . . .

Dr. Chan: This is where we came into the game.

Kaitlyn: This is where you guys came into game. Yeah. So just two. After not getting accepted that second year, I thought, "Okay, maybe I'm getting screened out with something basic."

Dr. Chan: Because I believe we provide feedback at that point.

Kaitlyn: Yeah. And so I did. And I got feedback from . . .

Dr. Chan: There was a mechanism. And I'm not sure . . . does Washington . . . did they give feedback?

Kaitlyn: So I got feedback from them both times and tried to do what they suggested and it was really helpful.

Dr. Chan: Did it line up? Did we give the same feedback, or was it polar opposites? Because I can see how that can be very frustrating.

Kaitlyn: Yeah. It's hard to focus your efforts I think when you're getting a lot of information coming in from different sides. I would say it was pretty consistent.

I did get some feedback from you guys that was frustrating to me after that second round. It was pertaining to my volunteer work and it was that it wasn't super applicable and it didn't seem to follow my story, is what the words were. And I thought, "What does that mean?" But it was really good for me. I think it was good to hear because I did end up, I think, finding that meaning and volunteering in a field that I was more passionate about and that was more applicable to my story. And so that ended up being really helpful.

Dr. Chan: I think what you're referencing is . . . I think it's good advice to all applicants, is establishing a good narrative. You know, we have a finite amount of time in our day, in our lives, and why does anyone pick these activities over others? And I think one shows what you're interested in by what you do with those activities. And I think that's what the committee was referencing.

Kaitlyn: Yeah. And it was fair.

Dr. Chan: It's how you tie them together. Like, who you are, how do these activities speak to your priorities and what you want to do in life and where you kind of see yourself going. And so that's what's a personal narrative.

You know, there's a reason why . . . I think Idaho State has this. You walk into these kind of community service centers and they have all these different activities. Why do you pick some ones over the others? You know, why did you pick . . .

Kaitlyn: Well, exactly. I felt like I went on this journey to figure that out, and I did. It took a lot of self-reflection, and I would absolutely encourage anybody who doesn't get accepted to get that feedback because it's important to have that honest feedback, especially from somebody who's seen you through the entire process.

And it prompted me to do a lot of self-reflection to think, "Okay, what is my narrative? Who am I and why am I doing this and what is something I'm passionate about? Go volunteer in that."

It doesn't have to be medically related. I mean, it's helpful I think to be around that and to see that, absolutely. But it just has to be something that you're passionate about and that you care about. And then you really are . . . when you're volunteering, then you're really are getting that extra benefit too of you feel really good helping because you feel like you've done something towards something that you really care about. And it's a benefit on both sides.

Dr. Chan: Did you, after the second year, have thoughts about giving up, doing something else?

Kaitlyn: Not really. I mean, yes and no. Of course, you have to reevaluate your position. And all the feedback that I had gotten was that I could do it. I don't know. I feel like I'm just a very determined person. Maybe that's a good thing. Sometimes not so much.

I didn't want to do anything else. I really did think about it because if anyone has gone through the application process, they know that it's not an easy one. It's emotionally and, I guess, kind of physically taxing, mostly emotionally taxing and financially taxing and taxing on your time. And so I did consider . . . I tried to look at other things and I thought, "Okay, well if this doesn't work, what am I going to do?" But there was nothing at all that I wanted to do more in the world than this.

And so my parents were absolutely amazing and so, so, so supportive. My friends too. But my dad said to me, "You don't build a plane and then not put the wings on it." And so they were just a huge support in that time and I was able to kind of push through and decided to take the gap year. And that was mostly for retaking my MCAT. I decided I would . . .I felt like I could get a better score.

Dr. Chan: Which you did. Congratulations.

Kaitlyn: Which I did, yes. Thank you.

Dr. Chan: Did you study on your own, or did you do Khan Academy, or did you pay, or Kaplan or Princeton Review or anything?

Kaitlyn: Yeah. So the first time, I self-studied, and then I thought I should switch that up if I wanted to change things, so I did end up paying for a Kaplan course and it was amazing. I had a really good experience. I did a live online version where you can take it from afar, because not a lot of people have cities that actually host them.

And not only did it help me with my MCAT, but I really think that it helped me learn how to learn better. And I do think that that's going to be super helpful now. So I'm very thankful for taking that. It's a little chunk of money, but especially if you don't have success your first time, it's totally worth it on that second round. So I did redo that.

Dr. Chan: Do they have a money-back guarantee? Because I've heard . . .

Kaitlyn: They do, yeah. They do, actually.

Dr. Chan:That's good.

Kaitlyn:So it's fairly . . . it's not really a gamble, I guess.

Dr. Chan: So your score should improve?

Kaitlyn: Yes. And if not, then I think you can retake the course. And they probably provide some counseling on that. I'm not sure. Don't quote me on that.

Dr. Chan: And then what different activities were you doing in between your second and third time?

Kaitlyn: Okay. So I was actually living in Pocatello at the time and I moved back home, retook my MCAT, and I did some self-reflection on what I should do for volunteering. And I thought, "All right. I'm really passionate about women's issues. Why don't I find a place in the area to volunteer helping with that?" There we go.

And so I ended up volunteering at a . . . it's a violence prevention center. And so I did a bunch of training in that. There's a women's shelter associated with it. And then I was essentially on call for if anybody came into the hospital with a sexual assault case.

Dr. Chan:Wow. Heavy stuff.

Kaitlyn:And I was an advocate for them. Yeah, it's tough, but at the same time, it's really, really rewarding to be there for somebody who is going through a tough time and have the training to be able to help them and offer what we offer.

Dr. Chan: What'd you learn from that? I mean, how'd you grow from that?

Kaitlyn: Well, it's hard to . . . I guess it would be hard to put it into words, but I think it was hard seeing the reality of what I already knew was there. But again, it just made me feel like I was in the right place doing something that I really cared about or helping somebody through a hard time.

I mean, I have known people in the past that have gone through similar things, and so it wasn't totally new to me, but I think it just was a reassurance of knowing I was in the right place and knowing I was following the right direction because I can help people like that in this field.

And so, really, I think it just reassured me on my path. But I learned a lot about talking to people in crises and kind of how to be gentle about it.

Dr. Chan: As a psychiatrist . . . do you know I'm a psychiatrist?

Kaitlyn: Yes.

Dr. Chan: I don't know if that's come up before. What really struck me about our healthcare system, our mental healthcare system, is that there are a lot of people who are alone and the system can eat people up. It's hard to navigate. People don't have loved ones. For whatever reason, bridges have been burned.

So, you know, Kaitlyn, I think that's awesome you did that experience because I think what I've learned doing psychiatry for these many years is sometimes people just want someone to talk to and listen and then just help them out because there are so many resources out there.

Kaitlyn: Yeah, it's hard to organize that.

Dr. Chan: But just to connect them to resources . . . It can be very daunting.

Kaitlyn: Yeah, especially when you're in a place where you're not thinking probably straight and are emotionally distraught. Everything is everywhere.

Dr. Chan: Yeah. Everything's kind of flying around and things aren't making sense. So that's really beautiful that you did that.

Kaitlyn: It was amazing. I feel like I wanted to help more in certain situations, but like you're saying, sometimes people just need someone to talk to and to point them in the right direction for resources they can use. That's essentially what I did. It was amazing. So that was kind of the big thing. And then I actually ended up volunteering as an assistant track coach with my old high school. So that was really fun too.

Dr. Chan: I'm curious. What was your coaching technique?

Kaitlyn: That was a learning curve for me because I hadn't done a lot of coaching.

Dr. Chan: Tough love?

Kaitlyn: I don't know if I'm that kind of person. Well, I learned a lot by watching other coaches. Mostly, I learned how to give kind of short, succinct advice to somebody, because while you're pole-vaulting, there are a million things running through your head and it's important as a coach to not tell your athletes to think about all these things that might be wrong and to really just focus on one thing at a time.

And so I think I learned a lot about how to be a better teacher. It was just fun because I got to work with my old coaches and I gained an appreciation for what they did for me.

Dr. Chan: Did you still have your skills? Because I imagine you would have to kind of show them and then there's pressure. "Okay. Here I go." You show them. You start running and then you can't . . .

Kaitlyn: You can't do it. You lose your credibility.

Dr. Chan: So you had your skills still?

Kaitlyn: I think so. I didn't end up . . . gosh, it's really hard to . . . you can't practice pole-vaulting much after school. It's a little different than volleyball in that respect. But it's still there. It's sort of like muscle memory. I'm not in any way near where I was . . .

Dr. Chan: According to YouTube, you can probably do lots of things with pole-vaulting that looks somewhat dangerous. People are always going over fences and . . .

Kaitlyn: It's scary.

Dr. Chan: . . . trying to go up into trees. I'm sure you have never done anything like that.

Kaitlyn: No. My friend and I, who also pole-vaulted with me at Idaho State, we like to pole-vault off of the dock into the lake. So that's fairly safe, right? You have sort of a soft landing, right?

Dr. Chan: Oh, okay. You have great YouTube clips out there. Did you have your own pole?

Kaitlyn: She does. Her family helps with all of the coaching of high school and stuff in the area. And so they actually have a pole-vaulting pit in their backyard, which is the coolest thing ever.

Dr. Chan:Wow.

Kaitlyn:They're very dedicated to the sport.

Dr. Chan: All right. So third time applying. Different schools? Same schools? Did you decide to go kind of more DOish? What was your philosophy?

Kaitlyn: Yeah, so third time around, I decided to go big or go home. So I applied to a total of 25 schools. I did apply to . . . I applied MD and DO, and then I applied also to Texas schools, which is a separate application service. So that was a lot, but it was really good.

And I had ended up having a very good response. I was really happy about it. I hadn't expected that because of my applications in the past of applying about 20 schools. I thought, "Well, if I'm applying to 20 and I get two interviews," I just didn't expect to get as many interviews as I did, so that was . . .

Dr. Chan: How many interviews did you get?

Kaitlyn: I interviewed at 13 different schools.

Dr. Chan: Thirteen? That's amazing.

Kaitlyn: Yeah. It was ridiculous.

Dr. Chan: That sounds expensive too and stressful on some level. Yeah. Double-edged sword.

Kaitlyn: It was all of those things. But I had a lot of support along the way and a lot of help getting there. So it wasn't all just . . . I wasn't alone. But it was . . . yeah, I was overwhelmed cause I really, really, really didn't expect that.

Dr. Chan: Did you go on all 13 or did you just start turning down some?

Kaitlyn: I went to all 13 because I ended up getting . . . let's see. I got two or three acceptances maybe at the end of the fall, in the middle of winter maybe, before the end of the year, but they weren't my top schools that I was really excited about.

And actually, for Idaho applicants, usually we have to wait at least for University of Washington's, which is our other in-state option, interviews until January or February. And so I was like, "I need to wait." And I hadn't heard from you guys yet either.

And so I ended up getting on seven waitlists or something. So I felt like I needed to go and explore my options. I needed to make sure that I was leaving my options open and not leaving any stone unturned.

It's really hard to get a feel of a program without going there, I think. You know, they can be great on paper or horrible on paper and you get there and have a totally different experience.

Dr. Chan: Going back to what we just talked about with muscle memory, the more interviews you did, did it become easier to interview, or is it still really anxiety-provoking and hard? I mean, did you feel you got better with all the different . . .

Kaitlyn: I hope so. I think so, yes. That was a huge part too. I'd think I practiced and prepared a lot more for interviews and researched the crud out of schools. I do think it got easier definitely, but you still have those nerves. I think you have those nerves because you care. And so that's not anything to be ashamed about it. It's totally normal. But I think it was easier as time wore on because it's like, "Well, I've done this. I know myself. I know my application. I really just need to research the school and make sure that you can speak to how you feel you're a good fit there."

Dr. Chan: That's amazing. I don't think I've talked to anyone that's gotten that many interviews.

Kaitlyn: It was unreal.

Dr. Chan: Yeah. Was it overwhelming or was it like too much information almost?

Kaitlyn: Yes and no. I mean, I was very pleasantly surprised. Had no expectation at all because of the past, obviously. Yeah, it was overwhelming at times. I think I got very lucky because I was working as a medical assistant at the time and my job was so, so flexible with me and my schedule, because that's a tough thing. You have to take time off of work. And at that time, you know, I was living on my own. I'm paying all my bills. I have to go to work.

And I think I got very, very lucky because I don't think a lot of jobs would've let me do that, but I was very upfront when I applied there, applied to work there, that I had this application coming up. I would probably have . . . I said I hoped I would have five interviews. Then it was overwhelming. I was like, "Wow."

Dr. Chan: So you're going all across the country?

Kaitlyn: Yes.

Dr. Chan: So is there a funny story you can share? Did you get any, "Idaho? Where's that?" Did you get any of that? Any potato jokes?

Kaitlyn: Yes, lots of potato jokes. Most people don't know about Idaho. Lots of people don't know about North Idaho too, just because the panhandle is kind of . . . it gets lumped in a lot to Washington and Montana. And so I kind of told people that it was . . . yeah, I don't know. There were a lot of people that didn't know. They thought it was really cold. You know, everyone thought it was really cold here.

Dr. Chan: Were you seeing people . . . did you start recognizing people from . . .

Kaitlyn: I did. You know, it was crazy. I ended up seeing at least three people at multiple interviews that I went to who had been at previous interviews and we'd be like, "Hey, what's up? How's it going?"

Dr. Chan: And then mostly MMI or just a wide mixture of interview techniques?

Kaitlyn: A good mixture, yeah. There was definitely MMI and different forms of MMI.

Dr. Chan:Do tell.

Kaitlyn:So here, you guys do the MMI where you're standing outside the door, you read the prompt, you hear the bell, you go in, and you talk to the person who's in the room.

But at one interview, I had an MMI that was a large room full of multiple desks and multiple interviewers asking you questions, and you had a bell and you would go from station to station with all the other applicants.

Dr. Chan:So it was loud.

Kaitlyn:And it was like this loud room, which was okay. It was not . . .

Dr. Chan: Oh, boy. Sounds a little stressful.

Kaitlyn: Yeah, it was almost . . .

Dr. Chan: Were you by yourself or were you supposed to do some of the activity with another applicant together, like a cooperation station?

Kaitlyn: So that one just by yourself. But at another interview, there was a cooperation station. I had an MMI with actors, which was scary.

Dr. Chan: Were the actors pretending to be sick or scared of flying?

Kaitlyn: Mostly angry or upset. So that was fun. I learned a lot. But yeah, a wide variety. I mean, there were interviews with panels of people and there were interviews with single people or interviews with two people. Yeah. So just kind of got a wide variety of it.

Dr. Chan: I feel so bad for you. It's like literally running the gauntlet.

Kaitlyn: It was, but I'm really happy for it. I mean, I can't complain, obviously.

Dr. Chan: All right. So now I can tell you this. So I remember when I called you, you didn't sound so happy. So I don't know if you were . . . I think you were working or maybe . . .

Kaitlyn: I was at work.

Dr. Chan: Yeah. And I kind of got off the phone with you and I'm going, "Eh, I don't know if she'll come here." I got this sense like . . . I've done this job long enough to know that I can tell by the tone. I was like, "Okay, Kaitlyn definitely has other offers." I got that tone from you. And so I was just like, "Okay, well, we'll see what happens." So that was my perception on my end. What was the perception on your end?

Kaitlyn: So this is what happened. I'm at work. My phone goes off. It's on vibrate. Probably should be on silent. It was on vibrate in my pocket, and I was with a patient, so I was not paying attention to my phone. I left, I got out of the room, looked at my phone, and I had a missed call from Salt Lake City. I was trying to talk myself down, you know? Like, "It's probably spam call. It's probably nothing. Don't get your hopes up."

And the doc who I worked for, Dr. James, so great, he was like, "Oh, just go check it. Go look." So I went to the break room and I called the number back and I got the Admissions Office. At this point, I'm losing my mind. And I talked to Tammy and she said, "So I'm not allowed to tell you anything, but Dr. Chan is in a meeting right now."

Dr. Chan: We played phone tag for a long time.

Kaitlyn: She was like, "I'm sure if he called you, though, probably an acceptance." And I literally started bawling because . . .

Dr. Chan: See, Tammy never told me that. When I called you, you sounded so laid back about it. You were like, "Oh, yeah. I know I got in. Okay."

Kaitlyn: No, I was absolutely . . . because it's a call I never thought I would get. And at that point, I had found out I was not accepted to the other in-state option for Idaho students, and so I had kind of given up on that. I thought, "Well, I'm on the waitlist. We'll see." But I had been on a waitlist before, so I didn't want to get my hopes up. And so I lost my mind. I was crying. And so, by the time you called me back, I had already cried.

Dr. Chan: Okay. That's good to know. This is why we're doing the pod.

Kaitlyn: So you got to miss the really beautiful ugly cry that I had. And I was kind of just in shock because this was a dream come true. This is my dream school. This is amazing.

Dr. Chan: So at the end of the day, how many schools were you accepted to?

Kaitlyn: So I want to say I had four or five acceptances. And I actually ended up getting off another waitlist of a school the same week after you guys called me. And that was crazy. So I want to say it might've been five.

Dr. Chan: And so the follow-up question is, Kaitlyn, why'd you choose us?

Kaitlyn: A lot of good reasons.

Dr. Chan: I'm just curious because, again, the way . . . you know, I've listened to your story and you've worked so hard, and all of a sudden, you go from no offers to five offers.

Kaitlyn:Yeah. Nuts.

Dr. Chan:How do you make that decision?

Kaitlyn: Yeah, it's a hard one. I'm kind of a pros and cons list person, so, of course, I'm making my pros and cons list, which, of course, I had my giant Excel spreadsheet of all the things about every school. Talking to my people, my parents, my best friends. But in the end, it really came down to the fact that this school was the best fit for me and my interests. I mean, it's in state. It kind of stinks that financial stuff has to come into play ever, but it does. It's realistic.

Dr. Chan: It's part of life in our American capitalist system.

Kaitlyn: Yes. It's an in-state option, and so that's great. Salt Lake is great as far as lifestyle goes. I'm a big snowboarder. I'm a mountain biker, and so it's kind of a perfect place for that. It's closest to home. But the program just was . . . it's amazing. I felt really welcome here.

I know people who are in the program already ahead of me, and I called one of them and they told me, "You absolutely have to come here. There's nothing bad I can say about this program. It's so great," and on and on and on.

And so, in the end, it really just ended up being the perfect fit for me and I felt like it was a place that I could learn and do the things that I wanted to do and be supported in doing that. So I think it just took a lot of sitting down and making priorities and choosing the school that fit those best, I guess.

Dr. Chan: Did you go back and . . . I mean, did you look at other programs? Did you fly in, do second looks? Did you do any of that?

Kaitlyn: No second looks.

Dr. Chan: More internet, looking up kind of thing?

Kaitlyn: Yeah. I had done a lot of research before interviews and stuff, so I had quite a bit of information, but I did go back and look at a couple of the schools that I was, you know, seriously comparing to. But I kind of knew, I think, in my heart where I wanted to be. So I ended up being here. I'm so excited. It's amazing.

Dr. Chan: Kaitlyn, this is . . . I love . . . yeah, I love talking to you.

Kaitlyn: It's crazy. It's been a journey.

Dr. Chan: I guess last question, just wrapping it up, what advice would you give someone out there who's thinking about med school or maybe didn't get in the first or second time? What would you tell them? What would you say to them?

Kaitlyn: Well, people who are thinking of it, I would say explore, explore. You know, do some shadowing. Make sure this is where you want to go because it's not an easy way there, but it's so worth it if it is what you want to do.

And if you have applied and not gotten accepted, don't give up. Seriously, don't give up. If this is the only thing you want to do, keep working at it. I mean, let your failures be moments of reflection and let that allow you to grow. And just keep going. You know, you're going to make it. If this is really what you want to do and you know you can do it and you have all this background to support that, then don't give up. You're going to do it. So that's all I would say.

Dr. Chan: Awesome. Sorry, I'm lying. One more question. With you being from, I would dare say, rural Idaho, have you thought about going back and practicing there or . . .

Kaitlyn:Yes, absolutely.

Dr. Chan:What are your thoughts about that?

Kaitlyn: So a little piece about Idaho and North Idaho. My family has lived there for generations, so they kind of have this . . . I don't know. I feel my family is very established there, is what I'm saying. And I love Idaho. I love North Idaho. It's beautiful. It's amazing. It's really my home. So yes, I've absolutely thought about going back there.

With that said, I don't know where I will end up. I don't know what specialty I will choose. I have no idea. And so, depending on that, of course, I hold . . . the future's open. You know, I hold options for that, but also I really want to end up there.

Dr. Chan: Cool. Well, Kaitlyn, we're going to have to have you come back because I want to hear more about the journey as you progress. And yeah, I'm just so excited you're here and I'm glad we were able . . .

Kaitlyn:It's amazing.

Dr. Chan:I have some phone calls with people and it's good to kind of hear the other side. I got the vibe from you like, "Oh, you're not coming."

Kaitlyn: Oh, my goodness. I was in shock. It was. I was so excited. You just missed the crying.

Dr. Chan: All right. Well, thanks, Kaitlyn.

Kaitlyn: Yeah, you're welcome. Thanks.

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.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: You may have heard recently of a drug called Naloxone. What it does is it reverses opioid-based overdoses. So if you have an opioid-based pain pill or if somebody has a drug overdose that's based on opioids, it can actually reverse it and save their lives. Dr. Jennifer Plumb is one of the founders of UtahNaloxone.org, is also in pediatric emergency medicine here at University of Utah Healthcare, and Sam Plumb is the program's manager at UtahNaloxone.org.

I wanted to ask you both, why is this important to you? I've gone to the website. I see that you've put a lot of work into it. I see on my Facebook feed a lot of times you're trying to increase awareness. Dr. Plumb, why?

Dr. Plumb: We are in this position, I think, at a position of passion, but also at a position of a true desire that we can bring awareness to the epidemic that's gripping our state with opioid overdoses. We are fourth in the nation, which is a distinction that certainly nobody wants. We're not talking about it a whole lot, and I think that there are a lot of people out there who have at-risk family members.

We unfortunately lost our brother in 1996 to a heroin overdose, and since that time the situation has just gotten worse and worse. Naloxone was not legal to have in the home setting when Andy died, and it is legal now. So I think that we both feel very passionately that if one family can be spared what we went through, it's all worth it.

Interviewer: It would've saved his life you believe?

Dr. Plumb: Absolutely, I believe it would've saved his life. It would've saved his life.

Interviewer: So when you say we have opioid-based overdoses, are you talking about pain pill overdoses, intentional, accidental? I mean, what are we talking about here, people abusing?

Dr. Plumb: When the figures all come out, the Health Department puts them together and the CDC also puts them together, and they do look at all of those categories. They look at intentional or suicides. They look at accidental or poisonings. We are seeing in this state that we have continued accidental overdose increases. So what do these look like from an opioid perspective? Most of these poisonings and overdose deaths in Utah are from opioid substances.

There are some others, cocaine, methamphetamine, alcohol, that can also kill people, and unfortunately does kill people. But the majority are from the opioid-based substances. Of those, the majority probably still is prescribed pain medications. So the pain pills, OxyContins, Percocets, codeines, these medications that we all have heard about in different incarnations in our lives, but heroin is another big one.

The CDC just this year basically released data and released recommendations calling it an epidemic. It's truly an epidemic what's happening. Since 2000, I believe, we're almost up 400% for heroin overdoses nationwide. It's everywhere.

Interviewer: Not a problem here, though, right? Not in Utah.

Dr. Plumb: You certainly wouldn't think so.

Interviewer: But it is.

Dr. Plumb: It absolutely is. It's really challenging, because I get that people don't want to talk about it. There's a lot of stigma around it. But to me, it really is just another medical problem, a critical one and one that will kill someone if it's not dealt with, and if we don't get people help. But we don't talk about it. You're exactly right. It doesn't exist if we don't talk about it. We don't see billboards about it. We don't see PSAs. We need to. We need to start encouraging conversations surrounding these substances so other families don't go through what we have gone through.

Interviewer: Sam, you're also involved in UtahNaloxone.org. You're the program's manager, and I understand you do a lot of outreach to people that have a drug addiction problem. Talk about that a little bit, and how Naloxone can change things.

Sam: Well, I think it could potentially have a drug addiction problem. When you're doing community street outreach, you're dealing with a population that they obviously aren't in a good place. If they themselves aren't active users, they could know people who are at risk of an overdose, for instance. So the idea is these are people that are typically missed by other realms of the medical field.

They don't typically go to the doctor. They don't have access to the pharmacy. They don't often have insurance. So for that reason, these people are most at risk for having an overdose and not having the access to Naloxone, which can save them.

Interviewer: You actually make these available to those at-risk individuals.

Sam: Yes. We go out to different areas, and you start to have an understanding of more at-risk areas of the city. For instance, I know Pioneer Park is one that people typically think of. The Road Home, places where there are typically going to be people that are living outside or don't have the means to often take care of themselves, or provide themselves the shelter. We will go out and we will educate each and every person that gets a kit so that they know everything that they need to do should they witness an overdose, or should they themselves have an overdose.

Then, we distribute the kits, and we've really had a great response for that matter from that group of people, and they're very willing to be honest about it. If you ask them if they're using, they will tell you frankly, "Yes, I am." When you tell them that you're willing to help them, to say that they're gracious is an understatement.

Interviewer: I'm going to be cynical here for a moment and say, what do you say to individuals that would say, "Well, they have a drug addiction, that's their own problem?"

Sam: I mean, that is probably what we hear the most frequently about that population. But these are people that do not have the typical resources that even somebody of no means may have, for instance family, support, friends, a place to stay, any type of income. Without some type of help, that doesn't mean that they should just die as a result. For these people, you can't recover if you're dead. So Naloxone gives them that chance to actually recover from a potentially fatal overdose, and then also have the opportunity to seek some type of treatment or go into recovery.

It's really surprising, and I think that if you have a doctor or an EMS responder, they revive you, well that person is just doing their job. But if you have a friend, or a mother, a father, actually revive you, I think that that has more of an impact on your future usage as well.

Dr. Plumb: We've seen that too. We've seen firsthand, as well as anecdotal reports from other states. But we've seen firsthand, if someone is revived by their mom, and they wake up and their mom is begging them not to die, there's a different lightbulb that goes off. There is a realization that, "Wow. Somebody really wants me to be alive. I need to be here for myself. I need to be here for them. My life does matter to them." It's been reported in the literature too that actually bystander-administered Naloxone is a much more powerful tool to get people to have that realization that their rock bottom has come.

Interviewer: So that very much near death experience is actually the thing that will help turn them around and perhaps get them unaddicted, or more willing to seek treatment?

Dr. Plumb: On a healthier path, basically.

Interviewer: Yeah.

Dr. Plumb: Just to have that realization that, "Wow. I actually need to be here. Someone else sees that I need to be here, not just someone whose job it was to save me. Someone else made the conscious decision to save my life. They're not medical. They just care about me."

Sam: It also is very important to mention that the experience of having Naloxone administered to you, especially if you are an active user, an addict, it is something that is terribly painful. It kicks them into instant withdrawals. Some of the people that we've spoken to have said, "I'd rather be tazed or shot before I get that Naloxone again." You're like, "Well, would you rather be dead?" "No. Well, if I'm going to die, then yes you can give it to me." But other than that, I mean, it's a terribly painful experience. So it's not something that people would use or to . . .

Interviewer: Yeah. Because I was going to ask, I was going to say, now I've got my safety net so, woo, party's on. Right?

Dr. Plumb: Your parachute, kind of. We hear people say, "Oh, you're providing a parachute to people," and that's just not the reality.

Sam: Because if you think about it too, these people who are active users, number one, nobody wants to overdose, nobody wants to be an addict, and beyond that they don't want to waste their last fix. So if you give them Naloxone and they've overdosed, they've just lost their last high. So it's another way to think about it.

Dr. Plumb: Yeah. We do get questions about that, though. "Well, aren't you just enabling use? Aren't you just enabling riskier use? Aren't you just basically telling people you're okay with this choice that they make?" The reality of it is, no, we're not. What we're telling them is, "Hey, listen. We want you to get to a healthier place. We want you to get to a place where your life is not so encompassed by your addiction. But we can't get you there and you can't get yourself there if you're not alive." Naloxone will get you basically breathing again if you've overdosed. That's all it does.

Interviewer: So I know that you're an advocate for having the conversation. It's not just for people that are homeless or at The Road Home. There are plenty of other people that have drug addictions, that have families and live in homes. What would you say to a person that's in that situation that's listening?

Dr. Plumb: Well, I think probably the best way to speak to them would be to provide some examples of folks that have reached out to us. Sam and I can both give you examples of different conversations that we've had with people. I think one of the most powerful ones for me thus far, since we have embarked on this, has come from a mom who desperately reached out to us to get Naloxone. She had asked multiple providers, her physician, other physicians, emergency department physicians, addiction physicians.

She'd asked for a prescription for Naloxone for her son, who was a heroin addict, and at the time he was clean. We all know that one of the times that you're most at risk of overdosing is when you've had a period of sobriety. So your body is not at all accustomed to opiates, even as short as a period of three days and you go back to using what you used before, and you can overdose. So this mom reached out to us and in desperation said, "Can you please help me get Naloxone?"

She came up to Primary Children's and met with me. I educated her on how to use that. I was willing to write her a prescription. She was so uncomfortable getting it from the pharmacy that I ended up just giving her a free kit, which we have the ability to do. She didn't want that on her record. She didn't want that anywhere in the medical record.

Despite the fact that it's completely legal, insurance companies cover it, that it's been done for two decades now in the U.S., she had that stigmatization worry. She got the kit, and within a week she had to use it to save her son. I mean, it gives me chills even now thinking about it, because whether it was her motherly sixth sense or her experiences from the past, but she knew, and she almost didn't have that opportunity to save her son's life. Sam took a call today from a gentleman . . .

Sam: He has some type of chronic back disorder and he's in tremendous pain, and surprisingly he told me that his prescription for pain relief is morphine. He's receiving six doses of morphine throughout one single day of 60 milligrams each dose. Typically, 100 milligrams is something where you start to think of somebody as very high risk, or is a very high dosage, and he's taking 360 milligrams a day.

He's bedridden, he can't work, but he made the effort to call out to get Naloxone, because he said, "I fear for my life with the amount of medication that I am being prescribed, and I worry that my doctor may prescribe more. I want my family to be able to save me if I overdose."

This is a similar story that we hear from other people as well. These aren't just people that are down on their luck. These are people who are taking their medication as prescribed.

Dr. Plumb: And are still just at risk, because at the bottom line, end of the day, these are risky substances. It isn't about a risky person. It isn't about a moral character judgment. It's about these are risky substances, and they are everywhere in our society. I think all of us should take a little thought about, "Do I have these in my home? Do I have these in my home for a legitimate reason, or what may be an illegitimate reason?"

It doesn't matter to me. If they're in the home, they don't discriminate. They can absolutely cause an overdose and a death, and being prepared is really just not only smart, but it's appropriate. It's not asking for anything wrong by asking to be able to keep yourself or the people that you love alive.

Interviewer: It's like having a fire extinguisher or a first-aid kit, or an EpiPen, or an inhaler, or any of those things that you would use.

Dr. Plumb: Absolutely. Although, interestingly, an EpiPen which is absolutely vital for people who have anaphylaxis or allergic reactions to things, an EpiPen can actually hurt you. It's epinephrine, adrenaline. That can cause heart arrhythmias. That can actually hurt you. Naloxone can't hurt you. So I mean, even a level beyond it, I absolutely advocate for EpiPens and think they should be everywhere we know where they should be, but Naloxone is even safer. But it is very much the same thinking, that if there were to be that worst case scenario, you'd be prepared.

Sam: I think that's something that is particularly salient here in Utah, because we have our own culture here and it is a very stigmatized issue, whether it's an opioid pain medication or if it's an illicit substance. But we do hear from people that call us to talk about Naloxone after it's too late. Oftentimes in Utah, unfortunately, the conversation starts too late, when somebody has already been lost and there's nothing that can be done. So given how simple it is and how safe it is, it just makes complete sense to have it.

Interviewer: That's right. This can be that conversation.

Dr. Plumb: Right. Absolutely.

Interviewer: Right?

Dr. Plumb: Think about it.

Interviewer: This is the conversation and now go out and get . . . So do you just, prescription from your physician?

Dr. Plumb: Yeah. Your physician can absolutely prescribe it there. It's 100% legal for them to do so. Some physicians are a little uncomfortable with it, and I think that this will come in time. The law is pretty fresh still. I think physicians will become more comfortable with it.

But if you do run into a conversation where your physician states they're not comfortable, reach out to us. I can absolutely call in a prescription statewide, and we have done so from St. George to Brigham City and Wendover to Vernal, statewide. It's absolutely legal for me to call in a prescription for anyone who's either at risk of an overdose or at risk of witnessing an overdose.

Sam: For more information or to view our training videos, or even for other resources such as treatment and medication-assisted treatment, we have all of that listed at www.UtahNaloxone.org.

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