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Dr. Chan: What inspires a person from humble beginnings to go into medicine? Why would one choose a cook position over an intelligence offer for the Army National Guard? What's it like to get all the way through nursing school, earning an LPN, then deciding to pursue an MD? And how do mock interviews help prepare you for interviews for med school?

Today, on "Talking Admissions and Med Student Life" I interview Michael, 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: Welcome to another edition of "Talking Admissions and Med Student Life." I have an incoming student, Michael. How are you doing?

Michael: I'm great. How are you, Dr. Chan?

Dr. Chan: I am so excited you're here. We have so much to talk about. So how does it feel? You're going to start med school next week?

Michael: Yep, next week.

Dr. Chan: So what kind of emotions are you feeling?

Michael: You know, I'm feeling really excited. A little, you know . . . you kind of get those butterflies, but I'm just excited to jump in and get doing what I love.

Dr. Chan: Yeah. It's been like . . . been working for it for so long. It's about to happen. All right. So let's go and jump in our time machine. Where did you grow up?

Michael: I grew up in Cedar City, Utah.

Dr. Chan: Okay. You grew up in Cedar, and how old were you when you started thinking about medical school and what was going on in your life?

Michael: For me, it was a little less conventional than usual. So I grew up with humble means. My dad was a meat cutter at Smith's, and a lot of my childhood we were living in trailer parks. And we had a couple of bankruptcies and stuff, and so I kind of got here on a winding road, but I'm super glad I ended up here.

So after high school, I joined the military to pay for college. I knew my parents wouldn't be able to help me pay for it.

Dr. Chan: That's interesting. So what high school did you go to?

Michael: I went to Canyon View High School.

Dr. Chan: Canyon View? Because I know they don't have recruiters, or did you just look them up on the internet? How did you get interested in the military? Do you come from a family military or . . .

Michael: Oh, no.

Dr. Chan: No.

Michael: Well, my grandpa was actually in the National Guard, but yeah, one of my buddies actually joined the military and he told the recruiters I might be interested. And I was like, "Oh, yeah." They asked if I'd meet with them and I was like, "You know, yeah. I'll meet with them. I'll at least give them a chance."

And they told me all the educational opportunities, because they do have an outstanding program for helping students pay for school. And I was like, "You know, this actually sounds pretty good. I didn't think I'd ever be joining the military, but this actually sounds like a really good route."

Dr. Chan: So what branch?

Michael: I joined the National Guard.

Dr. Chan: Okay.

Michael: Army National Guard.

Dr. Chan: Okay. And then what was . . . I mean, when you signed up, did you pick an area or did you take a bunch of tests and they kind of told you, "Oh, you're going to do X, Y, Z"? I mean, how did that work?

Michael: So one of the first things they have you do is they have you take the ASVAB. I mean, this might not be the best comparison, but it's sort of like the MCAT for the military. So it has your math, reading, all those kind of sections, and then they give you a score and based on that score, they're like, "Okay. Here's what you can do based on your score."

I scored pretty well, but they didn't actually have a whole lot of options and they were like, "Well, we don't have a whole lot of openings right now, but your score's amazing. Would you like to do military intelligence or Special Forces?" And I was like, "That sounds incredible."

Dr. Chan: It sounds intimidating, yeah.

Michael: But intimidating. I was like, "How long does the training take for those?" And they were like, "Oh, it's about two years." And I was like, "Yeah, I kind of want to get into college, you know? So do you have anything shorter?" And they were like, "Well, I mean, we have a cook, but . . ." And I was like, "Yeah. That sounds good. Let's do that."

Dr. Chan: Interesting.

Michael: Yeah, I went to basic training and then I went to cook school and I learned how to be a cook in the army, so . . .

Dr. Chan: What does that mean to be a cook in the army? Is it a lot of . . . I have this image of supply chain analysis and then the mess hall and then a lot of different ingredients and you had to do large meals, large portions. I mean, what does that mean to be an army cook?

Michael: So there are a lot of moving parts, just like you said, and it depends on if you're active duty or National Guard for . . . so for National Guard, that means, you know, a weekend a month you show up and they give you the meal schedule and they're like, "Okay. Here's what we're cooking. Here's some funding from supply." And you just go to Walmart and you're like, "Okay, what do we need for this meal?" So it's pretty different.

Active duty, they'd be, "Okay. Let's send the requisition to supply for what we need. Here's the recipe card." And we still had the recipe cards, but they have stock for almost everything, whereas we're just running to the grocery store and we're like, "Okay, let's get the stuffing and the turkey and just go to town."

Dr. Chan: And this is up at Camp Williams?

Michael: This was in St. George. I was with 213th Forward Support Company.

Dr. Chan: All right. So you'd just drive down to St. George . . .

Michael: Exactly.

Dr. Chan: . . . one time a month.

Michael: Exactly.

Dr. Chan: Okay. And I know there's this image in the movies that when a soldier disobeys or gets in trouble, they make them go peel potatoes. Did that actually happen or is that just a myth?

Michael: No, that really does happen. So those guys are called KPs. Yeah, if somebody shows up late to drill or if, you know, their uniform doesn't look right, they'll be like, "Oh, you're going to go be on KP duty." And it stands for kitchen police, I think, and . . .

Dr. Chan: Kitchen patrol or something.

Michael: Yeah, basically what that means, they're washing the dishes, which is really nice. Like, we really appreciate the help. They'd be. . .

Dr. Chan: So you kind of like that? You kind of secretly wish someone shows up late or has a poor uniform because that means more help for you?

Michael: Exactly. And they usually give us a few people anyway. So it's really convenient for them because they're like, "Well, Private Duffy over here was late, so, well, we have to send to KP. He's the one that gets to go," kind of thing.

Dr. Chan: All right.

Michael: And we always appreciated that just because we only have so many cooks. We don't have the manpower to do all the dishes and still cook the meals.

Dr. Chan: Yeah. So while you were in the National Guard, did you ever get . . . I don't know what the word is exactly. Called up or go overseas or . . .

Michael: Deployment?

Dr. Chan: Deployment, yes.

Michael: No, which is kind of funny. When I first joined, my recruiter was like, "You know, we're constantly at war right now. I'm not going to make you any promises. I'm going to tell you that if you join, you're almost certainly going to deploy." And yeah, funny thing is by the time I did my six years, I didn't renew my contract because I was planning on coming to medical school somewhere and I didn't end up deployed anywhere. So I guess he was wrong.

Dr. Chan: Was it just you or your entire battalion or unit or . . . I mean, did you follow the news and kind of go, "Oh my gosh"? I mean, what's the mindset of that? Like, how do you approach that?

Michael: It's kind of looked at as a badge of honor. Yeah, your whole unit would go and . . . yeah, a lot of people don't really see themselves as a soldier unless they've been on a deployment or two. And so, honestly, part of me kind of does wish I would've gone out just so I could say . . . because I don't really view myself as a veteran unless I've actually seen combat or actually been . . .

Dr. Chan: Deployed.

Michael: Deployed. But I mean, I did still serve. Yeah, I'm honestly kind of glad I didn't just because some people over there, they see stuff. Some of the toughest guys I ever know in the Guard could hear thunder and they'll be crying under the table from PTSD and I'm like, "Wow. I can't even imagine what that would be like." And so they come out of it with scars, so part of me is glad that I didn't go. Part of me does wish that I did.

Dr. Chan: So it sounds like you were in . . . and you were in National Guard for how long? Six years?

Michael: Six years.

Dr. Chan: So to have that kind of loom as always a possibility, the anticipation . . .

Michael: And I was always, always thinking about that. If stuff explodes with Iran or Syria, you know, whatever's going on with Korea. So yeah, that was always on the table.

Dr. Chan: And then while you were in the National Guard, is that when you started thinking . . . you mentioned medical school. Is that when you started pivoting or . . .

Michael: Yeah, I started pivoting . . . so I did always kind of like sciences when I was young, but I never really saw making a career out of it. But then once I got out of basic training, I started going to school on top of doing the National Guard stuff once a month. Yeah, that was kind of like . . .

At that time, I was like, "Oh, I like lifting weights. I'm going to do exercise science/nutrition." And I kind of figured, "Oh, I'll figure out how to make a career out of this." But then eventually, that track led me to take anatomy and chemistry and then I was like, "Wow. This stuff is really cool. I really like this stuff." And I kind of started seeing that as a possibility, like, "I can learn about this stuff and make a career out of it." And so I started pivoting towards medicine right around then.

Dr. Chan: And so SUU.

Michael: SUU.

Dr. Chan: Why did you pick SUU?

Michael: I picked SUU because it was close to home. I had my family there and I figured I could live with them for the first couple of years and save money. You know, it just seemed like the best option. I didn't really think of applying to some big other school. I was like, "I'll just stay here with what I know."

Dr. Chan: Okay. All right. So you're going to class and then once a month you're going down to St. George. What other activities were you doing to help you prepare for medical school? What were some of your different experiences?

Michael: I did a lot of stuff. One of the things I did, I volunteered at Best Friends Animal Sanctuary in Kanab.

Dr. Chan: Oh, what's that? Talk about that.

Michael: So they have basically a large parcel of land out there and their whole mission is to rescue animals, and so they'll go to neighborhoods where they've heard there's a stray cat and try to capture it and bring it back where they can nourish it and hopefully get somebody there that's looking for an animal that they can give to a good home.

So that was kind of a cool experience because I come from a livestock background and I was like, "Oh, you know, those people over there, they're kind of fanatics about their animal stuff." And it was kind of two different sides of the same thing. But I really ended up respecting that a lot. I was like, "These people really aren't that crazy. They're just really passionate about animals." So that was one of the things I did that was kind of a cool experience.

Dr. Chan: Were you ever tempted to bring them home or no? Not really?

Michael: No. my parents already had a couple of cats and I was like . . .

Dr. Chan: Okay. Never tempted, like, "Oh, this is such a nice dog"?

Michael: I mean, there were a few. When we were out walking the dogs, there was a . . . I think it was a pitbull and I always thought those were kind of scary dogs, but we were out taking it on a walk and I was like, "I actually kind of like the dog." And people I was volunteering with were like, "That dog really suits you. Maybe you should adopt it." And I was like, "I can't have another pet."

Dr. Chan: Plus, pitbulls kind of have a fighting, aggressive reputation. Maybe not this dog specifically.

Michael: And that's actually one thing they . . . that's part of their mission over there, is fighting the . . . they call it breed discrimination.

Dr. Chan: Breed discrimination?

Michael: Yeah.

Dr. Chan: So I just discriminated against a breed just now? Okay.

Michael: Yeah, they talk about that and they actually gave us a whole presentation on the statistics, and they're like, "You're no more likely to get attacked by a pitbull than you are another breed of dog."

And they talked about how a lot of cities are trying . . . or governments on local, maybe even state level are trying to make laws that basically discriminate against certain breeds. And they basically said there's no statistical evidence to support these kind of laws. And so that was kind of cool. I never thought that their mission would be that broad and encompassing and that they'd be fighting for things like that.

Dr. Chan: Who'd have thought that the golden retrievers, they just have a more powerful lobby and marketing team and everyone just loves golden retrievers or labradoodles.

Michael: Exactly. I mean, golden retrievers, they're just happy and good with kids. And so it'd be really easy to see that . . .

Dr. Chan: Or Lassie. Those are shepherd . . . what kind of dogs are those, the Lassie dogs?

Michael: Oh, I couldn't tell you for sure.

Dr. Chan: Okay. I feel so old right now. You're probably looking at me like, "What's Lassie?"

Michael: Yeah, pretty much.

Dr. Chan: All right. You worked down in Kanab volunteering. Anything else that you did that you felt that was really helpful to prepare you for the application process?

Michael: So one thing that I also did . . . I actually went to nursing school and got my LPN.

Dr. Chan: Oh, let's talk about that. What was going on there?

Michael: So this is kind of part of the pivot where I got to taking my pre-med classes and I got to the point after biochemistry I was about ready to apply, but I didn't feel ready. I was like, "You know, is this really what I want to do? This is so expensive. This is going to be such a long path. But I love the sciences and I want a career where I can help people. Maybe there's a shorter route that will still get me the same results."

And so I applied for SUU's nursing program and got in the next semester. And I enjoyed it. I learned a lot about patient care, but then I realized that some of the other parts in my background, like the biochemistry, genetics, psychology stuff that I had taken, I wasn't using it as much as I wanted to. They were focusing a lot on the patient care, but I wanted the whole big picture, like bring the science background that I have.

I was like, "You know, I really do think I want to do medicine. I can use all of these skills that I picked up over the years and the leadership experience that I eventually got in the National Guard to really help to the fullest of my capacity."

So I was glad that I did it. I gained a lot of experience in the patient care side of things, got to take care of some cool people.

Dr. Chan: So how long did you do that for?

Michael: So I did that for a year and got my LPN.

Dr. Chan: Okay. If I recall correctly, you were out doing LPN-type activities, right?

Michael: Exactly. So worked at a veteran's home actually in Ivins called Southern Utah Veterans Home.

Dr. Chan: That's cool. You know, kind of tying into the National Guard with . . . that kind of was a really cool narrative. Yeah.

Michael: Exactly. And so it was really cool working over there. I got to work with some really cool Vietnam vets, like war heroes. These people have all kinds of really cool stories, and so it was a privilege to be able to serve them and kind of hear what their experience was like. A lot of them didn't always talk about their experiences in war, but there were a few people I got to take care of that did.

Dr. Chan: So during this time, you're still thinking about school, and then did you start applying . . . that would be like your last year. Or did you take some time off after graduation?

Michael: Yeah, it was between . . . so it was a little unconventional because I was halfway through the nursing program, because it's an RN/BSN program there. I was like, "Yeah, you know, how am I going to get to med school? What's going to be the most efficient way to get here from where I am at?"

Because it was after my second semester where I was like, "Yeah, I'm definitely going to apply for med school. When is the best time? Should I do it this summer?" which would be the summer between my . . . basically the summer before my final year of nursing school.

And I was thinking, "Well, I could apply this summer and continue nursing school, but I still have to finish physics and a few other pre-reqs. Is now going to be the best time for that? Am I going to be able to stay in nursing school and realistically get through the application process, or am I going to apply the summer after I graduate as a nurse?"

So yeah, I played out all these different scenarios. I was like, "Which of these is going to be the best?" And I even calculated how much money I could make working as an LPN in the meantime.

So yeah, pretty much I was like, "Well, if I finish nursing school, I'd only work as an RN for three months before starting medical school if I apply this summer." And it was like, "I think I'm going to have to switch my major."

Dr. Chan: Yeah. Did anyone at the nursing school object to you . . . you know, your wanting to become a doctor?

Michael: They were actually really supportive.

Dr. Chan: That's cool. Okay.

Michael: Yeah. I had told some of them that I was like, "You know, switched from med school but now I'm kind of thinking I want to go back and go that route." And they were like, "Well, you know, yeah, you do kind of seem like . . . that's a better fit for you because you really like the sciences and we're mostly focused on patient care." And they were actually really supportive and they were like, "Yeah. You know, if that's what you want, we'll be supportive. We'll help you get there."

Dr. Chan: Awesome.

Michael: Yeah, one of my nursing professors actually wrote one of my letters, so . . .

Dr. Chan: I remember that. All right. Michael, what was your strategy in applying to schools? How many did you apply to? MD and DO? I mean, how did you kind of decide? How did you map it out? What was your plan?

Michael: Well, the first step was, "Okay, when am I going to take the MCAT?" So I still had two weeks left of nursing school.

So don't do it like this. I applied in a hurry. I had to think, "Okay. What's the soonest MCAT date I can study where I'll still be prepared to take the test, but I won't be so late in the application process that I'm not going to have a chance?"

So yeah, I eventually settled on taking it June 2nd. That gave me six weeks to study for the MCAT and it'd been a year and a half out of my pre-med courses kind of thing.

Dr. Chan: Did you do it on your own, or did you do test prep, or how did you study?

Michael: So this is another thing where I say probably don't do what I did.

Dr. Chan: Your story is a cautionary tale.

Michael: Yeah, exactly. So I was lucky enough to apply and receive the fee assistance program. And so I got all of their practice tests and MCAT preparation material from the AAMC for free included with my fee assistance program.

So yeah, I just did a practice test right off the bat before I even started studying to see where I was at, which I recommend doing that because then you can see where you're weak.

Dr. Chan: Yeah. And it generates a score, right? You can get a score and see where you fall.

Michael: Exactly. It generates a score and then I saw like, "Oh, wow. My chemical, physical foundation section is pretty low. I really need to spend a lot of time here."

So yeah, that's what I did. I started reviewing my gen chem, biochem, all that stuff where I felt like I was really weak. It was a lot of the chemistry stuff that I really needed to review.

And then I took another practice test after three weeks of studying and I was like, "Wow, I'm doing a lot better. What else do I need to focus on?" I kind of tailored it from there. So I was self-study. I didn't do a practice course. I was reading my biochem book and my notes and all that stuff.

Dr. Chan: Cool.

Michael: Yeah, if you're . . . so the reason I was able to do that and succeed is because I tried really . . . I was a really good student in those courses when I first took them. And I'd recommend that for anybody, because if you take the time to really learn the information while you're in the classes, you don't have to spend very much time reviewing.

Dr. Chan: So you took June 2nd?

Michael: Yeah.

Dr. Chan: Four weeks to get your score back?

Michael: Four weeks to get my score back and I . . .

Dr. Chan: So did you start applying then or did you want to get your score back to make a decision about where to apply? I mean, how did you . . . talk me through that.

Michael: So I took my MCAT and then immediately started writing my primary. In the meantime, I had pretty low expectations. I was like, "You know, people study for this test for years. I had six weeks. How well can I realistically expect to do?" So my goal was like 60th percentile. And I was like, "Okay. I might be able to squeak into a DO school." But then I got my score back and I was like, "Whoa."

Dr. Chan: Yeah, it was really good.

Michael: "Wow, yeah. I did pretty good." And so I was like, "I have a shot." So I only ended up applying MD. I applied to 11 schools. Yeah, I took about a month to write up all my stuff after I took my MCAT and ended up allying mid-July, which is a little behind the curve. I'd recommend to anybody to stay ahead and submit as soon as you can.

Dr. Chan: Yeah, because those secondaries come in pretty quick, and the sooner you apply, it puts you at a little stronger odds.

Michael: Exactly.

Dr. Chan: To get those interview spots, yeah.

Michael: Because that was stressful. I got all my secondaries within the same week and I was like, "Oh, man. They say two-week turnaround on these things and I'm . . . I guess I'll just knock out the highest priority first." So yeah, stay ahead on that. Start writing your secondaries as soon as you can.

But yeah, I ended up applying to 11 . . . or I applied to 15 schools, finished 11 secondaries, because those secondaries do just come all at the same time. And some of those schools, you get their secondary back and you're like, "Yeah, this is kind of weird. I don't know if I actually want to go to this school."

Dr. Chan: And of the 11 you filled out, how many interview offers did you get?

Michael: So I got four interview offers.

Dr. Chan: That's good.

Michael: Yeah.

Dr. Chan: You can kind of see, you know, if you sent out 11 and you only got 1 back, not as strong as if you got 4 interview offers, because then . . . you know, everything's about the odds. The more interviews you get, the more likely you are to get in somewhere.

Michael: Exactly. And there were three other places where I was waitlisted for interviews and I was like . . . I always was like, "Man, if I would've just applied a little sooner, I think those waitlists would've turned into interviews."

You're right. It's all about odds. It's all about how many slots they have and how many good applicants they've already picked from the pool.

Dr. Chan: Yeah. And then did SUU . . . did you use any of the pre-med advising, like mock tutoring? Was that helpful? Sorry, mock interviewing. Excuse me.

Michael: Yeah, I used the mock interview at their speech and presentation center. So they do a traditional practice interview over there and that was pretty helpful. They go through some of the basic questions and you kind of get used to just talking to somebody about your life and your experiences and . . .

Dr. Chan: Kind of like right now.

Michael: Exactly, kind of like right now. I've had a ton of practice.

Dr. Chan: All right. So you go out and start interviewing, and then when did you interview with us? Was that November, December?

Michael: It was December I interviewed with you guys. I actually have . . . and I'd recommend doing this for anybody who's applying to a school with MMI, which probably anybody who's applying [crosstalk 00:23:55].

Dr. Chan: Yeah. More and more schools are moving . . . especially in the Western U.S., have really moved to MMI model.

Michael: But that's a really good practice. MMI stuff, you can just find on Google. They'll have eight stations or however many stations that you can practice. And so I just met up with one of my good friends. I was like, "Hey, man. I helped you write this, so now you owe me. You're going to help me with my interviews." I had him be the interviewer. I pretended to knock on the door and he'd tell me to come in and . . .

Dr. Chan: Interesting, yeah.

Michael: Same thing, you know? I'd lift up the card on the door and it would have the prompt. So we set up realistic practice and when I came here, it was smooth.

Dr. Chan: So you felt good?

Michael: Felt very good going in.

Dr. Chan: A little nervous? Everyone's a little nervous. It's normal, but you felt well prepared.

Michael: Felt well prepared. Exactly.

Dr. Chan: And then when did you start . . . did you get any other offers aside from The U?

Michael: So I was waitlisted at Penn State and Wayne State.

Dr. Chan: Okay. So you got into The U and then case closed, or were you kind of like, "Oh, you know, I lived in Utah for all my life. Maybe I want to go somewhere else," kind of thing? I mean, what was your decision-making process?

Michael: I was like, "Well, you know, I really want to stay in Utah." And you guys have an excellent program. I was really excited to be accepted here. I was pretty much decided to come here, but I still waited a little bit. I was like, "Maybe I'll just see if I get accepted there for my own pride. I know I'm going to tell them no, but . . ."

Dr. Chan: Well, you then get into the finances, right?

Michael: Oh, yeah.

Dr. Chan: So I think it would've been . . . I'm not really up to date on Penn State's tuition per se, but I think it would've been cheaper to stay here as a Utahan, right?

Michael: Oh, yeah. Their tuition . . . I mean, you can't beat your guys' tuition here. Theirs was $50,000 a year and then Wayne State's was $60,000, and then you look at living expenses and moving costs and I would have to get a plane ticket to fly over to visit my family. So I figured, "You know, I was planning on coming here anyway but it just sold it all the more for me."

Dr. Chan: Awesome. And first doctor in the family?

Michael: Yeah, first doctor in the family.

Dr. Chan: So what does your family think about all this? Because you kind of had this really interesting, cool journey to get to this point.

Michael: Oh, yeah. No, they're super excited for me. My mom was just praying for me to get into The U. She was like, "I really hope you get into The U so we'll be able to visit you. I just can't stand to see you go somewhere else where we won't be able to see you for four years," kind of thing. So they're really excited for me.

And we do have other healthcare people. We have a dentist. We have a handful of nurses, a PA, but I'll be the first doctor, so that's kind of exciting.

Dr. Chan: Well, one of the things we were talking about, Michael, before I turned on the pod is . . . tell me about your desire, your dream to return to Cedar and practice. I think you alluded to that, but is that something that you want to do one day?

Michael: Yeah, I believe so. If not Cedar City, then somewhere in southern Utah that just needs some doctors. I see down there . . . I think the kidney specialist we have there only comes down a couple of days a week. I think there are only six psychiatrists in southern Utah. So there really is a need for physicians and I really would be able to provide some important services for the people down there.

Dr. Chan: And I think you talked about that in your application a fair amount. Correct? Like, you want to go back and serve, provide care to the people of southern Utah.

Michael: Exactly.

Dr. Chan: And it sounds like you've felt that way a long time.

All right. Well, Michael, last question. To anyone who's listening out there, what advice would you give them? You know, someone that's thinking about applying to med school and is not sure they can do it or don't think they're up to the task, what would you say to them? What advice would you give them?

Michael: I would tell them don't ever count yourself out. You've just got to believe in yourself and work hard even if you don't . . . If it's something that you're interested in, just go for it and give it all you've got. That's kind of what I did. I didn't really see myself getting here, but I'm super happy to be here.

Dr. Chan: Yeah. Well, Michael, you're going to be an outstanding doctor. Congratulations and we'll have you come back on because I want to hear more about your journey as you continue to grow during medical school and just kind of see where you're at and what direction, what field you end up choosing. Well, thank you for coming on.

Michael: Well, thank you, Dr. Chan.

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

Interviewer: Raising the potential of young adults with autism, up next on The Scope

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Anne Kirby, Assistant Professor of Occupational Therapy at the University of Utah. Doctor Kirby, you've published research that suggests that how well people with autism perform in life depends a lot on their parents. Can you explain what you mean by that?

Dr. Kirby: We found that parent's expectations are what we call mediating outcomes for adults with autism. What those parents say they expect after high school ends up usually playing out.

Interviewer: What are some of the behaviors or accomplishments that you're looking at?

Dr. Kirby: So three main areas that I'm interested in and that have been explored a good deal in the literature are employment after high school, living arrangements after high school, so whether they're still living at home with their parents or other family members or if they're living with roommates or independently or with a spouse. And then finally, social participation, so how often they're interacting with friends in sort of a social manner.

Interviewer: So you found basically a link between parents who have higher expectations for their kids, those kids tend to perform better during this age. How did you look at that?

Dr. Kirby: We don't exactly know whether parents are just doing a really good job of determining what their child is capable or of if their expectations are actually driving what ends up happening. But one example of how they may be driving, what happens is, for example, a parent that doesn't think that their child is going to be able to be employed after high school is most likely not going to be encouraging their child to get a part-time job while in high school or find summer employment, participate in volunteer work in the community, or take on other roles in the household and community that might be helping them build skills for later employment. And then, that would then turn into not having those skills later in life to be employed.

Interviewer: They might not realize the potential of their child if they don't put them in situations where they look and see what they can do.

Dr. Kirby: Right, exactly.

Interviewer: Could it also be that if a parent expects more from their child that then the child sort of believes in themselves and tries to accomplish more.

Dr. Kirby: Certainly, and there are some theories that suggest that not only what parents expect but what someone expects of themselves, which can be influenced by what parents expect of them, can make a big difference.

Interviewer: I'm wondering too, how much the parents' background might play into all of this. If someone is living in poverty, they might just have other things on their mind and may not have the time or ability to put these kids in different situations, like volunteer work, as you say, or things like that.

Dr. Kirby: Certainly, and so we did find that parents from a lower income background have lower expectations for their children and their children are having these less ideal outcomes that we studied. And I think the example you just gave is right on point in the fact that those families might have a lot more that they're dealing with and might not have the same resources to devote to helping build those skills.

But the other thing I've thought a lot about is that you can imagine a parent who's been struggling to be employed themselves would be less likely to think that their child with a disability is going to be able to find steady, high-paying employment if they're having trouble with that. And so some of it could be resources, but some of it could be perception of possibilities.

Interviewer: How much of a difference was there between kids whose parents had high expectations and kids whose parents didn't?

Dr. Kirby: So I think it's really important to mention that despite the fact that I'm saying high expectations lead to better outcomes, the outcomes are overwhelmingly poor. So very, very few people with autism in this national sample of over 1000 people with autism had employment of any kind at the end of this eight-year study. So they were in their 20s during this time. Similarly, very, very few of them were living independently and very, very few of them were socializing at any rate with their peers or friends.

Interviewer: I wonder how much of that, though, is just what is out there for these people to begin with. I mean, I think it's still a very new idea that people with autism can join the workforce.

Dr. Kirby: Right. And it's been said often that leaving high school for this population is like falling off a cliff. It's something that parents talk about and has been written about in the literature and popular news type articles. It's kind of repeatedly referred to as this cliff because they no longer have somewhere to go every day where they know what's expected of them. The world drastically changes for them after high school and at the same time, services are just totally disappearing. So they might exist. Vocational rehab is there and can help, but often families find themselves on wait lists for extremely long periods of time.

Interviewer: So how are you following up on these results? What are you doing next?

Dr. Kirby: So what I really want to know now is if we could make a meaningful change in what parents expect for their children and if that could then make a positive difference in outcomes for people with autism. And if that's possible, then it really might be a really important target for intervention, to not only focus only on intervening directly on children with autism and trying to give them work skills through groups and programs, but to work with families to really make a difference and how families are structuring what they do throughout the high school years to really prepare for life after high school.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.