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

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

Joe: I am excellent. How are you?

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

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

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

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

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

Joe: Correct.

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

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

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

Joe: It was very different.

Dr. Chan: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Joe: Exactly.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Joe: Sure.

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

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

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

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

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

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

Joe: There are . . .

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

Joe: Yeah.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Chan: Oh, go on. Sorry.

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

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

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

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

Joe: Yeah.

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

Joe: Yeah, absolutely.

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

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

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

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

Dr. Chan: All right. Thanks, Joe.

Joe: Hey, have a good day.

Dr. Chan: How does someone with plans to teach Spanish end up in medicine? How does a volunteer experience propel one into leadership? What's it like to have a nurse for a wife while studying medicine? And finally, how does one develop an interest in ophthalmology? Today on "Talking Admissions and Med Student Life," I interview Troy, a fourth-year medical student here at the University of Utah School of Medicine.

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

Dr. Chan: Well, welcome to another edition of "Talking Admissions and Med Student Life." Troy, I'm so excited you're here, Troy. A fourth-year student. Soon to be newly minted MD in a few short weeks, correct?

Troy: Correct. Three weeks.

Dr. Chan: All right. So let's start back in the beginning, Troy. What prompted you to become a doctor? When did that decision get made?

Troy: It was a very last minute decision for me. I was pretty sure that I wanted to teach high school Spanish during undergrad, and so I was teaching Spanish and I was volunteering with a couple of things. And a buddy of mine reached out and said, "Hey, you should volunteer with me for the Red Cross. They teach CPR classes in Spanish." And I thought, "Okay, sweet. I'll do that."

And so I went volunteered, and I don't know how to quite describe it. It was a new skill. I was totally foreign to medicine, you know, family medicine. And I just thought it was really fun. And I kind of felt like a rush from saving a mannequin's life and teaching that skill to different populations. And so, I kind of decided to pursue it a little bit, and I signed up for an anatomy class just for kicks and giggles.

Dr. Chan: This is down at BYU, right?

Troy: This is at BYU. Yeah. So I took an anatomy class from . . . oh, I can't remember her name. She was like . . .

Dr. Chan: She was very pivotal but we can't . . . yeah, it's okay. Yeah, she was important.

Troy: Okay. Am I not allowed to say names or . . .

Dr. Chan: Oh, no, you can say her name, but I'm just saying we can't remember her name. But she was very pivotal.

Troy: I cannot remember her name. Yeah. But she was incredible. She's an incredible teacher. And really kind of sparked my love for human anatomy and physiology. And I kind of started putting dots together and thought, "Wow, it was cool teaching a life-saving skill and I really enjoy, you know, human anatomy." And I decided to take some more science courses, and then it just kind of spiraled from there. And I ended up taking another year at BYU just to finish out because I switched to pre-med kind of late, but applied and got it and here I am.

Dr. Chan: All right. So being a BYU pre-med-er, what's that like?

Troy: It was kind of intense.

Dr. Chan: Would you even say competitive?

Troy: Yeah. There were so many pre-meds at BYU and I had no idea until I entered the pre-med world down there. And it was kind of like this "fend for yourself" mentality down there, at least how I got it just because the pre-med program down there, there's like . . . I don't know how many hundreds of pre-med applicants there are. And they don't really have time to sit down with every single one and kind of . . .

But they kind of portrayed it as it's very competitive, only the best of the best get in, and you should apply to MD and DO schools because most of you will go DO. So I kind of did a lot of it on my own, just kind of, I don't know, researching things and figuring it out.

Dr. Chan: Yeah, how did you find balance? Because, you know, applying to med school, it takes a fair amount of classes and test scores and MCATs and all that. But there's also research and community service. Like, how did you fit all that into your schedule?

Troy: It was hard, not easy. And, I mean, this is question that you're going of have to ask in every facet and asset of your life, right? Every time period. Pre-med, med school, residency as a physician. This is not something that's going to go away.

And I would say that at certain points, I had to make sacrifices in certain things. You know, there were some semesters where I like literally had no social life just because I didn't have time for a social life. And then other semesters, I didn't have the time to put into research that I wanted to because I wanted to have a social life.

And so it's kind of ebb and flow as far as every different aspect of my life goes. But I think it's important at least take, you know, a weekend a month where you don't do anything or a night every week. I got married at BYU two years into my schooling there. So Friday night was always date night.

Dr. Chan: Congratulations.

Troy: Thanks. And we continued that through med school. So I never studied on Friday night. That was always my wife's night. And we did things every Friday night, and still do. And so, I'd say kind of forcing yourself to carve out time in your week to yourself and your mental health and strengthening relationships with those around you.

Dr. Chan: Yeah. Did you use some of your Spanish for your volunteer work prior to med school?

Troy: Absolutely. All of my volunteer work. That was kind of the theme of my application, was my Spanish. And I found ways to translate and I did some volunteer work at elementary schools where I translated during parent-teacher conferences. I got really involved with the Red Cross, and so I taught a lot of Spanish CPR classes and emergency preparedness classes. And yeah, kind of wove my Spanish into kind of all of my activities.

Dr. Chan: And did you learn to speak Spanish on your mission?

Troy: I did.

Dr. Chan: Where did you go?

Troy: I went to Chile, to Vina del Mar.

Dr. Chan: Okay. So applied to med school, what was your strategy? How many schools did you apply to? You know, what did you do? Like, how did you kind of approach that?

Troy: Oh, I almost can't remember now. I think I applied to 20 to 30 schools. And it was almost . . . I'd say half was just basically geographical. Where is family? Where are friends? And then the other half was just kind of hearsay or, "I hear these schools have a good relationship with BYU and BYU applicants." And so, that was kind of how I split it half and half.

Dr. Chan: And if I recall correctly, you got into a fair amount of schools, right?

Troy: I got into four different schools.

Dr. Chan: Yeah. So how did you . . . I mean, what was the decision points to come here?

Troy: I think it came down to tuition.

Dr. Chan: Okay. Basic cost-benefit analysis.

Troy: Yeah. Well, I mean, this was definitely the best school that I got into as well. And so, there's, you know, a myriad of reasons why I decided to stay in Utah. But since I did spend five years in Provo, I could qualify for in-state tuition and my wife could get a job here as a nurse. And so, I've been fortunate enough to have half tuition for the past few years.

Dr. Chan: Cha-ching. Yeah.

Troy: Yeah. And that's a little better than paying the out-of-state, you know, $50,000 to $60,000 to basically any of the other schools I would have gone to. So just on a financial, you know, outlook, this was kind of a no-brainer for me.

But the reason I say it's the best school is because I think it had great opportunities for research outdoors. It's kind of hard to be living in Salt Lake. I'm a big skier. And so, you know, access to Big and Little Cottonwood Canyon was pretty incredible. And yeah, it just kind of worked out.

Dr. Chan: What kind of nurse is your wife?

Troy: She works on CVMU, so cardiovascular medical unit, which she loves.

Dr. Chan: Okay.

Troy: It's been really helpful for me too.

Dr. Chan: Oh, yeah. And it sounds like you've got . . . I mean, with both of you in health care, you know, something to talk about around your Friday night dates.

Troy: Absolutely. Yeah. It's funny, maybe a little sad how much of our conversation at home has to do with medicine. But, for example, I'm going into residency obviously in a month or two and you have to be ACLS and BLS certified. And so, last night I was working on the ACLS, you know, videos and everything that you do at home and there's these online simulations and she's like walking me through. She's like, "I do this literally every day." So it's been a huge advantage for me.

Dr. Chan: Is that how you guys met, in the hospital, or . . .

Troy: No, we actually met on a hike.

Dr. Chan: Hike into the Y? Because I heard about that.

Troy: We were that cliche actually. It was the Silver Lake hike.

Dr. Chan: Oh, I've been on that. It's very pretty.

Troy: So, yeah, we had some mutual friends and we ended up on the same hike and we started talking, and I asked her out and every day went after her. So it worked out really well.

Dr. Chan: Cool. All right. So you're coming here. How was the jump from undergrad to grad or med school? I mean, how was that first semester? Was it like, "Oh, my gosh, this is manageable," or, "Oh, this is really kind of overwhelming"?

Troy: Yeah. So I would say it was pretty on par with my education at BYU as far as time commitment. And that's probably because with my first semester of medical school, I didn't jump headfirst into all the extracurricular activities, into research and clinic work and all of the other things. I just kind of focused on my schooling. And so, I felt like the schooling . . . the hours that I put into that were equal to all the hours that I put and everything combined at BYU. And so, it wasn't a huge adjustment for me as far as time spent.

Dr. Chan: So it felt very doable?

Troy: Oh, yeah, absolutely.

Dr. Chan: And then when did you feel like you had more time to start doing research? Because I know there's community service. There are Spanish-speaking opportunities. When did you start kind of coming into that?

Troy: Yeah. So probably second semester first year is when I started getting involved in those things. And I wouldn't say that the coursework got easier or the hours got less or decreased. I would say I was more efficient with my time as far as studying went and I kind of knew what to focus on and how to focus on it and learned some tips and tricks on how to be a little more efficient. So I could kind of cut back on hours spent and just be more efficient, and that way, you know, kind of put those extra hours towards working in the clinics and jumping into research. And it just kind of worked out well as far as that transition went.

Dr. Chan: And a little bit of foreshadowing, but then when did you start getting interested in student government?

Troy: Yeah. So I came to med school with no intention of getting into leadership at all, and things just kind of fell into my lap. I remember first-year, you know, and second-year class elections for like class president and stuff, and I didn't run for anything, so I was never really interested.

But I was working at the Maliheh Clinic during first-year. And between first- and second-year, they always do a transition to leadership and they, you know, offered all my classmates and myself interviews to work as the co-director and I didn't even apply. But the co-directors from the year before approached me and said, "Hey, we think you'd be really great at this."

Dr. Chan: "We're going of appoint you," or, "Wink, wink, please apply. We'll look very favorably upon your application. Please submit it."

Troy: So my application was like a one sentence email back saying, "You know, I think I'll do this. I'm interested." And so, they said, "Okay, great. You have one of the spots." And so I was a co-director, and I just kind of loved it.

And a very similar thing happened with the LMSA group, which is the Latino Medical Student Association. I was heavily involved during first-year, again not seeking any kind of leadership position. And then our co-president, the summer between first- and second-year, left on vacation for a while and was doing some other things with research. And so, I kind of took command of the group and kind of let a lot of things . . . again, not hoping to be president or anything.

And then our co-president got back and said, "Hey, Troy, you've done a lot of work. You've done a lot more than I have. I talked to our mentor and we think we should appoint you as co-president." And so, you know, I'm not going of turn that down. So I said, "Okay, great."

And just kind of things like that as I went throughout med school, and things just kind of fell into my lap. And then it was time for third-year and there were applications for class president and I was kind of on the fence. And then I had a couple classmates approach me and say, "Hey, you should run for this." And so, I decided to and . . .

Dr. Chan: So it sounds like people really kind of respond to your leadership skills.

Troy: Maybe.

Dr. Chan: I mean, they see something. They like you having your organizational skills and have you be in charge of these different programs.

Troy: Yeah, and that might be true. And it was never a strength of mine in undergrad. And so, it wasn't something I was looking for coming to med school. And I feel like I've kind of developed into that person, that role during my medical training.

Dr. Chan: But correct me if I'm wrong, you're now student body president.

Troy: Correct.

Dr. Chan: So, like, what does that mean for the medical school and what does that entail? What do you do?

Troy: Yeah, so our official title is student body officers and there are three of us. It's Gwen and Julie and myself, and we work with the class co-presidents first- through fourth-year. And we work with basically all the student leaders and administration. And we're kind of the liaison between the student body and administration.

And we lead the meeting every month that incorporates all those members, and then we kind of deal with items as they come up. We put on some of the big school events, such as prom or the elections for the next year and then the roast, which I'm sure you've talked about in other podcasts. And so, yeah, kind of big events and then coordinating things.

Dr. Chan: Do you run on platforms or . . . you know what I'm saying? Like, how do you how do you campaign for this? I mean, what's kind of like the infrastructure, I guess?

Troy: So there's a week of campaigning and it's open to any group who wants to run, and it's kind of, I guess, everything you'd expect. Posters, flyers, a lot of social media is kind of how you get the word out. And then we kind of frown on spamming everyone with emails, and so we don't send out emails. But a lot of word of mouth and then kind of trying to say, you know, what is our platform and what we want to accomplish, and then there's a big vote, and then they announce the results.

Dr. Chan: So I like what you said, liaison. So if there's an issue that happens or an item that happens within the med school or maybe outside the med school, it sounds like there's administrative response, but also, they coordinate and they ask the students what they think and what they feel and what they want. Is that accurate?

Troy: Yeah, absolutely.

Dr. Chan: So I guess the hard part is, and just to put you on the spot, Troy, how do you represent 500 different students who all have different backgrounds, different thoughts, different perspectives, different ideologies? I mean, it sounds really hard. I mean, how do you do that? How do you speak for the students, I guess?

Troy: Case by case. Yeah, it's literally impossible to represent every person and every idea at the same time. And so, we just approach every issue case by case as it comes up. And there's never any one person or group who kind of takes command. It's more of a group consensus. And we have a lot of deliberation and talking back and forth before we come to conclusion.

Dr. Chan: It sounds hard.

Troy: Yeah, it's a lot of time. But it's been really fulfilling as well. Kind of opened my eyes to, I guess, what happens behind the scenes.

Dr. Chan: Yeah. Do you think this . . . I mean, you kind of talked about it, but do you think this will lead itself to, like, a career in academic medicine or working in leadership positions at a hospital or, you know . . . because you kind of understand some of the dynamics at play and some of the organizational, you know, strengths and weaknesses of large complex systems interacting with each other, I guess. I mean, do you see a future for yourself in that or . . .

Troy: Yeah, I think all signs point that way. And that's, again, a kind of a new development in my life. But I do feel very fulfilled in a leadership position, just representing people. And I enjoy teaching as well. And so, I guess I could see myself as, you know, trying to be program director in the future for a residency program, which I think would be just the funnest job. But we'll see. I guess time will tell.

Dr. Chan: All right. So you mentioned some events. So prom. What else?

Troy: Roast.

Dr. Chan: Roast.

Troy: Elections.

Dr. Chan: Elections.

Troy: And then we do kind of a back to school barbecue. We don't help out a ton with Second Look Day but we're involved a little bit.

Dr. Chan: And we're very thankful for that. So of those three or four you mentioned, which is like the funnest to kind of spearhead, and which one just causes you heartburn? From a student body officer perspective, yeah.

Troy: I think the most entertaining one is the roast. Every single year, it's always fun. And then . . .

Dr. Chan: That's interesting because my perspective, that also could be the most dangerous because people really like to get very close to the line on some of the stuff, on some of the skits or videos they create.

Troy: Yeah, or over the line.

Dr. Chan: Yeah, over the line.

Troy: And I think for similar reasons, kind of the biggest headache is prom. And just I guess dealing with alcohol and what's allowed and what's not. And what happens if there's an event. You know, I feel like there's always some kind of unforeseen adverse event. You know, a girl slipped on glass here at prom and had to go the ED.

Dr. Chan: Oh, no. I didn't hear this.

Troy: Yeah.

Dr. Chan: So you had a good plan in place in case someone got hurt at prom?

Troy: I mean, no. That's the problem. We did not.

Dr. Chan: The plan was, "Call Troy. Troy will know what to do."

Troy: Yeah. The plan was no plan. But, you know, I guess it's nice having very responsible medical students who are around.

Dr. Chan: Yeah. If there's any place, any event someone can slip and fall and hurt themselves, I guess at a med school event would be very advantageous.

Troy: Right, right. So I guess just kind of dealing with those setbacks as kind of a headache every year as far as prom goes. And I guess there are similar problems with the roast, but I just feel like the roast is more fun.

Dr. Chan: So going back to the prom, because there's like . . . did you grow up in Utah? You didn't grow up in Utah.

Troy: Colorado.

Dr. Chan: Colorado. Well, it may have seeped into Colorado. There is this sort of cultural thing, I don't know how to describe it, where you ask someone to the dance. I think this starts in high school. And you have to do in a very creative way. I don't know if you've heard about this. I've heard it kind of exists at BYU so you might have been exposed to this. Does the med school do that? Or have they put the kibosh on that?

Troy: We don't do that.

Dr. Chan: Okay. So that stops at grad school?

Troy: Yeah. At least the vibe I get is like if you have a significant other than, you know, it's kind of obvious you're going with them. And if you're single, then you go with your group of single friends. It's not kind of like an event where you pair off, if that makes sense.

Dr. Chan: Okay. Yeah. So it sounds more like a big party.

Troy: Yeah, that's exactly what it is. It's a party . . .

Dr. Chan: Okay. You say prom, people kind of think, you know, pictures and romantic stuff, but not necessarily that.

Troy: And there is that stuff too. Like, we do pictures. And the first year I went to prom, my wife made me ask in a cute way. So I think it does happen for some couples. But it's not like you go in the hall and you say, "Oh, you know, what girl or what guy are you going of ask? And how are you going to ask them?" Like, it's not really that high school kind of vibe.

Dr. Chan: Okay, it's good to know. How did you ask your wife? She made you ask in a creative way?

Troy: She'd never make me do anything, but she kind of gave me that like, "So, how are you going to ask me?" Wink, wink.

Dr. Chan: Oh, that's funny.

Troy: So I think I had like flowers and I used some mirror chalk and wrote something on the mirror.

Dr. Chan: Kind of pulled back to you BYU days, some of the creative juices.

Troy: Yeah, I tried to. Yeah.

Dr. Chan: All right. Okay, so back to med school. All right. So, Troy, if I had asked you any time during the first two years, what would you have said your field was? And how did third-year either solidify that or change that?

Troy: Great question. So I was kind of diehard emergency medicine during the first two years. I guess just without any experience, any clinical experience at all, it seemed like it was exactly what I was looking for, which was it doesn't matter who comes through the doors, I'm going of treat them. You know, I don't care who you are. I don't care if you have insurance. I don't care . . . anything. And I liked that philosophy.

And then I guess it was I like the idea of being a jack-of-all-trades. And, you know, if I was somewhere and something happened, then I'd know what to do. So a couple things tied me to that, to emergency.

And then going into third-year, I learned a lot of things about myself and what kind of relationship I wanted to have with patients in the future. And I realized that I enjoy long-term relationships a lot. And that's something that you definitely do not get in ED, and the long-term relationships that you get in the ED are not the kinds that you want because they're the, you know . . .

Dr. Chan: Frequent flyers.

Troy: Frequent flyers to the ED, yeah. Not the people you want to see all the time. So I was looking for something with long-term relationship. I enjoyed my outpatient experience. I enjoyed sitting down and talking to people and hearing their story. And I love the OR. And I loved operating and I loved using my hands and finding something wrong and being able to go in there and fix it and make a drastic difference, you know, in quality of life in a short amount of time. I thought that was just so fulfilling.

And so, I was looking for something where I could use my hands, be in the OR, and have long-term relationship with patients and still enjoy some, you know, laid-back clinic life. Should I say what I'm going into?

Dr. Chan: Yeah, yeah.

Troy: Okay. So at the end of third-year, I didn't really know what I wanted to do with my life, which was very stressful. And I actually didn't decide until the beginning of fourth-year.

Dr. Chan: Okay. That's extremely stressful with what you ended up choosing, because we'll talk about that.

Troy: Yeah, you're exactly right. So I didn't know what I was going of do with my life and I knew I wanted to do some sub-specialty with surgery. So I kind of floated through all the different specialties.

Dr. Chan: Surgical sub-specialties. So which ones did you kind of take a taste in?

Troy: I dabbled in ENT. I did some research in ENT and I watched some procedures in the OR with ENT. I did some neurosurgery and then did some research . . . or not research. Talked to a urologist. And then I did an elective in ophthalmology, and I just kind of fell in love with everything about ophthalmology.

Dr. Chan: So during third-year, you never got the chance to have a genuine ophthalmological experience?

Troy: Yeah, that's kind of the problem with med school in general, is there are, what, 7,500 different paths you can take as far as medicine goes. And you have a very finite amount of time to make a decision. And during third-year, which is your first and basically only clinical exposure that you get before you make your decision, there's not that much time to do anything other than the core specialties, which are surgery, internal medicine, family medicine, peds, psych, OB, and neurology.

Other than those specialties, if you're interested in something, you really have to bend over backwards to find time to get exposure to that specialty, and so it's really difficult if you don't fall in love with one of those core specialties.

So I was kind of scrambling at the end of third-year when I had a little bit of elective time and a neurology rotation, which is a little more laid back and just trying to like jump through as many different sub-specialties of surgery as I could. And ended up landing on an ophthalmology two-week elective.

Dr. Chan: Yeah, sell it to me. Why ophtho? Why did it resonate with you?

Troy: Yeah. So the first day I went to the ophtho clinic, I actually decided, "Wow, I'm never going of do this." And that's because I was in glaucoma clinic and I didn't realize that it was glaucoma day. I thought it was just ophthalmology day, like, every day. And so, every single patient that came in had glaucoma, and it was slit lamp exam. And if you're not familiar with what a slit lamp is, it's basically like . . .

Dr. Chan: That's where you put your chin on the little wrist. You have to be very still. Okay.

Troy: Yeah, that's exactly what it is. Yeah.

Dr. Chan: And the lights kind of shine back and forth.

Troy: Yeah. The ophthalmologists use their little slit lamp and not a microscope, but kind of a microscope.

Dr. Chan: They get really close to your face.

Troy: Yeah, exactly. And they say, "Don't blink," or, "Look left, look right." And so, everyone had glaucoma and everyone just had like a pressure check and then a slit lamp exam. And as a med student, you have no exposure to slit lamps. And so, when I would try to look, I had no idea how to use any of the knobs or what I was looking at. Like, the iris looked really cool close up, but I didn't really know what I was doing. And it just seemed very focused and kind of very foreign to me because I had such little ophtho.

And so I kind of ruled it out. And then the next day I came in, and it was neuroradiology that morning. And we had a patient who came in with ptosis, which is drooping of the eyelids. And we did something which was . . . the ice cube test is what it's called, where you put ice on their eyes and see if the ptosis resolves.

Dr. Chan: Interesting.

Troy: Yeah. And it did. And it turned out that they had myasthenia gravis, which was, you know, one of the things I learned in neurology and medicine. I was like, "Oh, wow, there's actually a lot of medicine in ophthalmology." Something that I hadn't realized before.

And then the next day, I was in the OR and I did a whole day of cataract surgery with Dr. Pettey. And I thought cataract surgery was just the coolest procedure done in all of medicine. And it kind of snowballed, I guess. Like, every day was cool and something new and more interesting. And I realized that the patients were all happy. You know, as opposed to other clinics where there's like a lot of no-shows. In ophthalmology, everyone goes because their vision is so important to them.

Dr. Chan: It's like 20%, 30% of our visual cortex is dedicated to looking out and seeing the world.

Troy: Yeah, it's incredible.

Dr. Chan: If you think of what your eyes are . . . I'm sorry, this is a psychiatrist in me.

Troy: Yeah, go for it.

Dr. Chan: It's like your eyes are just like your brain kind of pushing out. And this is how we interpret everything around us. Our eyes are fifth cranial nerve, right? No, second.

Troy: Second, yeah.

Dr. Chan: I'm so ashamed.

Troy: Second, third, fourth, sixth.

Dr. Chan: So it's literally our second cranial nerve pushing out and just this is how we take in all this stimulation.

Troy: Yeah, absolutely incredible. So patients were so grateful. And the residents and the attendings were just the most laid back, kind, well-adjusted people that I . . . And a lot of choosing your specialty is kind of finding your crowd and finding your people and what specialty is your people. And I finally felt like I found my people.

Dr. Chan: So when was this rotation?

Troy: This was the first two weeks of fourth-year.

Dr. Chan: So, June?

Troy: Probably May.

Dr. Chan: May? All right.

Troy: Yeah, early May.

Dr. Chan: So one of the complications is that ophthalmology participates in something called Early Match. So when was that application . . . I mean, so how was it from May . . . I mean, when was that application due?

Troy: The middle of August.

Dr. Chan: Okay, so what were you doing . . . how do you get a really competitive . . . so hint, hint, you matched, so we'll talk about that, but how did you do that? How did you put that together in three months?

Troy: I completely scrambled and I busted my butt for about two and a half months. And since ophthalmology is a pretty competitive sub-specialty, research is kind of big, and it's one of the specialties where they like to see that you did research in that specialty. And since I obviously hadn't had any ophtho exposure to that time, I didn't have any research. So I jumped on a bunch of projects and I got 10 publications and . . . Dr. Chan: What? That's amazing. That's really hard to do. I'm even scared to share that on the pod because people are going to measure themselves against you now.

Troy: So don't get me wrong. Let me not play that up as much. Dr. Chan: Did you eat or sleep during this time? That sounds crazy. Troy: Yes. They were not like first author journal publications, okay? Which is kind of the first thing you think of when I say I had 10 publications. Seven or eight of them were website publications through the Moran CORE website.

And the reason I had so many is because Dr. Pettey wanted to start a cataract surgery video textbook series for residents. And so, I would be in the OR and I would film parts of his procedures. And then I would type them up, kind of a basic explanation of like what this is and how to perform it, you know, the basic skills needed. And then we would put it on this new section of the website that we created. And it's kind of exploded since that time.

Now, this coming year in the American Academy of Ophthalmology, they are including the entire teaching video textbook as part of one of their hour-long seminars that they're doing. And Dr. Pettey is going of talk about how, you know, this should be implemented in every residency program.

And so I kind of got a lot of really good feedback and it came up in every single one of my interviews that I went on for residency. So I guess the stars just kind of fell into place, you know? I had an attending here, like a very well known attending Dr. Pettey is, who needed a very specific thing at a specific time. And I also needed that same thing at the same time.

Dr. Chan: So it sounds like a combination of hard work and a little bit of serendipity. A little bit of timing, I guess. Luck.

Troy: Yeah. And that's kind of a lot of things in med school.

Dr. Chan: I would say life.

Troy: Yeah. And life in general, absolutely. But it ended up working out. And, again, they all weren't first author, you know, major journal publications, which would have looked better, but it was enough to fill the page when I applied.

Dr. Chan: Using big font. All right. So you put together a competitive ophthalmology application. Early Match, you said August. So the Early Match, you . . . so how many programs did you apply to?

Troy: So I applied to 55.

Dr. Chan: How many are there?

Troy: There are 115.

Dr. Chan: Okay. So based on your application and feedback you were getting, 55 sounded like a good number.

Troy: Yeah. Average for ophthalmology is actually around 70 to apply to

Dr. Chan: Okay.

Troy: And then I decided to apply to 55, which was based on feedback and a number of factors.

Dr. Chan: And how many interview offers did you get?

Troy: I got 12 or 13 interview offers.

Dr. Chan: Okay. So that's good.

Troy: Yep.

Dr. Chan: So did you go on all 12 or 13?

Troy: I went on 10.

Dr. Chan: Ten, okay. So what was your strategy? I mean, how did you pick the 55? How did you pick these 10? I mean, what was your strategy at the start of the residency interview process?

Troy: So I picked the 55 based on location and reputation.

Dr. Chan: Okay. And then also the 10 it's like kind of the same thing, like, "Oh, you know, this is a good program."

Troy: Yeah, exactly.

Dr. Chan: And when you do an ophthalmology interview for residency, do they bring you back and make you do a little slit lamp test or test your fine motor skill in some way or . . .

Troy: I've heard stories of that happening in the past, but none of my . . . I didn't have a single experience.

Dr. Chan: Darn. I thought you'd have a really cool story.

Troy: I mean, the closest thing that happened to me was a stereopsis testing where they test your depth perception.

Dr. Chan: How do they do that?

Troy: So basically, they'll give you a sheet or this kind of like projector that has different shapes coming out at you in different shades. It's kind of like . . .

Dr. Chan: When you mention that, I have images of playing softball. As you go out in the outfield, they hit balls to you and see if you can run underneath it. You know what I'm talking about? That would be a fun test, to catch fly balls.

Troy: I would enjoy that a lot more.

Dr. Chan: I don't know if that is as scientifically rigorous as what you're describing.

Troy: Yeah, probably not.

Dr. Chan: It's always like, "Oh, you have good direct perception if you can run underneath a fly ball just based on the sound and how it came off the bat." Yeah.

Troy: Right. Yeah. So that was the closest thing. As I was interviewing, they said, "Hey, why don't you . . ." They just pull it out and are like, "All right. Stereopsis testing. Test your depth perception." They don't even tell you if you did well or not. But it's pretty obvious if you did because you know all the animals that are coming out at you.

Dr. Chan: Fascinating.

Troy: Yeah. Other than that, no microsurgery, no anything else.

Dr. Chan: No trying to put a little watch back together with your hands?

Troy: Nothing like that.

Dr. Chan: All right. So you're interviewing, you're going out there, you're seeing all these different programs. When for the Early Match do you have to submit your list, your rank list?

Troy: You submit January 3rd and then you get the results January 10th.

Dr. Chan: So pretty quick turnaround.

Troy: Yeah, which makes sense, right? Like, as soon as you put something in a computer algorithm, it takes what? Ten seconds?

Dr. Chan: But for some reason, it takes a month for the regular match.

Troy: I have no idea why. It makes no sense.

Dr. Chan: Tradition, process.

Troy: Yeah, I guess.

Dr. Chan: So how did you . . . like, what was your process for determining your rank order? I mean, what kind of values or what kind of . . . I mean, how did you prioritize things now?

Troy: Yeah, really good question. So for me, I guess making sure that my wife was on board and happy was number one priority. Family and location and then cost of living, actually, was a lot more important than I thought it would be over program rank or reputation. I should have mentioned that. All of those things over reputation.

So we really wanted to find somewhere that geographically was closer to family. So we were hoping to stay out west. We wanted somewhere where we would be happy, be able to go outdoors, do things. You know, great balance of life. I wanted to go somewhere where I felt, again, like found my people with the residents. And then cost of living came into factor as well and then reputation after that.

Dr. Chan: So you submit your rank list in January and you find it out a week later?

Troy: Yep.

Dr. Chan: How was that week?

Troy: Like waiting?

Dr. Chan: Yep.

Troy: It was really hard. I was on . . . what was I on? I can't even remember what I was doing at that time. Oh, I was on ICU, I think.

Dr. Chan: So you were busy?

Troy: Yeah, I was busy, which was actually nice because I didn't have to . . . well, obviously, it was in the back of my head the whole time, but at least I was doing something where I didn't just like sit there and think about it all day.

Dr. Chan: So I know there is this whole ritual with the regular match. How did you find out where and when you matched? Was it just like email and you just log in or . . .

Troy: Yeah. It was very anticlimactic. I mean, I guess I should clarify. Ophthalmology and urology, those are the two Early Match specialties, and military match, I should add. Other than that, everyone has this big Match Day in March. You know, the media is there. All the families are there.

Dr. Chan: Pictures galore.

Troy: Pictures. There's food.

Dr. Chan: Balloons.

Troy: They put envelopes on tables. They cut the ribbon and everyone gets their envelope. They open them up. Families are crying. It's a huge, just beautiful celebration.

For me, I got the email at 6:00 a.m. My wife had had food poisoning that whole night, so she was throwing up. And I couldn't sleep, first of all, because I was so anxious, and second of all, because she was sick. And I opened up the email and it was like 6:00 a.m., and I was just laying in bed. You know, I haven't even gotten out or gotten dressed or anything. And she looks over all excited like, "Where are we going? Where are we going?" I open it up and I read out Colorado. And the first thing she does is throw up into the trashcan. Yeah, so I was like, "Oh, no. Is this is a bad thing, or is she actually sicker?" So it was an extremely different experience for me than everyone else.

Dr. Chan: I mean, maybe you as a future leader in the organization will change. But I mean, how does that make you feel? Everyone else kind of did this whole other kind of ceremony, this ritual, but it sounds like it's non-ritual for ophthalmology.

Troy: Yeah, it's totally not. I think there are pros and cons to it. Pro is you get to know two months earlier than everyone else. So stress level goes way down, you know, like beginning of January. You have more time to plan, you know, where you're going, how much it's going to cost. Does your significant other need to work? You know, you can look at houses.

But at the same time, I felt like I kind of missed out of that glorious Match Day celebration. And I was there, you know? I could participate in all the excitement. And I got an envelope, too, but I knew what was on the envelope.

Dr. Chan: The Great Carnac. He was like, "Oh, I can just feel it. Colorado."

Troy: Yeah. I knew what was on the envelope already so it was kind of . . . I don't know. Anticlimactic is, I guess, the best word.

Dr. Chan: Okay. So Colorado. Are we talking Denver or . . .

Troy: Yep. It's University of Colorado in Denver.

Dr. Chan: Okay. So tell me about the program. Like, what's so great about it?

Troy: Yeah. So I interviewed there. Residents were maybe the happiest and most laid back of any program that I interviewed at. And they were telling me about how they went skiing together every other weekend.

Dr. Chan: Watch Bronco games together?

Troy: I'm a huge Broncos fan, so it was perfect.

Dr. Chan: Yeah, perfect.

Troy: And it just seemed like they were all happy with where they were at. They have . . . I don't know how in depth you want to get as far as like comparing programs, but a big thing for ophthalmology is how many procedures you get at the end of your residency training. And a big way to gauge that is how many cataracts you graduate with. And the national average is 160 to 170 as far as cataracts go.

And graduates at University of Colorado usually graduate with 250, which is very attractive to me. In case I want to go into private practice, you know, I'll feel very comfortable. And it was that way across the board as far as, you know, their pediatric cases, their retina cases, their oculoplastic cases. And so really good opportunities for surgical training.

Basically, every program you interview at, you go and tour the facility and the VA, because a lot of your OR time is at the VA. And they just completed a new VA in Denver, and it was a billion dollars over budget. And so, you can imagine how nice it is.

Dr. Chan: It was nice.

Troy: Yeah, compared to our VA here in Salt Lake, which I enjoy the VA here in Salt Lake. But it's pristine, like high-end everything over there.

Dr. Chan: Well, this also helps . . . like, there's the Air Force Academy up the road. So the Air Force is a huge deal in Colorado.

Troy: Yeah. So I guess great facilities, great people. The program director over there actually reached out to me personally before I even interviewed there. And he let me know, "Hey, Troy, I've heard great things about you from Dr. Petty, who's a program director here. I just want to let you know like we're really excited for come here and interview. And I look forward to meeting you." So that like kind of meant a lot to me that a program director from another program would reach out to me personally. And this probably speaks to him more than does to me. But I just felt like if he's that willing to do that for medical students, what is he willing to do for his residents?

Dr. Chan: That's really great. That's really great of him. That's really great idea. I don't know if I could pull that off at admissions because I'd be like call it all these pre . . . I don't feel like . . . that's a really great idea. Kind of puts a nice connection to the program even before you set foot there.

Troy: Yeah. And so, I had a tie going in to interview day. Like, I already knew that they were excited that I was there. And so, it was a whole different experience for me.

Dr. Chan: Interesting.

Troy: As opposed to other programs where, you know, you never hear anything. And then you send a thank you afterwards and you never hear anything after. You know, I got an email from him before and after I interviewed there. And, you know, he got my number. And so, we're like texting, you know? And so, I really felt like they wanted me there. And that was the only program that happened for. And it really kind of elevated that program for me.

And just talking to the residents there when I interviewed there, it seems like Dr. SooHoo, who is the . . . he's the program director over there. He really is invested in his residents. And he'll drop everything to make sure, you know, that they get the experience they need and they go to the places that they want to go to as far as their career. So it seems like the administration there is really invested in their residents.

Dr. Chan: Awesome. How big is the program? How many residents?

Troy: So for ophthalmology, it's pretty big. Average number of residents per program is about four to five. Here at the Moran, there are four residents. In Colorado, there are six, so they just went up from five to six last year.

Dr. Chan: That's great. So, you know, before we turned on the pod, we were kind of talking. You know, the match has already happened. Graduation is coming up. How does it feel to be at med school for the last few weeks? Is it kind of hard or is it . . . because you're thinking about that next step. I mean, where's your mind right now?

Troy: My mind is not in med school. And maybe I shouldn't say that.

Dr. Chan: That's okay. By the time we get this posted, it will be after graduation. So you can say whatever you want, within reason.

Troy: Perfect. I guess it's been that way for the past month. I've had clinical duties this whole semester. So, you know, I've had two months of medicine rotation. And this past month has just kind of been anesthesia and radiology electives. And so I guess in the past, you know, in med school, you look up your patients before you get there, you do your work, you go home, you study for the shelf, you study for the next day, you look up on stuff the attending points out, which is great for education. And now it's just kind of like . . .

Dr. Chan: Not really . . .

Troy: Yeah. Like, I go in at 9:00, and then, you know, obviously I participate and be helpful to the team while I'm there, not that there is much I can do in radiology anyway. But then, you know, you go home early afternoon. And for me, it's like I'm looking for housing. We're looking at moving expenses. We're looking at . . .

Dr. Chan: Denver Broncos blog posts?

Troy: Exactly.

Dr. Chan: Free agent acquisition, potential drafts . . .

Troy: I'm very involved in the NBA playoffs right now. I've gotten a lot of good skiing in, and I go to the park with my daughter every day. And my wife and I go on runs together. And so, I guess it's a lot of . . . for me right now, my mindset is next step.

Dr. Chan: Yeah. It sounds like you're . . . you know, to focus on wellness and balance, it sounds like you're creating this reserve. Because, you know, intern years are hard and stressful and it's going of kick off probably what? Mid-June?

Troy: Yep.

Dr. Chan: So, yeah. And life changes pretty quickly. So I think it's good to get that stuff, those activities, in now, as you kind of move towards the next phase of your medical education.

Troy: Absolutely. And, I mean, you're only fourth-year medical school . . . you know, you're only in fourth-year once. And so I think you should take full advantage of the extra time that you have to spend with your family and really focus on your wellness. So I've been trying to do that.

Dr. Chan: Okay. So going back to your leadership skills to kind of wind down this podcast, action items. We're going of make more of a celebration/ritual for Early Match. And we're going of add catching softballs in the outfield part of the ophthalmology residency interview process.

Troy: That would be awesome.

Dr. Chan: I can just imagine you with a big kind of bag of softballs and hitting fly balls and watching applicants in their best interview day attire running around that field. Dropping balls would be a negative. Getting hit in the face while you have your mitt up . . .

Troy: Yeah. You probably can't be a good cataract surgeon if you can't catch the softball.

Dr. Chan: Great. Well, thank you, Troy, so much. Best of luck to you. And, yeah, I hope you come back to Utah and practice one day.

Troy: Thanks. I really appreciate that. Thanks, Dr. Chan.

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